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Exposure to toxic substances occurs in children of all ages. Children younger than 6 years are primarily involved in unintentional exposures, with the peak incidence in 2-year-olds. Of the more than 2 million exposures reported by the American Association of Poison Control Centers’ National Poison Data System in 2021, almost 60% of exposures occurred in those younger than 20 years: 40% in children aged 5 years and younger, 6% aged 6–12 years, and 9% aged 13–19 years. Fortunately, young children’s exposures are typically unintentional and in low dose or volume. They can be exposed to intentional malicious administration through the actions of parents or caregivers and involvement of child abuse specialists is helpful in these cases (see Chapter 8). Recreational drug use and intentional ingestions account for more exposures in the adolescent population. From July 2019 through December 2021, the median monthly overdose deaths among persons aged 10–19 years increased 109%, with 90% of deaths involving opioids. Illicit fentanyl has been responsible for majority of these overdose deaths. Fentanyl is being sold as other prescription pharmaceuticals such as Xanax, Oxycodone (often referred as “M30’s”), and Vicodin. Fentanyl has also been found in heroin, methamphetamine, and cocaine. Industrial or manufacturing processes may be associated with homes and farms, and exposures to hazardous substances should be considered in the history.
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Pediatric patients also have special considerations pertaining to nonpharmaceutical toxicologic exposures. Their shorter stature places them lower to the ground as well as the fact that many are crawling, and some gas and vapor exposures will gather closer to the ground. They may have a greater inhalational exposure due to their higher minute ventilation. They may not be physically mature enough to remove themselves from exposures. They also have a large body surface area to weight ratio making them vulnerable to topical exposures and hypothermia.
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Gummin
DD
et al: 2021 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 39th Annual Report. Clin Toxicol (Phila). 2022 Dec;60(12):1381–1643
[PubMed: 36602072]
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Tanz
LJ
et al: Drug Overdose Deaths Among Persons Aged 10-19 Years – United States, July 2019-December 2021. MMWR Morb Mortal Wkly Rep. 2022 Dec 16;71(50):1576–1582
[PubMed: 36520659]
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PHARMACOLOGIC PRINCIPLES OF TOXICOLOGY
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In the evaluation of the poisoned patient, it is important to compare the anticipated pharmacologic or toxic effects with the patient’s clinical presentation. If the history is that the patient ingested a sedative 30 minutes ago, but the clinical examination reveals dilated pupils, tachycardia, dry mouth, absent bowel sounds, and active hallucinations—clearly anticholinergic toxicity—diagnosis and therapy should proceed accordingly. In addition, standard pharmacokinetics (absorption, distribution, metabolism, and elimination) often cannot be applied in the setting of a large dose, since these parameters have been extrapolated from ...