Çocuklarda Zehirlenmelere Genel Yaklaşım
Synopsis
Poisoning refers to the signs and symptoms occurring in the body following the intake of a harmful substance or a toxic level of a harmless substance. Being a common cause of emergency department admissions in childhood, poisonings constitute a disease group where mortality can be reduced through preventive measures, early diagnosis, supportive care, and etiology-specific treatment. Accidental poisonings are most common in children under 5 years of age, whereas suicide attempts and substance use predominate in those over 15 years, with drugs and cleaning agents being the most frequent causal agents. In the approach to a poisoned child, airway, breathing, and circulation (ABC) support, investigation of the toxic agent and its severity, decontamination, supportive care, and antidote administration must be conducted simultaneously. Following initial evaluation, the National Poison Advisory Center (UZEM - 114) should be contacted, and a detailed history as well as a physical examination addressing vital signs, characteristic odors, and toxidromes must be performed. Laboratory tests, ECG, and radiological imaging are utilized during the diagnostic process. Management involves controlling hypoglycemia, hypotension, seizures, and arrhythmias; in suitable cases, gastric lavage, activated charcoal, whole bowel irrigation, enhanced elimination methods (ionized diuresis, hemodialysis), specific antidotes, lipid emulsion therapy, and hyperinsulinemia/euglycemia therapy are administered. Severe cases presenting with central nervous system or respiratory depression, resistant hypotension, seizures, or arrhythmias require monitoring and treatment in the pediatric intensive care unit.
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