Ingested button batteries also may produce a caustic mucosal injury. Batteries that remain in the esophagus may cause esophageal burns and erosion and should be removed with an endoscope. Acid agents can injure the lungs (with hydrochloric acid fumes), oral mucosa, esophagus, and stomach. Because acids taste sour, children usually stop drinking the solution, limiting the injury. Acids produce a coagulation necrosis, which limits the chemical from penetrating into deeper layers of the mucosa and damages tissue less severely than alkali. The signs, symptoms, and therapeutic measures are similar to those for alkali ingestion.
A poisoned child may also have a high anion gap metabolic acidosis (mnemonic MUDPILES) (Table 45-3), which
Table 45-1 Historical and Physical Findings in Poisoning ODOR Bitter almonds Cyanide Acetone Isopropyl alcohol, methanol, paraldehyde, salicylate
Garlic Arsenic, thallium, organophosphates, selenium
Miosis Narcotics (except propoxyphene, meperidine, and pentazocine), organophosphates, muscarinic mushrooms, clonidine, phenothiazines, chloral hydrate, barbiturates (late)
Mydriasis Atropine, cocaine, amphetamines, antihistamines, cyclic antidepressants, PCP, LSD
Nystagmus Phenytoin, barbiturates, ethanol, carbamazepine, PCP, ketamine, dextromethorphan
Lacrimation Organophosphates, irritant gas or vapors
Poor vision Methanol, botulism, carbon monoxide
Needle tracks Heroin, PCP, amphetamine
Dry, hot skin Anticholinergic agents, botulism
Diaphoresis Organophosphates, muscarinic mushrooms, aspirin, cocaine
Alopecia Thallium, arsenic, lead, mercury
Erythema Boric acid, mercury, cyanide, anticholinergics ORAL SIGNS
Salivation Organophosphates, salicylate, corrosives, strychnine, ketamine
Dry mouth Amphetamine, anticholinergics, antihistamine
Burns Corrosives, oxalate-containing plants
Gum lines Lead, mercury, arsenic
Dysphagia Corrosives, botulism INTESTINAL SIGNS
Diarrhea Antimicrobials, arsenic, iron, boric acid, cholinergics
Constipation Lead, narcotics, botulism
Hematemesis Corrosives, iron, salicylates, NSAIDs CARDIAC SIGNS
Tachycardia Atropine, aspirin, amphetamine, cocaine, cyclic antidepressants, theophylline
Bradycardia Digitalis, narcotics, clonidine, organophosphates, β-blockers, calcium channel blockers
Hypertension Amphetamine, LSD, cocaine, PCP
Hypotension Phenothiazines, barbiturates, cyclic antidepressants, iron, β-blockers, calcium channel blockers, clonidine, narcotics
Depressed respiration Alcohol, narcotics, barbiturates
Increased respiration Amphetamines, aspirin, ethylene glycol, carbon monoxide, cyanide
Pulmonary edema Hydrocarbons, organophosphates CENTRAL NERVOUS SYSTEM SIGNS
Ataxia Alcohol, barbiturates, anticholinergics, narcotics
Coma Sedatives, narcotics, barbiturates, salicylate, cyanide, carbon monoxide, cyclic antidepressants, alcohol