Unintentional Household Poisoning in Children

Abstract

Despite the major reduction in fatal paediatric poisonings that has been achieved in industrialised countries over the last few decades, unintentional paediatric poisoning remains a major public health issue worldwide. In this article, we aim to provide clinicians dealing with poisoned children an overview of the problem and specific guidance on the identification and management of significant poisoning. Substances most frequently ingested by children in the developed world include household chemicals, medication, and plants. Although the great majority of such poisonings have no or limited clinical effects, it puts substantial burden on health care systems. Importantly, a few poisons can kill after ingestion of very small amounts. Unintentional poisoning in developing countries can be much more serious, following ingestion of kerosene, caustic agents, herbal remedies, insecticides or herbicides. Management of symptomatic patients involves supportive care, if available the administration of antidotes, and the removal of the offending drug from the body. Recent position papers on gastric decontamination indicate that such interventions are only rarely necessary. To further reduce the number of deaths and disabilities in the industrialised world and to begin to have an effect in the developing world, much more work is required to both identify and implement prevention strategies to reduce the number of cases of paediatric poisoning.

Zusammenfassung

Trotz der Verringerung der tödlichen Vergiftungen im Kindesalter in den letzten Jahrzehnten in den Industrieländern stellen akzidentelle Vergiftungsunfälle bei Kindern weiterhin ein schwerwiegendes Problem dar. Ziel dieser Arbeit ist es, einen Überblick über akzidentelle Vergiftungen im Kindesalter und deren Behandlung zu geben. Die am häufigsten ingestierten Substanzen in Industrieländern durch Kinder sind Haushaltsmittel, Medikamente und Pflanzen. Obwohl die meisten dieser Ingestionen zu keiner oder nur geringer klinischer Symptomatik führen, stellen sie durch Inanspruchnahme medizinischer Leistungen eine nicht unerhebliche Belastung für das Gesundheitssystem dar. Von Bedeutung ist zudem, dass einige wenige Substanzen auch in sehr geringen Mengen zu Todesfällen führen können. Akzidentelle Vergiftungen in Entwicklungsländern sind häufig durch Kerosin, ätzende Substanzen, traditionelle Heilmittel und Insektizide und Herbizide verursacht. Die Behandlung vergifteter Kinder ist meist supportiv; in Einzelfällen ist die Gabe eines Antidots, oder eine primäre oder sekundäre Giftentfernung notwendig. Nach Maßgabe der neuen Leitlinien zur primären Giftentfernung der europäischen und amerikanischen Fachgesellschaften ist diese allerdings nur noch in seltenen Fällen indiziert. Um die Anzahl der Vergiftungs- und Todesfälle durch Vergiftungen weiter zu reduzieren sind weitere Maßnahmen insbesondere auf dem Gebiet der Prävention erforderlich.

Key words

Unintentional poisoning - children - developed world - developing world - household

Schlüsselwörter

Akzidentelle Vergiftungen - Kindesalter - Industrieländer - Entwicklungsländer

References

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