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The
pattern of accidental drug poisoning in children
..........................................................................................................................
Murad Massadeh, MD
From the department of pediatrics, Princess Haya
hospital, Royal Medical services
Address correspondence to:
Dr. Murad
Massadeh
Department of pediatrics, Princess Haya Hospital,
Aqaba, Jordan
E-mail: muradmassadeh@yahoo.com
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ABSTRACT
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Objectives:
To
review the pattern of drug poisoning in
children in regard to age, sex and type
of drug ingested, and the circumstances
that lead to poisoning which, hopefully
lead to fruitful conclusions.
Methods:
This is a retrospective study that involved
all children who were admitted to pediatric
ward or the intensive care unit at Pprincess
Hhaya military hospital as cases of drug
non- deliberate poisoning. The studied group
involved children aged below 14 years, during
the period from 2004 to 2006. All cases
were reviewed and studied referring to their
medical records.
Results:
The data showed that, the majority of cases
occurred in children between the age group
1-6 years;, males recorded a higher rate
than females. Acetaminophen was the most
frequently ingested drug. No fatality as
well, was recorded. The only case which
was registered to be deliberate self harm
was excluded from the study.
Conclusion:
Drug poisoning
is a major health problem; prevention should
involve a multidisciplinary approach including
family education, particularly the seriousness
of drug poisoning and the preventive measures
that should be taken. A national poison
center is crucial, that could conduct further
valuable studies in collaboration with other
medical authorities.
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Key
words:
Accidental drug poisoning, children, risk factor
..........................................................................................................................
With
the explicit stretching of health services in
Jordan provided by different health provisions,
one expects an escalated risk of drug poisoning
due to increased availability (1), A rich medical
literature surrounding this issue is found.
Poisoning per se is considered to be a common
medical emergency in childhood particularly in
the preschool age group worldwide (2); the severity
and frequency of poisoning is reduced by different
preventive measures, however, we still need more
effective and safer means of prevention as well
as treatment (3).
Given the lack of poisoning
incidents registry in this hospital, the author
retrospectively collected and reviewed all medical
records of children who were diagnosed and admitted
as cases of drug poisoning to princess Haya military
hospital in Aqaba - a city south of Jordan, with
a population of around 200,000 - during the period
from February 2004 to February 2006. All cases
were admitted to the pediatric ward or intensive
care unit.
Age, sex, type of drug ingested,
and history of the circumstances that lead to
poisoning were recorded. Toxicological screenings
of blood or urine were not executed. The study
excluded cases of poisoning caused by all other
substances. Munchausen's by proxy syndrome and
subjects above 14 years of age were also excluded
(hospital policy regards pediatric age group as
up to 14 year of age).
The sample involved a total
of 56 children (n=56). Thirty-two (57%) of them
were males and twenty four (43%) were females.
Male: female ratio was 1.3:1 .The youngest child
in the studied sample was aged 10 months, while
the eldest aged 13 years. However the proportion
of age groups within the sample varied, most of
the cases occurred in younger age group, the commonest
age group was that aged less than six years n=
44 (78.5%), while the older age group from eleven
to fourteen years constituted the least n= 3 (5%),
Table 1.
It was also found that Acetaminophen
was the most frequent drug involved accounting
for (12.5%) of cases ,which is comparable to the
findings in studies done worldwide (2,4,5) , to
be followed by different antibiotics (10.7%) and
antihistamine preparations (7.1%) . Aminophlline
recorded the least in the list, Table
2.
The average hospital stay was
one to three days. Only two cases were rushed
to the intensive care unit due to their critical
condition. No deaths were recorded.
The proportion
of such medical emergencies in the pediatric hospital
admissions in our retrospective study reached
3.7%, despite the fact that this study dealt with
poisoning due to drugs only while most literature
focused on poisoning due to medicinal and non-medicinal
agents. However, such conditions seem to be major
health issues as the incidence sequalae, are considered
to be quite high (6).
The highest risk age group in our sample was found
to be those aged less than six years, which is
globally agreed upon in regard to poisoning by
different agents. (2, 4, 7) Most researchers thought
that such findings could be attributed to the
exploratory nature of the developmental stage
in this age group (1, 8).
One
point of interest is the temptation of the flavoring
additives, the coloring, and the attractive smell
that some children may think drugs are candies.
(9) Some parents prompt resentful children to
take medications, telling them that it is a delicious
candy (8). Most
medications are unfortunately dispensed in non
child-proof containers, a fact that should be
considered with care in future.
The author believes such explanations
are applicable in this study sample. Other factors
are also important, such as the easy reach children
have to medications, leaving children unattended
for a relatively long period of time, availability
of medications, the improvement of medical services
and coverage of larger groups of populations that
made drugs more available.
Some researchers found the
family size to be a determinant factor in increased
risk of incidence (8), a similar finding applied
to this study. This study found that 57.1% of
children came from large sized families (five
or above).
The author couldn't find any
particular data in regard to the family circumstances
passed through (pregnant mother, death of a family
member, divorce, new comer, illness of a sibling,
change of residence etc, that may increase the
incidence of accidental poisoning, while some
researchers did find so (10 ,11).
The educational level of the
caregivers (8) and the presence of an adult with
chronic medical illness within the family (7)
that may be considered as risk factors were not
studied by the author which was a limitation of
this study.
As formerly mentioned, analgesic,
antipyretic and antibiotic preparations were incriminated
to be the commonest causative drugs; they seem
to be the most dispensed medications to children
given the fact that infectious conditions are
common and unfortunately, as the author believes,
some physicians tend to over prescribe antibiotics.
The relative ease in reaching
emergency services enabled such condition to be
handled early, Most cases reached casual\ty within
less than two to three hours after the ingestion
of the drug and only two cases warranted ICU admissions.
Despite the fact that the study wasn't primarily
interested in methods of parent's discovery of
poisoning, most cases were discovered accidentally
i.e. lips or clothing soiled with treatments,
empty or reduced amount in medication containers,
presence of child witness,etc. Less commonly children
were discovered after developing significant features
of poisoning.
Accidental drug poisoning in
children is conspicuously a crucial health concern
to all health workers and pediatricians in particular,
pharmacy industry and lay community. There has
been a generous medical literature concerning
preventive and safety measures surrounding this
issue. The author believes that adoption of such
measures should be continuously refined see Box
1.Further in-depth studies will add more to our
knowledge and alertness.
The
author is aware that the national poison control
center has been recently established in Jordan,
affiliated to Jordan University Hospital,
however, this centre needs to be more advocated
to refer to expert advice and collaboration.
Safety measures:
- Keep all medications in
a secure cabinet out of reach of children and
use Child-resistant proof containers
- Keep medications in the
original containers and discard all residual
or expired drugs.
- Never interchange dosages
among different drugs.
- Avoid calling drugs candies.
- Education of parents and
lay community, pediatricians, family doctors,
and GP's awareness.
- Don't take your medications
in front of children.
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Table 1. Non-deliberate
drug poisoning according to age
groups.
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Age
(years)
|
Male
n
|
Female
n
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Total
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n
|
%
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<1
|
3
|
2
|
5
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(8.9%)
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|
1-3
|
11
|
7
|
18
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(32%)
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|
4-6
|
12
|
9
|
21
|
(37.5%)
|
|
7-10
|
5
|
4
|
9
|
(16%)
|
|
11-14
|
1
|
2
|
3
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(5.3%)
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Table
2.
Drugs involved in nondeliberate
poisoning:
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Drug
|
n
|
%
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Acetaminophen
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7
|
12.5
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Antibiotic
|
6
|
10.7
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Antihistamine
|
5
|
8.9
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Vitamin preparation
|
5
|
8.9
|
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Anticonvulsant
|
4
|
7.1
|
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Ibuprofen
|
4
|
7.1
|
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Cough preparation
|
4
|
7.1
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Oral hypoglycemic agent
|
3
|
5.3
|
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Antidepressant
|
3
|
5.3
|
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Antihypertensive
|
3
|
5.3
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Iron
|
3
|
5.3
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Benzodiazepine
|
2
|
3.5
|
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Cardiac drugs
|
2
|
3.5
|
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Topical agent
|
2
|
3.5
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Salbutamol
|
2
|
3.5
|
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Aminophylline
|
1
|
1.7
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- Izuora G, Adebowale Adeoye. A seven -year
review of accidental poisoning in children at
a military hospital in hafr albatin, Saudi Arabia.
Ann Saudi Med 2001; 21(1-2):13-15.
- Andiran N, Sarikayalar F. Patterns of acute
poisoning in childhood in Ankara: what has changed
in twenty years? .The Turkish Journal of Pediatrics
2004; 46: 147-152.
- Shannon M. Ingestion of toxic substances
by children. The New England Journal of Medicine
2000; 342(3):186-191.
- Lawrence T Lam. Childhood and adolescence
poisoning in NSW, Australia: an analysis of
age, sex, geographic, and poison type. Injury
Prevention 2003; 9:338-342.
- Mintegis S, Fernandez A, Alustiza J, Canduela
V, et la. Emergency visit for childhood poisoning:
a2 -year prospective multicenter survey in Spain.
Pediatric Emergency Car 2006 may; 22(5):334-338.
- AL-Hazmi AM. Pattern of accidental poisoning
in children in Jeddah. Ann Saudi Med 1998; 18:457-459.
- Burt A, Annest JL, Ballesteros MF, Budnitz
DS.Nonfatal, unintentional medication exposures
among young children-united states, 2001-2003:
a report from the center for disease control
and prevention. JAMA 2006; 295:882-884.
- Chatsantiprapa K, Chokkanapitak J, Pinpradit
N. Host and environment factor for exposure
to poisons: a case-control study of preschool
children in Thailand. Injury Prevention2001;
7:214-217.
- Wilkerson R, Northington L, Fisher W. Ingestion
of toxic substances by infant and children,
what we don't know can hurt. Critical Care Nurse
2005; 25:35-44.
- Juurlink D.N, Tenenbein M, koren G, Redelmeier
D.A. Iron poisoning in young children: association
with the birth of a sibling. Canadian Medical
Association Journal 2003; 168:1539-1542.
- Sibert R. Stress in families of children
who have ingested poisons. BMJ 1975; 3(5975):87-9.
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