CHAPTER 74
Innocuous Ingestions
Presentation
Frightened parents call or arrive in the ED or clinic with a 2-year-old child who has just swallowed some household product, such as laundry bleach.
What To Do:
Establish exactly what was ingested (have them locate the package or container and have them bring in a sample, if possible), how much was ingested, and how long ago it occurred, as well as any symptoms and treatment so far. It is essential to gather as much information as possible from emergency medical services, bystanders, babysitters, and parents about all of the agents to which the patient might have been exposed.
If there is any question about the substance, its toxicity, or its treatment, call the regional poison control center (see Appendix G). In fact, it is a good policy to call the regional poison center, even if you are completely comfortable managing the case, so that they can record the ingestion for epidemiologic purposes.
If there is any question of this being a toxic ingestion, follow the instructions of the regional poison center.
Reassure the parents and child, and instruct them to call or return to the ED if there are any problems. Teach parents how to keep all poisons beyond the reach of children and how to call the regional poison center first for any future ingestion(s).
What Not To Do:
Do not totally believe what is told about the nature of the ingestion. Often some of the information immediately available is wrong. Suspect the worst.
Do not depend on product labels to give you accurate information on toxicity. Some lethal poisons carry warnings no more serious than “use as directed” or “for external use only.”
Do not follow the instructions on the package regarding what to do if a product is ingested. These are often inaccurate or out of date.
Do not automatically give ipecac for emesis. Follow the recommendation of your regional poison center.
Do not improvise treatment of a patient referred by the regional poison center. He probably has special information and a treatment plan to share, if he has not called already.
Discussion
Fortunately, most products designed to be played with by children are also designed to be nontoxic when ingested. This includes chalk, crayons, ink, paste, paint, and Play-Doh. Many drugs, such as birth control pills and thyroid hormone, are relatively nontoxic, as are most laundry bleaches, the mercury in thermometers, and many plants.
However, some apparently innocuous household products are surprisingly toxic, including camphorated oil, cigarettes, dishwasher soap, oil of wintergreen, and vitamins with iron. Because the ingredients in common products and the treatment of ingestions continue to change, broad statements and lists are not reliable. The best strategy is always to call the regional poison center (see Appendix G).
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