By Dr. Rhonda Hutson, ContributorA POISON is a substance which, in small amounts, can cause damage to the structure and/or function of the body. The poison may be ingested, inhaled or absorbed from the skin. Examples of poisons include insecticide and rat poison. These are easily recognised as poisons but there are substances, such as medications, which are not classified as poisons but can be dangerous when taken in high doses. Acetaminophen (paracetamol), a medication used to treat fever and pain, can cause serious damage to the liver if taken in large quantities.
Poisoning in adults is usually intentional while in children the majority of cases are accidental. Male children between the ages of one and three years old are more vulnerable to accidental poisoning. This is the age at which most children begin to explore their environment. Studies throughout the Caribbean, including Jamaica, show that improper handling and poor storage of toxic substances account for the majority of accidental poisoning in children. A common contributing factor is lack of adult supervision.
DRINKING KEROSENE
Children commonly ingest prescribed medications such as anti-hypertensives and drugs used to treat diabetes mellitus. Studies done at the Bustamante Hospital for Children reveal that kerosene is the most commonly ingested toxic substance. Though this form of poisoning has declined elsewhere in the Caribbean, it remains a significant cause of poisoning in children in Jamaica.
Kerosene is a hydrocarbon which is poorly absorbed by the stomach and gastrointestinal tract (gut). It exerts its toxic effects mainly on the lungs, where it causes a chemical pneumonitis (inflammation). Other effects include burning of the mouth and oesophagus (gullet), resulting in scarring that may require extensive surgery to treat. Death can occur from the respiratory complications resulting from the pneumonitis.
Organophosphate insecticides, such as those used in farming and some household insect sprays, can cause excessive sweating, diarrhoea, production of large amounts of fluid in the lungs, seizures (fits), coma and death. Rat poison typically causes bleeding that may lead to death. Bleach is a common household substance ingested by young children. Usually, the dose is no more than a teaspoon and typically will not cause serious damage. In large quantities, and in the case of industrial strength bleach, a great deal of damage can be done to the throat, upper airway and oesophagus.
A child suspected of ingesting a known poison must be taken immediately to a hospital. Early features can include vomiting, coughing, drowsiness and seizures. In cases where none of these symptoms are present, some milk or juice may be given to the child in an attempt to dilute the poison.
Caregivers should refrain from causing vomiting by sticking the fingers at the back of the child's throat. Oftentimes, this action may cause additional damage that can complicate the child's condition and possibly treatment. This is especially true for kerosene ingestion, as vomiting can cause the kerosene to get into the lungs. Where a liquid or powder has touched the skin or clothing, all the clothing should be removed and the child washed off with running water. In all cases of accidental ingestions or exposure, the containers in which the substance was held should also be taken to the hospital.
LOCK POISONS AWAY
Preventing a child from having access to poisons and potentially dangerous medications is always the best form of treatment. All known poisons such as insecticides and rat poison should be locked away. Unfortunately, despite many pleas against the practice, many persons continue to store kerosene and other toxic liquids in juice boxes and soda bottles. These items are attractive to toddlers who will easily put them to their mouths.
Read medicine labels carefully and give only the recommended dose. All medications must be kept away from children, even if the medication is for the child. As much as possible a child should be educated about substances which are considered dangerous, especially if it is to be stored in the house. However, it is important to understand that simply telling a child about possible dangers and instructing him or her not to touch it, is not enough. Toddlers should never be left alone. It takes only a few seconds for a child to swallow a poison or spill liquids.
Do not hesitate to take a child for evaluation, even in uncertain cases. It is better that the child be observed in a controlled environment than at home where prompt medical attention may not be available.
Dr. Rhonda Hutson, DM (Emerg. Med)
