Pediatric Single-Dose Fatal Ingestions Clinical Presentation

Updated: Dec 22, 2019
  • Author: Chip Gresham, MD, FACEM; Chief Editor: Timothy E Corden, MD  more...
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Presentation

History

Risk assessment is a specific and cognitive step taken in the assessment of all patients with possible ingestions. It involves a detailed history around the likely agent, the amount and timing of ingestion, and any current symptoms.

Some patients may present before developing significant symptoms. Other patients may present in an obtunded state and without a clear history of ingestion. Obtain collateral history from patients, family, paramedics, doctor, or pharmacist.

Elicit the following information:

  • What substance was ingested? If the substance was a medication, obtain the name, dosage strength, and preparation type (immediate verses sustained release).

  • What are the ingredients of the ingested substance? Learning the product name or finding the container helps determine the specific ingredients and concentrations.

  • When was the substance ingested?

  • Did anyone observe the ingestion? If so, ask to speak with the person who saw the incident, because this may help determine the amount and timing of ingestion.

  • Is the patient exhibiting any clinical features of ingestion?

  • What is the patient's medical history?

  • Is the ingestion consistent with the history provided? If the history is inconsistent, the suspicion of abuse or neglect is raised, and the incident must be reported.

Always assume a worst-case scenario. Assume all unaccounted for tablets have been taken. Do not account for spillage. Place the timing of ingestion at latest possible. If two children are involved, presume all the missing tablets were consumed by either child.

Next:

Physical Examination

Physical examination findings are variable and depend on the specific agent and amount ingested. Findings may range from normal to obtundation or even cardiopulmonary arrest. Some examination results may offer subtle but specific clues regarding the type of ingestion. The recommended process is as follows:

  • Begin the examination by evaluating the patient's airway, breathing, and circulation (ABCs). Initiate appropriate interventions for any abnormalities.

  • Perform a complete physical examination, and record all vital signs.

  • Search for evidence of specific toxidromes (sedatives, hypnotics, sympathomimetics, serotonin toxicity, anticholinergic syndrome)

  • Perform a neurologic examination, checking for level of consciousness, pupils, tone, reflexes, ocular clonus, and lower limb clonus.

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