Pediatric Single-Dose Fatal Ingestions Workup

Updated: Dec 22, 2020
  • Author: Chip Gresham, MD, FACEM; Chief Editor: Timothy E Corden, MD  more...
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Approach Considerations

Consider specific symptoms related to the ingestion or to the patient's preexisting medical conditions, if any. Order laboratory studies directed to the specific ingestion.

Have a low threshold for obtaining a electrocardiogram (ECG) in patients who have potentially ingested any toxin associated with sodium channel or potassium channel blockade or any cardiac medication, such as the following:

  • Calcium channel blocker
  • Beta-blocker
  • Digoxin
  • Clonidine

Radiography may help in specific ingestion cases. For example, in iron ingestion, radiopaque tablets may be visible in the GI tract. Other radiopaque substances include the following:

  • Heavy metals
  • Iodine
  • Phenothiazines
  • Enteric-coated tablets
  • Chloral hydrate


ECG changes in sodium channel blocker toxicity include widened QRS and right axis deviation of the terminal QRS. Sodium channel blockers include the following:

  • Tricyclic antidepressants (TCAs)
  • Class 1A and C antidysrhythmics
  • Local anesthetics
  • Phenothiazines
  • Chloroquine and Hydroxychloroquine/Chloroquine

ECG changes in potassium channel toxicity include prolongation of the QT interval; plot the QT interval on a QT nomogram to identify patients at risk of developing torsade de pointes.Potassium channel blockers include the following:

  • Antipsychotics
  • Class IA and IC antidysrhythmics
  • Class III Antidysrhythmics
  • TCAs
  • Other antidepressants
  • Antihistamines
  • Chloroquine/Hydroxychloroquine.

ECG changes from calcium channel blocker and beta-blocker toxicity include the following:

  • Sinus bradycardia
  • Decreased atrioventricular (AV) node conduction
  • Intraventricular conduction defects