Transcript PARACETAMOL POISONING:

PARACETAMOL POISONING:
• Hepatic damage: more than 150mg per kg
Clinical feature :
• Nausea ,
• vomiting ,
• abdominal discomfort
• In untreated patient`s developing liver damage , vomiting
continues beyond 12 hrs and there is tenderness over the
liver , jaundice ,hepatic encephalopathy , loin pain ,
haematuria , proteinuria suggest renal failure.
• Investigation :LFTs, liver enzyme ,INR(international
normalised ratio)
Management :
• Paracetamol antidotes:
• Acetylcysteine :is given by iv infusion in 5 %
dextrose .
• Initial dose :150mg per kg body weight in 200 ml
dextrose over 15 mins ,
• Than 50 mg per kg in 500 ml over 4 hrs ,
• Then 100 mg per kg in 1L over 16 hrs
• Methionine :if acetylecysteine is not available
• 2.5g every 4 hrs to a total of 10 g.
IRON POISONING:
• Serious toxicity: more than 60 mgper kg body weight,
• Lethal dose :150-300 mg per kg.
C / F:
• Nausea ,
• vomiting ,
• diarrhoea ,
• abdominal pain
Severe poisoning :
• haematemesis ,
• drowsiness ,
• convulsion ,
• coma
• metabolic acidosis and shock
Management:
• Check serum iron ,FBC ,glucose
• Gastric lavage if more than 20 mg iron per kg body
weight
• Use supportive measures if required
• In serious :
Desferrioxamine :
• iv infusion (15 mg per kg per hr , max 80 mg per kg
in 24 hr)
Salicylate poisoning(Aspirin):
Mild toxicity :150mg per kg body weight
Severe and fatal dose :500 mg per kg body
weight
Clinical features
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Acid-base status :Stimulate the respiratory center, leading to
hyperventilation and respiratory alkalosis
Interfere with the Krebs cycle, limit production of
ATP, and increase lactate production, leading to
ketosis and metabolic acidosis
Respiratory system effects : Causes stimulation of respiration
level of 35 mg/dL or higher causes increases in both
rate (tachypnea) and depth (hyperpnea)
Glucose metabolism : Hypoglycemia (increased cellular metabolic activity)
Cont..
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Fluid and electrolyte effects : dehydration because of increased GI tract losses (vomiting)
and insensible fluid losses (hyperpnea and hyperthermia).
Renal clearance of salicylate is decreased by dehydration.
CNS effects : Salicylates are neurotoxic, which manifests as tinnitus, and
ingestion can lead to hearing loss at doses of 20-45 mg/dL or
higher.
CNS toxicity is related to the amount of drug bound to CNS
tissue.
Other signs and symptoms include nausea, vomiting,
hyperpnea, and lethargy, which can progress to
disorientation, seizures, cerebral edema, hyperthermia, coma,
and, eventually, death.
Cont..
GI tract effects : • Nausea and vomiting are the most common
effects.
Hepatic effects : • Hepatitis
• Reye syndrome (characterized by nausea,
vomiting, hypoglycemia, elevated levels of
liver enzymes and ammonia, fatty infiltration
of the liver, increased intracranial pressure,
and coma)
Cont..
Hematologic effects : • Hypoprothrombinemia and platelet
dysfunction are the most common effects.
• Bleeding (either by inhibition of vitamin K–
dependent enzymes or by the formation of
thromboxane A2).
Musculoskeletal effects : • Rhabdomyolysis can occur because of
dissipation of heat and energy resulting from
oxidative phosphorylation uncoupling.
Management
• Gastric lavage
Mild poisoning :
plasma salicylate less than 350 mg per L than
increase oral fluids
Moderate :
• more than 350 mg per L than IV fluids to correct
dehydration , sodium bicarbonate 1.26% alkalinises
the urine
Severe :
haemodialysis.
KEROSENE OIL POISONING:
• SERIOUS PAEDIATRIC PROBLEM IN DEVELOPING
COUNTRY.
• C / F : age between 1 and 3 years of age ,
common symptoms:
• chemical pneumonitis ,
• fever ,
• cough ,
• breathlessness ,
• abdominal distention
Rarely :
• Convulsion , Coma ,cyanosis
• Radiological changes: right basal infiltrates.
• Emphysema ,pleural effusion and pneumatoceles
have also been observed.
Management:
• Supportive and symptomatic :
• Gastric lavage :if amount ingested is massive (within
30 mins of ingestion)
• Oxygen if respiratory involvement
• Antibiotic
• Observation for at least 24 hrs is essential even in
an asymptomatic child
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DROWING AND NEAR DROWING:
DROWING : when the victim dies
NEAR DROWING :when submersion victim survives
WET DROWING :aspiration of fluid into lungs
C / F:
Respiratory distress
Cyanosis
Hypothermia
Coma
Respiratory faliure
Apnea
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Treatment:
Initial resuscitation
Basic life support
Diuretics (pulmonary oedema)
Sodium bicarbonate (correct metabolic acidosis)
Diazepam (convulsion)
Adequate warming (hypothermia)
LEAD POISONING:
• TREATMENT :
• Symptomatic children :dimercaprol (BAL) ,calcium
disodium edetate
BURNS:
TREATMENT : describe under three heading
• Treatment of shock:
• General treatment :
• Local treatment of burn wound:
TREATMENT OF SHOCK :
• sedative and analgesic,
• fluid resuscitation
• maintenance of airway
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GENERAL TREATMENT :
Fasciotomy
Tetanus prophylaxis
Antibiotics
Nutritional support
Gastric decompression
Treatment of G.I. complication
LOCAL TREATMENT :
First-aid measures
Burn wound care (exposure and closed method)
Skin grafting
Physcial therapy and rehabilitation