Emergency Medicine Book

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Accidental Poisoning Causes

Aka: Accidental Poisoning Causes, Poisoning Causes, Poisoning Causes in Children, Medication Overdose Causes, One Pill Can Kill
  1. See Also
    1. Poisoning
  2. Epidemiology: Incidence of specific agents in childhood Poisonings
    1. Most common: Cosmetics, personal care products, cleaning agents
    2. Moderately common: Analgesics, topicals, Cold Preparations
    3. Other: Plants, Pesticides, Vitamins, Antihistamines, antibiotics, arts and craft supplies
    4. Most common cause of pediatric lethal Overdose (even single doses may be lethal to a toddler)
      1. Sedative-Hypnotics (esp. Benzodiazepine Overdose)
      2. Antipsychotics
      3. Oral Hypoglycemic agents (esp. Sulfonylurea Overdose such as Glipizide 5 mg)
      4. Cardiovascular agents (e.g. Calcium Channel Blockers such as Verapamil 240 mg)
      5. Analgesics (e.g. Acetaminophen Overdose, Opioids such as Methadone 20 mg)
    5. References
      1. (2014) Presc Lett 21(3)
      2. Watson (2005) Am J Emerg Med 23(5): 589-666 [PubMed]
  3. Causes: Lethal agents to small children (<10 kg) in small doses ("One Pill Can Kill")
    1. Benzocaine
    2. Beta Blocker Overdose
    3. Calcium Channel Blocker Overdose
    4. Chloroquine
    5. Clonidine Overdose
    6. Iron preparations
      1. One of the most toxic agents in Overdose for small children
      2. Morris (2000) South Med J 93(4): 352-8 [PubMed]
    7. Lindane
    8. Methyl Salicylate (oil of wintergreen - even in small amounts)
    9. Opioid Overdose
      1. Lomotil
      2. Methadone
      3. Oxycodone
    10. Oxymetolazoline (Afrin) - see below
    11. Phenothiazines
    12. Phenylpropanolamine
    13. Podophyllum
    14. Quinine
    15. Quinidine
    16. Sulfonylurea Overdose
    17. Tea Tree Oil
    18. Theophylline
    19. Tricyclic Antidepressant Overdose
    20. Bar-Oz (2004) Paediatr Drugs 6(2): 123-6 [PubMed]
  4. Causes: Medications with Higher Toxicity
    1. Beta Blocker Overdose
    2. Calcium Channel Blocker Overdose
    3. Chloroquine
    4. Clonidine
    5. Glucophage
    6. Iron preparations
    7. Isoniazid
    8. Lomotil
    9. Methadone
    10. Oxycodone
    11. Phenothiazines
    12. Phenylpropanolamine
    13. Quinine
    14. Quinidine
    15. Sulfonylureas
    16. Theophylline
    17. Tricyclic Antidepressant Overdose
  5. Causes: Non-Medications or Topical Agents with Higher Toxicity
    1. Alcohols (Ethanol, Methanol, Ethylene Glycol)
    2. Benzocaine
    3. Caustics (e.g. toilet cleaners, drain cleaners)
    4. Hydrocarbons (Kerosene, furniture polish, paint thinner, lighter fluid)
    5. Laundry Pods (contain Ethylene Glycol and ethoxylated Alcohols)
      1. Have resulted in deaths and life threatening Poisonings
      2. Esophageal thermal burns may occur
      3. Observe for 3-4 hours while trialing oral liquids
      4. Swadron and Nordt in Herbert (2016) EM:Rap 16(11): 16-7
    6. Lindane
    7. Methyl Salicylate (oil of wintergreen)
    8. Nail products (acetonitrile, methacrylic acid, nitromethane)
    9. Organophosphates
    10. Oxymetolazoline (Afrin)
      1. Even 1 ml may be lethal due to central alpha-2 agonist, Clonidine-like CNS depression)
      2. If a nasal Decongestant is used in children, Neo-Synephrine (Phenylephrine) is preferred
    11. Paraquat
    12. Podophyllum
    13. Tea Tree Oil
  6. Causes: Toxins with delayed effects in Overdose
    1. Acetaminophen Overdose
    2. Acetonitrile
    3. Anticoagulants (e.g. Warfarin)
    4. Aspirin or Salicylate Overdose
    5. Carbamazepine (Tegretol)
    6. Dapsone
    7. Enteric-coated or sustained release medications
    8. Ethylene Glycol (also in laundry pods)
    9. Iron
    10. Lithium
    11. Lomotil
    12. Meprobamate
    13. Methanol
    14. Monoamine Oxidase Inhibitors
    15. Sulfonylureas
    16. Theophylline
    17. Thyroid hormones
    18. Toxic Mushrooms
    19. Barry (2005) Pediatr Ann 34(12):937-46 [PubMed]

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