Emergency Department, ICU and Inpatient Clinical Pathway
for Children with Known or Presumed Toxic Ingestion
Child with suspected or known toxic ingestion
Notify Poison Control Center (PCC)
1-800-222-1222
1-800-222-1222
Critically Ill
- NPO, IV access, POC glucose
- Administer naloxone, antidotes and medications as indicated
- ECG, serum studies, imaging as indicated
- Collect appropriate urine studies
- Indications for decontamination, enhanced elimination, hemodialysis
ED Team Assessment
- Primary Survey ABCDE
- Consider naloxone
- History and Physical
- Identify Ingestion Red Flags
Testing Guidance
Ingestion Red Flags
- Intentional ingestion
- Ingestion of substances lethal at low doses
- Polysubstance Ingestions
- Arrhythmia on ECG
Asymptomatic
and
No Ingestion Red Flags
and
No Ingestion Red Flags
Symptomatic
or
Asymptomatic with Ingestion Red Flags
or
Asymptomatic with Ingestion Red Flags
- Consider
- POC glucose
- ECG
Ingestion with intent to self-harm
or
Symptoms not consistent with expected toxidrome and substance effects
or
Symptoms not consistent with expected toxidrome and substance effects
- Consider PCC consult
- Consider
- Testing as clinically indicated
- Consult PCC
- Obtain
- Review Urine Test Selection Guide
- Testing as clinically indicated
Management
- Supportive Care
- Decontamination, GI, topical and ocular
- Enhanced Elimination
- Antidotes and Medications
- Consult Social Work for all ingestions
- Considerations for Childline report, Suspected Child Abuse and Neglect (SCAN) Consult
- Behavioral Health Consult Indications
Discharge or admit as clinically indicated
Evidence
- The Poisoned Pediatric Patient
- Acute Poisoning: Understanding 90% of Cases in a Nutshell
- Toxidromes
- Pediatric Toxicology: Specialized Approach to the Poisoned Child
- Urine Drug Screening: Practical Guide for Clinicians
- False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review
- THC Ingestions and Child Protective Services: Guidelines for Practitioners
Educational Media
- CHOP Poison Control Center: Common Exposures
- Introduction to Medical Toxicology: Acute Pediatric Poisonings—PEM Core Curriculum
CHOP Program
