#paeds #toxicology See also: [[Essential oils]] see: - [Murray chapter poisoning in children](x-devonthink-item://C8AE745C-C96E-4AEF-9010-D441840C6DF4?page=138) - [Toxicology case of the month: ingestion of two unidentified tablets by a toddler. 2006](bookends://sonnysoftware.com/ref/DL/65609) - [bear one pill can kill](bear://x-callback-url/open-note?id=A3D48955-5CC4-4344-9E03-F54F074729D6-6643-000002FF34FCFAA7&header=Paediatric%20overdose%20pill) - [RCH poisioning guideline](https://www.rch.org.au/clinicalguide/guideline_index/Poisoning_-_Acute_Guidelines_For_Initial_Management/) - [Devonthink RCH paediatric antidotes table](x-devonthink-item://763D1D4B-792A-47C2-BB50-EA84BA03F1F3?page=47) # tablets that are life-threatening if ingested by a small child (1 pill kills) ![[Pasted image 20241024195058.png|also opiates, clonidine]] | Drug | Effect | | ------------------------------- | --------------------------------------------------------------- | | beta blockers | coma, [[Seizures]], VT, [[hypoglycaemia\|hypoglycemia]] | | CCBs | delayed-onset bradycardia, hypotension, conduction defects | | chloroquine / hydroxychlorquine | rapid-onset coma, seizures, cardiovascular collapse | | ecstasy and other amphetamines | agitation, hypertension, [[Heat-related illness\|hyperthermia]] | | [[TCA overdose\|TCAs]] | coma, seizures, hypotension, VT | | theophylline | seizures, SVT, tachycardia, [[Vomiting]] | | oral hypoglycaemics | | | propranolol | [[Sodium channel blocker\|Na-channel blocker]] | **Sodium channel blockers** - chloroquine/hydrocychlorquine - dextropropoxphene - [[beta blocker overdose|propranolol]] - [[TCA overdose]] **[[Calcium channel blocker overdose| calcium channel blockers]]** - verapamil - diltiazem **Sulfonylureas** - [[Sulfonylureas|gliclazide]] **Recreational drugs** - amphetamines, MDMA **opiates** theophylline ![[Pasted image 20230711202310.png]] ![[Pasted image 20230711202319.png]] ![[Pasted image 20230711202328.png]] # non-toxic household exposures ![[Pasted image 20230711202524.png]] # potentially lethal 1-3 tablet ingestions |drug|effect| |---|---| |[[beta blocker overdose\|beta blockers]]|coma, seizures, Ventricular Tachycardia, hypoglycaemia| |[[Calcium channel blocker overdose\|calcium channel blockers]]| delayed onset bradycardia, hypotension, conduction defects| |Chloroquine / hydroxychloroquine| rapid onset coma, seizures, cardiovascular collapse| |Ecstasy and other amphetamines | agitation, hypertension, hyperthermia| |Oral hypoglycaemics eg [[Sulfonylureas]] |hypoglycaemia may be delayed 8 hours | | [[TCA overdose \| TCAs]] |coma, seizures, hypotension, VT| |Theophylline | seizures, Supraventricular Tachycardia, tachycardia, vomiting | # potentially harmful 1-3 tablet ingestions/small exposures - Anticholinesterase inhibitors eg [[organophosphates]] - [[Cholinergic syndrome]], seizures, LOC - Baclofen (25 mg)  - coma - Camphor - rapid decrease in conscious state, seizures, hypotension - [[carbamazepine]] (400 mg) - coma - Centrally acting alpha adrenergic agonists eg **clonidine** - like opiate but more hypotension and bradycardia - Clozapine 100mg/ 200 mg - coma - [[colchicine]] - Corrosives - strong alkali or acid - Gastroesophageal injury - Dextropropoxyphene 100 mg - Ventricular Tachycardia - **Opiates** eg buprenorphine (8 g sublingual or film absorbs in <5 min), codeine, methadone, fentanyl - [[Hydrocarbons]] solvents/ kerosene / [[Essential oils]] - decreased level of consciousness, seizures, aspiration pneumonia - Illicit/street drugs, eg amphetamine. - Loperamide and diphenoxylate - Naphthalene - 1 mothball (but most mothballs aren't naphthalene) - methaemoglobinaemia, haemolysis - Podophyllin - Paraquat - oesophageal burns, multi-organ failure - [[Aspirin overdose|Salicylates]] - Strychnine - muscle spasm and respiratory arrest - [[Venlafaxine]] 150 mg - seizures.