acute poisoning in children
Introduction
Introduction to acute poisoning in children Acute poisoning is one of the common emergencies in pediatrics. Children are most likely to suffer from food poisoning, and the age is more common in 1 to 5 years old. Because young children have certain activity ability, but lack of cognitive ability and life experience, lack of understanding of the harm of certain poisons and drugs, the incidence of poisoning is higher in this age group. In the literature, the poisoning is less than 5 years old. Although the incidence rate of the population is relatively high, most of them are unintentional poisoning. The dose of poisoning substances is small and the type of poison is single. The mortality rate is lower than that of adolescent patients, and a considerable number of adolescent patients are in the presence of mental depression or psychological disorders. Self-injury poisoning, its dosage is usually large, and the mortality rate is relatively high. When a child is sent to a hospital after poisoning, the parents of the sick child can not accurately provide the medical history of the poison type and the poison intake, so that there is no The targeted detoxification measures can cause the sick child to die in a short time. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: dehydration, electrolyte imbalance, metabolic acidosis, arrhythmia, pulmonary edema, anemia
Cause
Causes of acute poisoning in children
(1) Causes of the disease
There are many kinds of poisons, which can be divided into the following categories according to their scope of use and use:
1. Industrial poisons: including industrial raw materials such as chemical solvents, paints, heavy metals, gasoline, chlorine, cyanide, methanol, hydrogen sulfide, etc.
2. Agricultural poisons: organophosphorus pesticides, chemical herbicides, rodenticides, fertilizers, etc.
3. Poisoning: Many drugs (including Chinese medicine) can cause poisoning, such as digoxin, antiepileptic drugs, antipyretics, anesthetic sedatives, antiarrhythmic drugs, etc.
4. Animal poisons: snakes, cockroaches, bees, cockroaches, spiders, puffer fish, fresh sea otters, etc.
5. Food poisons: expired or moldy foods, spoiled foods, toxic food additives.
6. Botanical poisons: wild mites, aconite, ginkgo and so on.
7. Others: strong acid and alkali, carbon monoxide, cosmetics, detergents, insecticides, etc.
In addition, according to the physical state of the poison, it can be divided into volatile and non-volatile poisons, which are classified into ingestion, inhalation, skin contact and absorption of poisons according to the way of absorption of the poison.
(two) pathogenesis
1. The role of poison
The toxic pathways, targets, time, range and intensity of various poisons enter the body vary. The route of entry is the most in the gastrointestinal tract. Others include respiratory tract, skin, facial features, wounds, injections, etc. The characteristics of the poison itself, some poisons have only one or two kinds of invasive pathways (such as poisonous mites), while others can have multiple ways (such as organophosphorus pesticides). The action sites of poisons directly affect the degree of poisoning, when poisons act on Oxygen metabolism, nervous system, heart and other metabolic key links or important organs can cause serious symptoms and even death. The damage caused by poisons entering the body is called toxicity. The stronger the toxicity of poisons, the stronger the toxicity. The greater the harm to the body, in addition, the dose of toxic substances, toxicological characteristics and the state of the body and tolerance are also closely related to the degree of poisoning. In a short period of time, the intake of a large number of toxicants with high absorption rate is usually more serious.
2. Toxic metabolism
Most of the poisons enter the body and are metabolized and metabolized by the liver. The toxicity is weakened or disappeared, and excreted by the kidneys. Some poisons can also be excreted by the kidneys. Some of the poisons can be excreted by sweat glands, breasts, tears, respiratory tracts, biliary tracts or intestines. The rate of excretion varies greatly depending on the nature of the poison and the kidney function of the patient. The excretion time of the poison can be as long as several weeks or even months. The distribution of the drug in the pharmacokinetics is of great significance for guiding the treatment of poisoning. The method of promoting toxic excretion in treatment is effective for patients who have accumulated most of the poisons in the early stage of poisoning. When the distribution of poisons reaches equilibrium in the body, only about 5% of most poisons are present in the blood. The effect of excretion treatment is poor. In addition, the toxic substance has high fat solubility or high plasma protein binding rate. When poisoning, the dose of poison is large, and shock and other factors may also cause the toxic excretion rate to slow down.
Prevention
Acute poisoning prevention in children
1. Child safety supervision and publicity and education.
2. Former children should be supervised, carry out safety education, and take appropriate safety measures to create a safe and safe living environment for children; school-age children should explain the hazards to them, do not collect wild plants and wild fruits for consumption; Psychology and awareness of quality education, do not blindly worship, imitate film and television characters.
3. Medical staff should strengthen the management and publicity of pesticides, rodenticides, highly toxic drugs and children's unsuitable drugs, explain to parents the knowledge of preventing poisoning, and inform them that poisons should be kept safely to avoid contact with children; Visit a doctor, do not listen to the advertisement and arbitrarily buy medicine; before taking the medicine, follow the doctor's advice and carefully check the label, dosage, and method of taking the medicine. Do not take the medicine that is deteriorating or unclear. "Use gas and water heaters correctly, and strengthen ventilation and safety of windows. # Inform parents that if children have unexplained nausea, vomiting, convulsions, etc., they should seek medical treatment as soon as possible to reduce the serious consequences. Medical staff should pay attention to contact with children's parents. To conduct face-to-face health education, to integrate child health work into families, to actively engage in family intervention, to eliminate the impact of family negative factors on children, to create a good family atmosphere, and to early discover the psychological problems of children.
4. Drug market management, the implementation of pesticides, rodenticides, and highly toxic drugs in strict accordance with the monitoring regulations. "Strive to carry out spiritual civilization construction and correctly handle neighborhood relations and family disputes. # Medical institutions should strengthen cooperation with the media, adopt a way to open up columns and set up special programs for a fixed period of time, and publicize anti-virus knowledge and appropriate treatment to all levels of society. method.
Complication
Acute poisoning complications in children Complications dehydration electrolyte disorder metabolic acidosis arrhythmia pulmonary edema anemia
Can be dehydration, acidosis, electrolyte imbalance, liver damage, jaundice, hepatitis symptoms.
Fatal heart failure and shock, can be complicated by severe arrhythmia, pulmonary edema, respiratory muscle paralysis and respiratory failure, kidney damage, hematuria, proteinuria, acute renal failure, hypertension, azotemia, etc., nervous system There are convulsions, paralysis, coma, central respiratory failure, causing anemia, hemolysis, induced DIC, extensive bleeding, after the acute phase of acute poisoning, some children may have sequelae, such as gastrointestinal tract deformation caused by corrosive poisoning Narrow, affecting normal diet; brain poisoning damage or mental dysfunction after severe hypoxia.
Symptom
Symptoms of acute poisoning in children Common symptoms Abdominal pain, nausea and convulsions, photoreaction disappeared, hypotension, hypotension, azotemia, diarrhea, dyspnea, convulsions
The history of poisoning is extremely important for providing the nature and diagnosis of poisons. However, if the poisons are not clear at the moment, the clinical manifestations will also help to identify the types of poisons and the degree of the disease. Due to the variety of poisons, the symptoms depend on the characteristics of the poisons. The clinical manifestations of poisoning vary greatly. Physical examination is generally carried out according to each system to avoid omission. Table 1 shows some common symptoms, signs and possible poisons. For some suspected toxic symptoms, key examinations should be made. Vital signs. Heart, brain, kidney and other major organ function damage often indicates that the poisoning is serious, the following are common symptoms and manifestations of various systems during poisoning.
Digestive system
In acute poisoning, gastrointestinal symptoms are usually the most significant. Most of the poisons are poisoned by ingestion. A few are non-ingestion poisoning. After the poison enters the digestive tract, the poison directly stimulates the intestinal tract and destroys the local tissue of the digestive tract. Can cause abdominal pain, nausea, vomiting and diarrhea and other symptoms, toxic substances can also pass the nerve reflex and systemic effects, causing the same symptoms, therefore, for children with unexplained acute gastrointestinal symptoms, should pay attention to identify the presence of poisoning, digestion Symptoms of severe symptoms are often accompanied by symptoms such as dehydration, acidosis, electrolyte imbalance, etc. The liver is the main site for the metabolism of toxic substances. Most of the poisons that enter the digestive tract are poisonously reduced or lose toxicity after liver metabolism, and the liver may be invaded by poisons. Different degrees of damage occur, jaundice, hepatitis symptoms, the original liver dysfunction can be aggravated by the detoxification function.
2. Circulatory system
Most children with poisoning have circulatory symptoms, such as tachycardia and poor peri-circulatory perfusion. Some of them have fatal heart failure and shock during acute poisoning. There are two reasons: one is poison directly. Acts on the myocardium, causing myocardial dysfunction and heart failure; the other is the action of toxic substances on the blood vessels and nervous system, inhibiting oxygen uptake and oxygen metabolism, leading to severe arrhythmia, hypotension, or electrolyte metabolism disorder, eventually causing secondary Sexual heart failure, autonomic nerves have a greater impact on the cardiovascular system. Toxic sympathetic stimulants can increase blood pressure, rapid heart rhythm and abnormalities, while parasympathomimetic toxicants can cause bradycardia.
3. Respiratory system
Many poisons (including inhaled toxic gases) can damage respiratory function. Children with poisoning can have irritating cough, difficulty breathing, cyanosis, pulmonary edema and irregular breathing rhythm, severe respiratory depression or respiratory muscle paralysis and respiratory failure. The exhaled gas of organophosphorus poisoning can smell garlic odor.
4. Urinary system
The kidney is the main organ excreted by poisons and toxic metabolites. The circulation after poisoning, renal ischemia and hypoxia caused by respiratory disorders, can cause different degrees of kidney damage symptoms, manifested as hematuria, proteinuria, edema, decreased urine output, etc. Toxic substances also have selective renal toxicity, which directly damages the kidneys. Kidney damage is most severe in acute renal failure. The latter usually manifests as short-term urinary occlusion, hypertension, azotemia, and severe changes in consciousness. , convulsions and acute pulmonary edema.
5. The nervous system
The central nervous system is an important organ of the human body's advanced living organs and regulating the physiological functions of the body. When the nervous system is directly damaged by toxins, or after ischemia and hypoxia injury after poisoning, neurological dysfunction may occur, and the brain may be severe. Sexual destruction and functional failure, clinically relevant symptoms are irritability, convulsions, paralysis, coma, denervation and central respiratory failure and neurogenic shock. The pupil is an important sign of brain function observation, and can identify the poison species to some extent. When the brain function status, morphine, alcohol, organic phosphorus and other poisoning, the pupil is usually significantly reduced; while the mandolin, sedative poisoning, the pupil dilated, dilated pupils with the disappearance of photoreaction, suggesting severe brain damage.
6. Other
Some poisons can inhibit bone marrow hematopoietic function, destroy red blood cells, cause anemia, hemolysis, etc. Stress, shock and hypoxia can also induce DIC, causing extensive bleeding in the skin, digestive tract, etc. Corrosive poisons can cause skin, facial features, digestive tract And respiratory mucosal damage, cell respiratory inhibitors can cause cell energy metabolism disorders and death (such as cyanide).
Examine
Examination of acute poisoning in children
Poison identification check
First, the poison identification test should be carried out. The collected specimens should be taken early, including the original poison samples, gastric juice or vomit, blood, urine, etc.
2. General laboratory inspection
Should do blood, stool, urine routine examination, blood gas analysis, serum electrolytes, myocardial enzymology, liver function enzymes, serum urea nitrogen (BUN), serum creatinine (Cr) and other tests.
3. X-ray photo inspection
Partial poisoning can be diagnosed by X-ray photograph or understand the complications after poisoning. Chronic lead or sputum poisoning may have special changes of bone X-ray. X-ray can evaluate the degree of pulmonary edema caused by inhaled poison, diagnostic chemistry. Pneumonia and other secondary lung injuries.
4. ECG, EEG examination
Ancillary examinations such as electrocardiogram and electroencephalogram can be used as reference indicators for judging the condition and prognosis.
Diagnosis
Diagnosis and diagnosis of acute poisoning in children
Diagnostic criteria
Due to the variety of toxicants and clinical manifestations, clinicians can combine the odor, symptoms, other signs, traits of excreta, etc. according to the face of the poisoned patient, and comprehensively analyze and obtain a preliminary diagnosis; Screening and identification of poisoning poisons with high epidemiology, and acute poisoning caused by various poisons often have their own characteristics. These characteristics are important clues and basis for the diagnosis of poisoning. Special attention should be paid to the collection of history of poison contact. Identification of the original poison.
For patients with a clear history of toxic ingestion or exposure, the diagnosis can be quickly established in combination with clinical symptoms. For those whose medical history is unclear, toxicant identification may be considered. Whether the history is typical or not, it is necessary to identify the toxicant in order to obtain accurate evidence. Collection of specimens should be carried out as early as possible, including original poison samples, gastric juice or vomit, blood, urine, etc. After the poison is determined, it is also necessary to know the dose of the poison, the onset time and the organ involvement and pre-treatment, etc., in order to determine the corresponding Processing plan.
Differential diagnosis
1. It should be identified with the following diseases: those who are unclear for diagnosis and have a coma:
1 low blood sugar.
2 ketoacidosis.
3 intracranial hemorrhage.
4 central infection.
5 hepatic encephalopathy.
6 uremia.
7 electrolyte disorder.
2. Prompt for critical illness: acute poisoning accompanied by the following manifestations:
1 deep coma.
2 shock or unstable blood pressure.
3 high fever or body temperature does not rise.
4 respiratory failure.
5 heart failure or severe arrhythmia.
6 horror persistence.
7 renal failure.
8DIC.
9 blood sodium is higher than 150mmol / L or less than 120mmol / L, for these children, routine monitoring of liver, kidney and other organ functions, to provide a basis for disease judgment and support.
