Innocuous Ingestions

6.04 Innocuous Ingestions

Presentation
Frightened parents call or arrive in the emergency room with a two- year-old child who has just swallowed some household product.
What to do:



Establish exactly what was ingested (have them locate the container or bring in a sample if possible), how much, how long ago, as well as any symptoms and treatment so far.



If there is any question about the substance, its toxicity, or its treatment, call the regional poison control center. In fact, it is a good policy to call the regional poison center even if you are completely comfortable managing the case, so that they can record the ingestion for epidemiologic purposes.



If there is any question of this being a toxic ingestion, give the child syrup of ipecac, 15ml po, followed by one glass of water, and expect to see emesis in 20-40 minutes.



Reassure the parents and child, and instruct them to call or return to the ED if there are any problems. Teach parents how to keep all poisons beyond the reach of children; how to get syrup of ipecac for home use (at any pharmacy, without a prescription, for $1-$2) and how to call the regional poison center first for any future ingestions.



Do not totally believe what you're told about the nature of the ingestion. Often some of the information immediately available is wrong. Suspect the worst.



Do not depend on product labels to give you accurate information on toxicity. Some lethal poisons carry warnings no more serious than "use as directed," or "for external use only."



Do not follow the instructions on the package regarding what to do if a product is ingested. These are often inaccurate or out-of-date.



Do not give ipecac for emesis of liquids that are corrosive or toxic only when aspirated, such as hydrocarbons.



Do not improvise treatment of a patient referred to you by the regional poison center. They probably have special information and a treatment plan to share with you, if they have not called already.
Discussion
Fortunately, most products designed to be played with by children are also designed to be non-toxic when ingested. This includes chalk, crayons, ink, paste, paint, and Play-Doh. Many drugs, such as birth control pills and thyroid hormone, are relatively non-toxic, as are most laundry bleaches, the mercury in thermometers and many plants. On the other hand, some apparently innocuous household products are surprisingly toxic, including camphorated oil, cigarettes, dishwasher soap, oil of wintergreen, and vitamins with iron. Because both the ingredients of common products and the treatment of ingestions continue to change, broad statements and lists are not reliable. Your best strategy is always to call the regional poison control center.