Carbon monoxide Oxygen 100%; hyperbaric O2 Half-life of carboxyhemoglobin is 5 hr in room air but 1.5 hr in 100% O2
Cyclic antidepressants Sodium bicarbonate 1–2 mEq/kg IV, followed by continuous Follow potassium levels and replace as infusion; titrated to produce pH of 7.5–7.55 needed be used selectively in the management of a poisoned patient. Charcoal is ineffective against caustic or corrosive agents, hydrocarbons, heavy metals (arsenic, lead, mercury, iron, lithium), glycols, and water-insoluble compounds.
The administration of a cathartic (sorbitol or magnesium citrate) alone has no role in the management of the poisoned patient. The AACT has stated that based on available data, the use of a cathartic in combination with activated charcoal is not recommended.
Whole-bowel irrigation using polyethylene glycol (GoLYTELY) as a nonabsorbable cathartic may be effective for toxic ingestion of sustained-release or enteric-coated drugs.
Aminoglycosides—gentamicin, tobramycin, and amikacin Chloramphenicol Vancomycin
The AACT does not recommend the routine use of whole-bowel irrigation. However, there is theoretical benefit in its use for potentially toxic ingestions of iron, lead, zinc, or packets of illicit drugs.
Multiple-dose activated charcoal should be considered onlyif a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. Alkalinization of urine may be helpful for salicylate or methotrexate ingestion. Dialysis may be used for substances that havea low volume of distribution, low molecular weight, low proteinbinding, and high degree of water solubility, such as methanol,ethylene glycol, salicylates, theophylline, bromide, and lithium.
SEE TABLE 45-6.
When in doubt about therapy, contacting one of the U.S. Poison Control Centers (1-800-222-1222) can help to determine what additional treatment is necessary.
Most poisonings result in minimal or no toxicity. Major toxicity is seen in fewer than 1% of ingestions, with fatality in fewer than 0.1%. Only 12% of children 12 and under with poisoning require treatment in a health care facility, compared with 48% of adolescents.
Properly educating parents regarding safe storage of medications and household toxins is necessary for preventing ingestions. If a child has ingested poison, a poison control center should be called.
Iron Deferoxamine Infusion of 5–15 mg/kg/hr IV (max 6 g/24 hr) Hypotension (worse with rapid infusion rates)
Succimer (2,3-dimercaptosuccinic acid ([DMSA]) 35–50 mg/kg/day IV × 5 days; continuous infusion or divided q 12 hours 10 mg/kg/dose PO tid × 5 days, then 10 mg/kg/dose PO bid × 14 days
May cause sterile abscesses. Prepared in peanut oil, do not use in patients with peanut allergy.
Few toxic effects, requires lead-free home plus compliant family
Opiates Naloxone 0.1 mg/kg IV, ET, SC, IM for children, up to 2 Naloxone causes no respiratory mg, repeat as needed depression
From Kliegman RM, Stanton BF, St. Geme JW, et al., editors: Nelson Textbook of Pediatrics, ed 19, Philadelphia, 2011, Saunders, pp 256–257.