J Natl Med Assoc. 2008 Aug;100(8):952-6.
Hon KL, Ho JK, Hung EC, Cheung KL, Ng PC.
Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong Special Administrative Region, People’s Republic of
China. ehon@cuhk.edu.hk
INTRODUCTION: Childhood poisonings are common, but usually trivial, and
infrequently necessitate intensive care unit (ICU) admissions. METHODS: A
retrospective record review was conducted to analyze the pattern of severe
poisoning-associated ICU admissions at a teaching hospital between May 2002 and
December 2007. RESULTS: Six cases (4 boys and 2 girls, aged 2 months to 11 years)
of drug poisoning-associated ICU admissions were identified. Methadone was the
culprit in 3 boys and 1 girl, resulting in respiratory failure, depressed
conscious state and pinpoint pupils. As relevant exposure history was not
immediately apparent, diagnosis at the emergency department was only made
correctly in 2 patients. Phenobarbitone overdose occurred in 1 girl with past
history of phenobarbitone overdose as a clue. She was also considered to have
pinpoint pupils that were unresponsive to naloxone. Features consistent with
cholinergic toxidrome, including small pupils, and increased secretion occurred
in an infant fed with milk prepared with an herbal broth suspected to have been
adulterated with a pesticide. Atropine as an antidote was used when the child was
in the pediatric ICU. All children made an uneventful recovery following their
short ICU stay. CONCLUSIONS: Life-threatening poisonings requiring ICU support
can pose diagnostic difficulties and challenges to frontline medical officers at
the emergency department. Children from all age groups can be affected. Prompt
diagnosis is based on relevant history, careful clinical examination and a high
index of suspicion in patients known to be at risk. The pupillary size and its
reaction following treatment serves as an important diagnostic clue.