Pediatric Single-Dose Fatal Ingestions Workup

Updated: Apr 21, 2022
  • Author: Michael J Verive, MD, FAAP; 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 bradycardia, tachycardia, or other arrhythmias, or those who may have 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



Laboratory Studies

Assessing acid-base status, electrolytes, renal and hepatic function, and effects of substances on bone marrow can help identify potential toxins and guide treatment decisions.  Recognizing specific laboratory abnormalities (such as falsely elevated creatinine in nitromethane poisoning) [87] can give clues to substances ingested and avoid inappropriate treatment.


Imaging Studies

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