POISON IDENTIFICATION

Wherever possible the constituents of the substance ingested and its dosage per kilo body weight should be identified as accurately as possible.

In younger children the substance taken is often easily identifiable but the dosage can be difficult to ascertain. Some idea of the maximum amount of substance that could have been ingested can be gathered from comparing the number of tablets, or volume of liquid remaining, with details on packaging.

Care must be taken not to overlook the involvement of other children in a poisoning incident.² When children share a poisonous substance, it must be assumed that each child has taken the maximum amount.

In older children, a clear history of ingestion may not be forthcoming and illicit drugs are more likely to be involved. Specific enquiry should be made into the medicines prescribed to each member of the household, both currently and in the past.

RECOGNISABLE POISON SYNDROMES

In cases where poisoning is suspected, but cannot be confirmed by clinical history, a detailed physical examination, including a full neurological assessment, is an essential part of substance identification. Table 2 shows collections of signs and their possible causes.

A number of toxins acting on the autonomic nervous system can produce a mixed clinical picture because of effects on both muscarinic and nicotinic receptors.

In most …