Poisoning Potpourri

Michael E. McGuigan

doi:10.1542/pir.22-9-295

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Michael E. McGuigan, MD^*

^*Medical Director, Long Island Regional Poison Control Center, Winthrop University Hospital, Mineola, NY.

Objectives After completing this article, readers should be able to:

Manage a suspected acetaminophen overdose.
Describe one of the metabolic effects of ethanol ingestion in young children.
Delineate the signs and symptoms of theophylline toxicity.
Determine the cardiac anomaly that may be associated with an overdose of tricyclic antidepressants and how to assess the risk.
Manage a child who has ingested a hydrocarbon substance.
Recognize the signs and symptoms of methanol ingestion and know how to treat it.

Introduction

Unintentional poisoning can occur following exposure to any of a very large number of pharmaceutical or nonpharmaceutical products. This article briefly reviews the clinical toxicity resulting from the acute ingestion of selected substances by young children; clinicians are encouraged to discuss poisoning cases with colleagues at their regional poison control centers to obtain further information.

Acetaminophen

Definition/Epidemiology

Acetaminophen is one of the most common medications used to treat fever and pain in children. It also is the most common analgesic overdose in children younger than 6 years of age; more than 37,000 cases were reported in 1998 by the American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System. Although 99.8% of these exposures resulted in no or minor toxicity, it is important for clinicians to understand the mechanism of toxicity, clinical presentation, and treatment of a serious ingestion.

Clinical Aspects

The toxicity from acetaminophen overdose arises from metabolism of the drug. During hepatic metabolism of large quantities of acetaminophen, as in an overdose, a toxic metabolite accumulates in the hepatocyte and binds to intracellular molecules, causing damage to the liver cells. The minimum toxic dose of acetaminophen is 140 mg/kg. A single ingestion of this quantity may cause transient reversible liver damage. More severe toxicity results from ingestions in excess of 250 mg/kg.

The initial symptoms and signs of an acetaminophen overdose are nonspecific, …