pediatric poisoning - emory university：小儿中毒-埃默里大学

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1、PediatricPoisoningsMarkSutter,MDOverviewEpidemiologyImportantLegislationPackagingandMarketingProblemsPhysiologicDifferencesIronPesticidesDeadlyPediatricPoisonsEpidemiologyUSPoisonCentersreceive1.5millioncallsayearregardingpediatricingestions.79%ofthesecallsinvolvechildre

2、nyoungerthanagesix.56%ofpediatricexposuresarefromproductsaroundthehouseincludingmedicines,cleaningagents,pesticides,plantsandcosmetics.Epidemiology99%ofingestionsbychildrenunder6areunintentional.Approximately40%ofingestionsreportedtothepoisoncenterbyadolescentsareintenti

3、onal.Approximately56%ofadolescentingestionsarebyfemales.EpidemiologyLegislationThePoisonPreventionPackagingActof1970.(PPPA)Requireschildprotectivepackagingofhazardoushouseholdproducts.Overthelast30yearsthelistofsubstancesregulatedbythePPPAhaveexpandedtoincludemedicines,s

4、olvents,andoils.Datashowsreductionof45%mortalityofpediatricpatientssincetheintroductionandexpansionofPPPA.SpecialPediatricIssuesALLTHINGSTENDTOENDUPINTHEMOUTHSOFYOUNGCHILDREN!!WhichisCandy?SweetTartsvs.EcstacyPoisonCenterCampaignPhysiologicDifferencesBloodbrainbarriersti

5、llmorepermeabletotoxicologicsubstancesuntilaround4months.Nostudiesdemonstratingincreasedpermeability,ratherthisisanestimatebasedontoxicitynotedwithsmallerdosesthanexpected.Highermetabolicdemands.Decreasedabilitytoglucuronidateintheinfantperiod.Secondtrimesterpregnanciest

6、hatwereterminatedshowedonly10%activityoftheP-450system.Nobetterstudiestodate,butmostbelievebetweenages2-4yearsthatglucuronidationisequivalenttoadults.Decreasedglycogenstores.PhysiologicDifferencesIncreasedbodysurfaceareacanleadtothermoregulatoryissues.Childrenresidelower

7、totheground.Thisputsthemathigherriskforingestingcompoundsheavierthanair.OftenadultswillNOThavethesameexposure.Inabilitytoavoidhazards–theydonotreadwarninglabelsor“DoNotEnter”signs.IronThemostcommoncauseofdeathintoddlers.Classicallytaughtashavingfiveclinicalstages.Remembe

8、rprenatalvitamins,supplements,and“naturalproducts”.IronToxicdosesoccurat10-20mg/Kgofelementaliron.Prena