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Chapter-19 Poisoning

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

Author
1. Ramachandran P
2. Rajakumar PS
ISBN
9789352501977
DOI
10.5005/jp/books/12810_20
Edition
1/e
Publishing Year
2016
Pages
8
Author Affiliations
1. Madras Medical College and Institute of Child Health, Chennai, Sri Ramachandra University, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
2. Sri Ramachandra Medical College, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu
Chapter keywords
kerosene ingestion, scorpion sting, Leukocytosis, pneumonitis, Hemolysis, consumptive coagulopathy, central nervous system, Respiratory failure, viper bites, Renal failure, tachycardia, whole blood clotting test, systemic symptoms

Abstract

This chapter provides an overview of poisoning due to kerosene ingestion, scorpion sting and snakebite. Kerosene ingestion is diagnosed due to smell of kerosene. Leukocytosis occurs early unrelated to pneumonitis. Hemolysis, hemoglobinuria and consumptive coagulopathy rarely occur. Respiratory failure with or without central nervous system (CNS) disturbances or pulmonary edema should be aggressively treated with early ventilation, afterload reduction, careful sedation and acid-base correction during scorpion sting. First aid in snake bite includes reassuring the patient. 70% of all snakebites are from nonvenomous species. Most bites are dry bites. Immobilize in the same way as done for a fractured limb. Children can be carried. Use bandages or cloth to hold the splints. Do not apply any compression in the form of tight ligatures, they do not work and can be dangerous. Get to hospital immediately. Traditional remedies have no proven benefit in treating snakebite. Tell the doctor of any systemic symptoms such as ptosis or local swelling or bleeding that manifest on the way to hospital. Snakebite causes severe pain, it is managed with paracetamol. Support airway, breathing, circulation. Debridement or decompression may be needed in the presence of severe necrotic tissue or severe compartment syndrome. Bleeding is usually arrested by the use of ASV and only in severe persisting cases blood products are needed. Antibiotics are needed in the presence of severe local cellulitis. Renal failure is known to occur following viper bites requiring dialysis. 20-minute whole blood clotting test is the standard test for coagulopathy in snakebite. Twenty WBCT is useful in the initial diagnosis and monitoring during management with ASV. Urticaria, itching, fever, chills, nausea, vomiting, diarrhea, abdominal cramps, tachycardia, hypotension, bronchospasm and angioedema may be features of ASV reaction.

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