Highlights & Basics
- Toxic ingestions refer to the accidental or deliberate ingestion of a substance with resultant toxicity or risk of toxicity. Children may ingest a toxic substance accidentally while exploring their environment, or deliberately in response to stress or underlying mental problems, or in an attempt to get "high."
- A regional poison-control center or medical toxicologist should be contacted with any suspected overdose in a child.
- The range of possible ingestions is broad; diagnosis is based on a combination of thorough clinical evaluation and comprehensive laboratory investigation to identify all ingested substances.
- Some asymptomatic patients require observation for 6 hours, or 24 hours for high-risk ingestions; most asymptomatic patients in the US can remain at home with phone follow-up with a poison control center.
- The mainstay of management of symptomatic patients is management of airway, breathing, and circulation, with appropriate supportive care. Specific antidotes may also be required.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Hoffman RS, Burns MM, Gosselin S. Ingestion of caustic substances. N Engl J Med. 2020 Apr 30;382(18):1739-48.
McKay C. Can the laboratory help me? Toxicology laboratory testing in the possibly poisoned pediatric patient. Clin Pedi EM. 2005;6:116-22.
Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018 Mar;71(3):314-25.e1.[Abstract][Full Text]
Royal College of Emergency Medicine. College of Emergency Medicine and National Poisons Information Service guideline on antidote availability for emergency departments, 2021 update. Dec 2021 [internet publication].[Full Text]
American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.[Abstract][Full Text]
- WikiTox
- American College of Medical Toxicology: positions, guidelines and recommendations
- American Association of Poison Control Centers: National Poison Data System
- IPCS INCHEM: poisons information monographs
- World Health Organization: chemical safety
- Royal College of Emergency Medicine: guidance
- American Academy of Clinical Toxicology: recommendations
1. American Association of Poison Control Centers. 2021 poison center data snapshot: overview of the 39th annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS). 2021 [internet publication].[Full Text]
2. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 annual report of the National Poison Data System (NPDS) from American's Poison Centers: 39th annual report. Clin Toxicol (Phila). 2023 Jan;60(12):1381-643.[Abstract][Full Text]
3. Gillies D, Christou MA, Dixon AC, et al. Prevalence and characteristics of self-harm in adolescents: meta-analyses of community-based studies 1990-2015. J Am Acad Child Adolesc Psychiatry. 2018 Oct;57(10):733-41.[Abstract]
4. Gupte G L. Management of paracetamol overdose.Paediatr Child Health. 2016 Oct;26(10):459-63.
5. Hall AH, Smolinske SC, Conrad FL, et al. Ibuprofen overdose: 126 cases. Ann Emerg Med. 1986 Nov;15(11):1308-13.[Abstract]
6. O'Malley GF. Emergency department management of the salicylate-poisoned patient. Emerg Med Clin North Am. 2007 May;25(2):333-46; abstract viii.[Abstract]
7. Williams RH, Erickson T. Emergency diagnosis of opioid intoxication. Lab Med. 2000 Jun 1;31(6):334-42.[Full Text]
8. Namba T. Cholinesterase inhibition by organophosphorus compounds and its clinical effects. Bull World Health Organ. 1971;44(1-3):289-307.[Abstract]
9. Barceloux DG, Bond GR, Krenzelok EP, et al. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40(4):415-46.[Abstract]
10. McQuade DJ, Dargan PI, Wood DM. Challenges in the diagnosis of ethylene glycol poisoning. Ann Clin Biochem. 2014 Mar;51(pt 2):167-78.[Abstract][Full Text]
11. Slaughter RJ, Mason RW, Beasley DM, et al. Isopropanol poisoning. Clin Toxicol (Phila). 2014 Jun;52(5):470-8.[Abstract]
12. Hoffman RS, Burns MM, Gosselin S. Ingestion of caustic substances. N Engl J Med. 2020 Apr 30;382(18):1739-48.
13. Royal Children's Hospital Melbourne. Foreign body ingestion. Apr 2020 [internet publication].[Full Text]
14. Gurevich Y, Sahn B, Weinstein T. Foreign body ingestion in pediatric patients. Curr Opin Pediatr. 2018 Oct;30(5):677-82.[Abstract]
15. National Health Service England. News: NHS surgeons safety plea after surge in kids swallowing dangerous objects. Dec 2022 [internet publication].[Full Text]
16. McNeill IR, Isoardi KZ. Barium poisoning: an uncommon cause of severe hypokalemia. Toxicology Communications. 2019 Jan 1;3(1):88-90.[Full Text]
17. Tenenbein M. Toxicokinetics and toxicodynamics of iron poisoning. Toxicol Lett. 1998 Dec 28;102-103:653-6.[Abstract]
18. Zaremba M, Serafin P, Kleczkowska P. Antipsychotic drugs efficacy in dextromethorphan-induced psychosis. Biomedicines. 2023 Jan 3;11(1):123.[Abstract][Full Text]
19. Beasley DM, Glass WI. Cyanide poisoning: pathophysiology and treatment recommendations. Occup Med (Lond). 1998 Oct;48(7):427-31.[Abstract][Full Text]
20. Buckley NA, Dawson AH, Isbister GK. Serotonin syndrome. BMJ. 2014 Feb 19;348:g1626.
21. Sessler CN. Theophylline toxicity: clinical features of 116 consecutive cases. Am J Med. 1990 Jun;88(6):567-76.[Abstract]
22. Santos C, Kieszak S, Wang A, et al. Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers - United States, 2011-2014. MMWR Morb Mortal Wkly Rep. 2017 Mar 3;66(8):223-6.[Abstract]
23. American Association of Poison Control Centers. American Association of Poison Control Centers warn about potential poison exposure to single-load laundry packets. Jan 2018 [internet publication].[Full Text]
24. Day R, Bradberry SM, Jackson G, et al. A review of 4652 exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service 2008-2018. Clin Toxicol (Phila). 2019 Dec;57(12):1146-53.[Abstract][Full Text]
25. McKay C. Can the laboratory help me? Toxicology laboratory testing in the possibly poisoned pediatric patient. Clin Pedi EM. 2005;6:116-22.
26. Isbister GK, Prior F, Kilham HA. Restricting cough and cold medicines in children. J Paediatr Child Health. 2012 Feb;48(2):91-8.[Abstract]
27. Halmo LS, Wang GS, Reynolds KM, et al. Pediatric fatalities associated with over-the-counter cough and cold medications. Pediatrics. 2021 Nov;148(5):e2020049536.[Abstract][Full Text]
28. Rumack BH, Peterson RC, Koch GG, et al. Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981 Feb 23;141(3 Spec No):380-5.[Abstract]
29. Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics. 1975 Jun;55(6):871-6.[Abstract]
30. Wu AH, McKay C, Broussard LA, et al. National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem. 2003 Mar;49(3):357-79.[Abstract][Full Text]
31. Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018 Mar;71(3):314-25.e1.[Abstract][Full Text]
32. Royal College of Emergency Medicine. College of Emergency Medicine and National Poisons Information Service guideline on antidote availability for emergency departments, 2021 update. Dec 2021 [internet publication].[Full Text]
33. Eldridge DL, Van Eyk J, Kornegay C. Pediatric toxicology. Emerg Med Clin North Am. 2007 May;25(2):283-308.[Abstract]
34. Rodgers GC Jr, Ross MP. Intensive care of pediatric poisoning patients. In: Brent J, Wallace KL, Burkhart KK, et al, eds. Critical care toxicology. Philadelphia, PA: Elsevier Mosby; 2005:103-22.
35. Tenenbein M. Recent advances in pediatric toxicology. Pediatr Clin North Am. 1999 Dec;46(6):1179-88.[Abstract]
36. McIntosh GC, Katcher ML. Pediatric poisonings: know what kills. AAP Grand Rounds. 2005;13:22-3.[Full Text]
37. Michael JB, Sztajnkrycer MD. Deadly pediatric poisons: nine common agents that kill at low doses. Emerg Med Clin North Am. 2004 Nov;22(4):1019-50.[Abstract]
38. Ross JA, Eldridge DL. Pediatric toxicology. Emerg Med Clin North Am. 2022 May;40(2):237-50.[Abstract]
39. American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.[Abstract][Full Text]
40. Eddleston M, Juszczak E, Buckley NA, et al; Ox-Col Poisoning Study collaborators. Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet. 2008 Feb 16;371(9612):579-87.[Abstract]
41. Thanacoody R, Caravati EM, Troutman B, et al; American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila). 2015 Jan;53(1):5-12.[Abstract][Full Text]
42. Benson BE, Hoppu K, Troutman WG, et al; American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013 Mar;51(3):140-6.[Abstract][Full Text]
43. Höjer J, Troutman WG, Hoppu K, et al; American Academy of Clinical Toxicology, European Association of Poison Centres and Clinical Toxicologists. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila). 2013 Mar;51(3):134-9.[Abstract][Full Text]
44. American Academy of Clinical Toxicology, European Association of Poisons Control Centres and Clinical Toxicologists. Position paper: cathartics. J Toxicol Clin Toxicol. 2004;42(3):243-53.[Abstract][Full Text]
45. Marraffa JM, Cohen V, Howland MA. Antidotes for toxicological emergencies: a practical review. Am J Health Syst Pharm. 2012 Feb 1;69(3):199-212.[Abstract]
46. Dart RC, Rumack BH. Patient-tailored acetylcysteine administration. Ann Emerg Med. 2007 Sep;50(3):280-1.[Abstract]
47. Heard KJ. Acetylcysteine for acetaminophen poisoning. N Engl J Med. 2008 Jul 17;359(3):285-92.[Abstract][Full Text]
48. American College of Medical Toxicology. ACMT position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.[Abstract][Full Text]
49. Boyer EW, Duic PA, Evan A. Hyperinsulinemia/euglycemia therapy for calcium channel blocker poisoning. Pediatric Emerg Care. 2002 Feb;18(1):36-7.[Abstract]
50. Di Grande A, Giuffrida C, Narbone G, et al. Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts. Eur Rev Med Pharmacol Sci. 2010 Jan;14(1):25-30.[Abstract]
51. Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55.
52. Brent J. Fomepizole for the treatment of pediatric ethylene and diethylene glycol, butoxyethanol, and methanol poisonings. Clin Toxicol (Phila). 2010 Jun;48(5):401-6.[Abstract]
53. Roberts DM, Aaron CK. Management of acute organophosphorus pesticide poisoning. BMJ. 2007 Mar 24;334(7594):629-34.[Abstract][Full Text]
54. Thomas C, Svehla L, Moffett BS. Sodium-nitroprusside-induced cyanide toxicity in pediatric patients. Expert Opin Drug Saf. 2009 Sep;8(5):599-602.[Abstract]
55. Shepherd G, Velez LI. Role of hydroxocobalamin in acute cyanide poisoning. Ann Pharmacother. 2008 May;42(5):661-9.[Abstract]
56. Lheureux PE, Zahir S, Penaloza A, et al. Bench-to-bedside review: antidotal treatment of sulfonylurea-induced hypoglycaemia with octreotide. Crit Care. 2005;9(6):543-9.[Abstract][Full Text]
57. American College of Medical Toxicology. ACMT position statement: interim guidance for the use of lipid resuscitation therapy. J Med Toxicol. 2011 Mar;7(1):81-2.[Full Text]
58. Gosselin S, Hoegberg LC, Hoffman RS, et al. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning. Clin Toxicol (Phila). 2016 Dec;54(10):899-923.[Abstract][Full Text]
59. Baydala L; Canadian Paediatric Society. Position statement: inhalant abuse. Paediatr Child Health. 2010 Sep;15(7):443-54.[Abstract][Full Text]
60. Proudfoot AT, Krenzelok EP, Vale JA; American Academy of Clinical Toxicology, European Association of Poisons Control Centres and Clinical Toxicologists. Position paper on urine alkalinization. J Toxicol Clin Toxicol. 2004;42(1):1-26.[Abstract][Full Text]
61. American Academy of Clinical Toxicology, European Association of Poisons Control Centres and Clinical Toxicologists. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. J Toxicol Clin Toxicol. 1999;37(6):731-51.[Abstract][Full Text]
62. Al-Taweel D, Koshy S, Al-Ansari S, et al. Expert consensus for a national essential antidote list: e-Delphi method. PLoS One. 2022 Jun 16;17(6):e0269456.[Abstract][Full Text]
63. World Health Organization. World report on child injury prevention. 2008 [internet publication].[Full Text]
Key Articles
Other Online Resources
Referenced Articles
Sign in to access our clinical decision support tools