History & poison identification (Substance, dose, time, intent, co-ingestants, formulation (SR/EC); product containers; consult poison center databases — most pediatric poisonings are benign with supportive care (AAP, EAPCCT))
Max 50 mg/dose · Duration: Single dose · **1 g/kg PO/NG** (max **50 g**) within 1 h of ingestion — up to 2 h for some agents; NOT corrosives, petroleum distillates alone, or unprotected airway with GCS ↓; consult poison center (AAP, EAPCCT, TOXBASE)
• **Poison center consultation:** all significant ingestions/exposures in children; unknown substance; symptomatic patient; need for antidote, decontamination, or enhanced elimination guidance; social/safeguarding concerns (AAP, EAPCCT, national poison control).
• **Labs when indicated (not routine tox screen):** paracetamol level at 4 h if unknown ingestion possible; salicylate, iron, lithium, ethylene glycol/methanol if suspected; VBG/ABG, glucose, electrolytes, co-oximetry (methemoglobin), osmol gap as clinically directed (AAP, TOXBASE).
• **Route-specific care — ingestion:** activated charcoal if appropriate; antidote per substance; observation period per poison center; **inhalation:** remove from source, 100% O₂, CO/cyanide consider (see **Smoke Inhalation** card); **dermal:** remove clothing, wash with water, protect staff from contamination; **ocular:** irrigate 15–20 min with NS/LR, check pH, ophthalmology if caustic (AAP, WHO, EAPCCT).
• **GI decontamination — activated charcoal:** within **1 h** (up to 2 h for some agents); dose **1 g/kg** (max **50 g**); NOT for corrosives, hydrocarbons alone, or reduced GCS without airway protection (AAP, EAPCCT, TOXBASE).
• **Discharge criteria:** asymptomatic, low-risk exposure, appropriate observation period elapsed, reliable caregivers, poison center agreement, return precautions documented (AAP, WHO).
Duration: As indicated · Admit symptomatic patients, antidote infusions, extended-release ingestions, social concerns — discharge when asymptomatic and observation complete per poison center (AAP, WHO, EAPCCT)
• **Hospital admission:** symptomatic poisoning; need for antidote infusion (e.g. NAC); extended-release or enteric-coated ingestion requiring prolonged observation; electrolyte/metabolic abnormalities; social/safeguarding concerns; unreliable follow-up (AAP, WHO, EAPCCT).
• **Gastric lavage:** rarely — life-threatening dose ingested **<1 h** AND charcoal insufficient; contraindicated for corrosives and petroleum distillates; risk outweighs benefit in most cases (AAP, EAPCCT, TOXBASE).
• **Whole bowel irrigation (WBI):** iron, slow-release, enteric-coated packet ingestions — polyethylene glycol via NG until clear rectal effluent; consult poison center (AAP, EAPCCT).
• **Antidotes — general principles:** use specific antidote when available (NAC for paracetamol, naloxone for opioids, atropine for organophosphates, etc.) — **consult poison center** for substance-specific guidance; do not delay NAC for charcoal in paracetamol if both indicated (AAP, TOXBASE, EAPCCT).
• **Enhanced elimination (brief):** multiple-dose charcoal for carbamazepine, phenytoin, theophylline, digoxin; hemodialysis for methanol, ethylene glycol, severe salicylate, lithium, severe valproate — poison center/PICU referral (AAP, EAPCCT).
Clinical notes
• ABCDE first: treat life-threatening toxidromes before identification; remove ongoing exposure; consult poison center for all significant pediatric exposures (AAP, WHO, EAPCCT).
• Labs: targeted only — paracetamol at 4 h if unknown ingestion; avoid routine comprehensive tox screen; glucose, electrolytes, VBG as indicated (AAP, TOXBASE).
• Activated charcoal 1 g/kg (max 50 g) within 1 h — not for corrosives, hydrocarbons alone, or reduced GCS without airway protection (AAP, EAPCCT).
