Title: Toxic Pediatric Ingestions<br/>Author: To-Lam Nguyen<br/><a href='http://umem.org/profiles/resident/2182/'>[Click to email author]</a><hr/><h2 class="section-title jumplink-heading" data-section-title="Introduction" helvetica="" id="9311609" line-height:="" open="" scrollto-destination="9311609" style="margin: 1.5rem 0px 0.5rem; padding: 0px; border: 0px; font-size: 1.5rem; vertical-align: baseline; color: rgb(48, 50, 53); font-family: ">
<span style="font-size: 1rem; color: rgb(26, 26, 26);">It's finally spooky season with Halloween around the corner and candy to be ingested, so let's talk about pediatric ingestions. Here are some common pediatric ingestions that are quite toxic. </span></h2>
<h2 class="section-title jumplink-heading" data-section-title="Introduction" helvetica="" line-height:="" open="" scrollto-destination="9311609" style="margin: 1.5rem 0px 0.5rem; padding: 0px; border: 0px; font-size: 1.5rem; vertical-align: baseline; color: rgb(48, 50, 53); font-family: ">
<strong>1) Magnets</strong></h2>
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<span style="font-size: 1rem; color: rgb(26, 26, 26);">- Magnets move through the GI tract at different rates and become lodged in adjacent loops of intestine. Adjacent bowel segments can stick together when the magnets attract each other through the bowel walls which can cause <strong>obstruction, perforation, fistula formation, and necrotic bowel.</strong></span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Obtain xray to identify ingested metallic object(s)</span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Any object lodged in the <strong>esophagus </strong>should be emergently removed by a <strong>pediatric gastroenterologist</strong>. </span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Once an object is <strong>past the stomach </strong>and beyond the reach of endoscopy, affected patients need to be watched carefully for signs of obstruction or peritonitis, either occurrence requiring the prompt consultation of a <strong>pediatric surgeon.</strong> </span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Enhancement of magnet movement through the GI tract may be aided by a laxative such as <strong>polyethylene glycol</strong>, but there is no clear data that this approach speeds the passage of the magnet. There is no clear guidance on how frequently to obtain abdominal radiographs to determine movement or passage of ingested magnets.</span></p>
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<strong>2) Button Batteries</strong></h2>
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<font color="#1a1a1a"><span style="font-size: 16px;">- More frequently lodge in esophagus due to seize and cause electric urn on contact</span></font></p>
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<font color="#1a1a1a"><span style="font-size: 16px;">- Complications include <strong>perforation or fistula formation</strong></span></font></p>
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<font color="#1a1a1a"><span style="font-size: 16px;"><b>- Honey or liquid ulcer medication carafate </b>can slow extent of esophageal injury</span></font></p>
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<font color="#1a1a1a"><span style="font-size: 16px;">- Current recommendations from National Button Battery Hotline: caregiver to<strong> give 2 teaspoons of honey every 10 minutes while en route to hospital</strong></span></font></p>
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<strong>3) Laundry Pods</strong></h2>
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<font color="#1a1a1a"><span style="font-size: 16px;">- Causes caustic contact to vocal cords, which leads to acute laryngospasm </span></font></p>
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<font color="#1a1a1a"><span style="font-size: 16px;">- Airway compromise, if to occur, occurs rapidly. If after brief obs period, it does not appear, it is very unlikely to be a late occurance. </span></font></p>
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<font color="#1a1a1a"><span style="font-size: 16px;">- Corrosive on GI tract. pH of detergents range from 7-9. </span></font></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Any child with difficulty swallowing, drooling, stridor, and recurrent vomiting should have GI consulted for endoscopy</span></p>
<h2 class="section-title jumplink-heading" data-section-title="Introduction" helvetica="" line-height:="" open="" scrollto-destination="9311609" style="margin: 1.5rem 0px 0.5rem; padding: 0px; border: 0px; font-size: 1.5rem; vertical-align: baseline; color: rgb(48, 50, 53);">
<strong>4) Other Household Look-alikes: Tiki Torch Oil and Hydrogen Peroxide</strong></h2>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: "><strong>Tiki Torch Oil</strong></span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Tiki torch oil looks like apple juice (the container looks similar too)</span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Lamp oil ingestion (hydrocarbons) can cause excessive drowsiness, lung injury, difficulty breathing</span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Preventing accidental tiki torch oil ingestion: NEVER use torch fuels near area where food or drinks are served, keep out of reach and out of sight of young children, and only buy bottle of torch fuels with child-resistant cap and make sure to replace cap securely after every single use</span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: "><strong>Hydrogen Peroxide</strong></span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- 35% hydrogen peroxide has become more popular as food-grade or nutraceutical product (food additive purportedly used for medicinal purposes)</span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- When hydrogen peroxide reacts with HCl in the stomach, it liberates large volumes of oxygen causing immediate frothy emesis and systemic absorption of oxygen. Gastric oxygen, once absorbed, passes through the portal vein to liver causing <strong>gas embolisms in liver</strong></span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- Preferred evaluation of kids with known ingestion and acute vomiting should image by noncontrast limited upper abdominal CT (to reduce radiation exposure) to assess bubble burden. </span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- There is no consensus on what is considered a significant air embolism burden that would require <strong>hyperbaric treatment</strong></span></p>
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<strong>4) Buprenorphine</strong></h2>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: "><b>- </b> A single tablet of buprenorphine, or a <strong>single dissolvable gel strip</strong> of its formulation as <strong>Suboxone </strong>has been lethal to children. </span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- </span><span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">Prescribing intranasal<strong> naloxone spray</strong> to the family of patients on <strong>buprenorphine </strong>(and <strong>methadone </strong>as well) is potentially lifesaving to the patient, should they take too much, but also for children in their homes who may accidentally eat a single tablet or chew on what appears to be a “gummy” product, a dissolvable formulation of Suboxone. </span></p>
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<span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">- </span><span helvetica="" open="" style="font-size: 1rem; color: rgb(26, 26, 26); font-family: ">Pediatricians doing anticipatory safety guidance to parents at the 9-month-old to 1-year-old health supervision visit should ask about opiates and medication-assisted therapy present in the home or used by caregivers (especially grandparents) and should offer to write a prescription for <strong>naloxone </strong>nasal spray </span></p>
<fieldset><legend>References</legend>
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https://publications.aap.org/pediatricsinreview/article/42/1/2/35444/Pediatric-Ingestions-New-High-Risk-Household</p>
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