Toddler Time Bombs (Poison Center Triage)

Author: Clinical Toxicology LLC
Published: Wed 22 Jul 2020
Episode Link: https://thepoisonlab.com/episode/toddler-time-bombs-poison-center-triage

Ryan and Toxo cover some topics off the "one pill can kill" list, try breaking down the toxic mechanism of opioid induced respiratory depression in a simplistic way (but maybe fail), and walk through the triage and management of poison center case where a child was "potentially" exposed to a lethal toxin at home.

Case Report

Pediatric ingestion case study discussed at the beginning of the episode: https://pediatrics.aappublications.org/content/130/6/e1700

"One Pill Can Kill" Resources

Missouri Poison Center resource guide:http://missouripoisoncenter.org/wp-content/uploads/2015/02/2011-One-Pill-Can-Kill.pdf
Pediatric poison prevention article:https://pubmed.ncbi.nlm.nih.gov/16419734/
HealthyChildren.org guide on medication safety:https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Poison-Prevention-One-Pill-Can-Kill.aspx

Respiratory Centers and Drug Effects

Detailed overview of the impact of drugs on respiratory centers:
https://www.ncbi.nlm.nih.gov/books/NBK482414

Buprenorphine Studies

Epidemiology

AAPCC Annual Report on poisoning trends:https://pubmed.ncbi.nlm.nih.gov/31752545/
Trends in pediatric opioid exposures:https://pubmed.ncbi.nlm.nih.gov/32178937/
Trends in ED visits for unsupervised medication exposures:https://pubmed.ncbi.nlm.nih.gov/26347435/

Exposure Studies

U.S. Poison Center data on buprenorphine: https://pubmed.ncbi.nlm.nih.gov/29941678/
Harvard Emergency Medicine group analysis: https://pubmed.ncbi.nlm.nih.gov/27756148/
Maryland Poison Center/RADARS data:https://pubmed.ncbi.nlm.nih.gov/18381506/
ICU exposures in children:https://pubmed.ncbi.nlm.nih.gov/20921918/

Triage Considerations for Pediatric Exposures

Symptoms: What are the current symptoms and their severity?
Causative Agent & Exposure Characteristics: What substance was ingested, and in what quantity? What’s the context of the exposure?
History: Includes past medical history, patient weight, and the time elapsed since exposure.
Onset: When are symptoms expected to appear?
Labs: Perform toxin-specific assessments where applicable.
Aggravating/Remitting Factors: What interventions have already been performed, and how have they affected the patient?

If you have questions about these studies or poisoning scenarios, consult your local poison center or toxicologist. Thank you for tuning in!