Toxic Ingestions: Initial Management

Toxic ingestions represent a small but potentially life-threatening category of pediatric concerns. The peak age group for a toxic ingestion is 1 to 2 years, although the distribution in the pediatric population is bimodal, with a second peak in adolescence. Because toddlers tend to explore with their mouths, they are especially susceptible to unintentional ingestions of inappropriately stored household substances or medications. In contrast, adolescents may willfully ingest substances in an attempt to achieve a high or cause self-harm. Intentional ingestions are disproportionately more likely to have serious outcomes, including death. Therefore, all pediatricians should be familiar with the initial steps in assessment and treatment of potentially toxic ingestions.

Parents or health-care providers encountering a child with a known or suspected ingestion should always contact the Poison Control Center (PCC). This 24-hour hotline (1-800-222-1222) is staffed by toxicologists who provide expert medical advice to parents regarding whether the ingestion necessitates immediate medical assessment. The PCC will also assist physicians in the initial evaluation and management of an ingestion and provide recommendations about appropriate disposition. Note that the PCC hotline routes the call to the nearest center based on the telephone’s area code, so calls made from mobile phones with long-distance area codes will be routed to the corresponding region’s PCC.

The physician’s first steps in management must include a rapid assessment of the ABCDs (airway, breathing, circulation, and disability/decontamination) and vital signs. …