Pediatric Poisoning - Emory University：小儿中毒-埃默里大学.pptVIP

Pediatric Poisonings Mark Sutter, MD Overview Epidemiology Important Legislation Packaging and Marketing Problems Physiologic Differences Iron Pesticides Deadly Pediatric Poisons Epidemiology US Poison Centers receive 1.5 million calls a year regarding pediatric ingestions. 79% of these calls involve children younger than age six. 56% of pediatric exposures are from products around the house including medicines, cleaning agents, pesticides, plants and cosmetics. Epidemiology 99% of ingestions by children under 6 are unintentional. Approximately 40% of ingestions reported to the poison center by adolescents are intentional. Approximately 56% of adolescent ingestions are by females. Epidemiology Legislation The Poison Prevention Packaging Act of 1970. (PPPA) Requires child protective packaging of hazardous household products. Over the last 30 years the list of substances regulated by the PPPA have expanded to include medicines, solvents, and oils. Data shows reduction of 45% mortality of pediatric patients since the introduction and expansion of PPPA. Special Pediatric Issues ALL THINGS TEND TO END UP IN THE MOUTHS OF YOUNG CHILDREN!! Which is Candy? Sweet Tarts vs. Ecstacy Poison Center Campaign Physiologic Differences Blood brain barrier still more permeable to toxicologic substances until around 4 months. No studies demonstrating increased permeability, rather this is an estimate based on toxicity noted with smaller doses than expected. Higher metabolic demands. Decreased ability to glucuronidate in the infant period. Second trimester pregnancies that were terminated showed only 10% activity of the P-450 system. No better studies to date, but most believe between ages 2-4 years that glucuronidation is equivalent to adults. Decreased glycogen stores. Physiologic Differences Increased body surface area can lead to thermoregulatory issues. Children reside lower to the ground. This puts them at higher risk for ingesting compounds heavier than