Severe Acute Poisonings in Childhood

Objective: The aim of the study is to define the incidence of severe acute poisonings in childhood presenting to the emergency room in Italian hospitals that contacted the Milan Poison Control Centre (MPCC) for toxicological advice in 2006 in order to estimate incidence, agents involved, course, treatment and outcomes. Methods: Using "CAVOL", the MPCC's database, we have analyzed all the clinical cases for which toxicological advice was requested due to severe acute exposure to toxic substances in childhood with "High Risk of admission to Intensive Care Unit". Results: We considered 101 clinical cases (n=101 equivalent to 0.45%) consistent with the criteria for inclusion in the study, from a total of 22,092 paediatric consults. During the study we have observed the involvement of agents pertaining to different categories such as drugs, household products, industrial and agricultural products, finding a peak of incidence connected with children aged from 1 to 4, due to accidental ingestion of single toxic agents, and from 15 to 17, due to intentional self-injury ingestion. In every age group, the exposure has been mostly accidental (n=69) and it has taken place above all due to ingestion (n=86) of single substances (n=87), drugs (n=84) and in a domestic environment (n=88). Decontamination has been carried out by gastric lavage and activated charcoal (n=58) or forced diuresis (n=14). Endotracheal intubation has been necessary in 22 patients and the use of vasoactive drugs in 5 patients. The outcome has been unknown in 4 cases; we have recorded complete recovery (n=89), gastric sequelae (n=5) in cases of caustic ingestions, death in 3 cases due to corticosteroids, amphetamines and hypoglycemic agent ingestions. Conclusion: Analyzing the literature (1,2) and the several cases collected, makes it imperative to act on prevention, information and optimization of treatment and on timely toxicological advice to improve the patients' outcome.