[Acute poisoning in childhood]

B Gossweiler, P J Meier-Abt, P A Wyss
Therapeutische Umschau. Revue Thérapeutique 1994, 51 (9): 622-7
Accidental ingestions of noxious substances are frequent events during childhood, especially in children one to three years of age. In contrast, severe symptoms and a serious outcome of these intoxications have been observed rather rarely; therefore, it is very important to avoid unnecessary and potentially harmful therapeutic measures. An extensive body of information has been collected nationally and internationally, allowing an accurate risk assessment in a constantly increasing number of cases. If there is need for treatment at all, the early application of activated charcoal (dose: 1 g/kg body weight) will efficiently inhibit absorption of noxious substances in most instances. Whereas the first dose of activated charcoal is administered to block absorption, repeated administration (0.5 g/kg body weight, every 2 to 4 hours) has been shown to shorten half-life and enhance the nonrenal clearance of chemically different substances even after absorption. Only few substances like heavy metals, lithium, or alcohols are not adsorbed by activated charcoal. Whole bowel irrigation may be a valuable alternative in cases where activated charcoal has been shown to be ineffective. Poisoning with ferrum formulations is an instructive example of this type of intoxication. Gastric lavage and pharmacologically induced emesis are no longer considered a routine treatment in poisoning but rather a special therapeutic option for very special situations. In all cases of severe poisoning, maintenance of vital functions, applying the principles of emergency medicine, has to have first priority.(ABSTRACT TRUNCATED AT 250 WORDS)

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