Pediatric clinics of North America
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Pediatr. Clin. North Am. · Apr 1986
ReviewThe alcohols: ethanol, methanol, isopropanol, ethylene glycol.
More than 6 per cent of poisonings involve alcohols and glycols, reflecting their availability in a wide range of household products, including aftershave, brake fluid, gas line antifreeze, model airplane fuel, mouthwash, rubbing alcohol, and windshield washing solution. Diagnosis involves recognition of an osmolal gap and variable degrees and delays in development of an anion gap metabolic acidosis. Therapeutic modalities are similar for methanol and ethylene glycol, both cases requiring ethanol-blocking of alcohol dehydrogenase and hemodialysis. More often, treatment of ethanol and isopropanol poisoning is limited to supportive care.
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Gastric decontamination remains an important element in the therapy of pediatric poisoning; however, several issues remain unresolved. Additional studies, particularly in the clinical setting, are necessary to establish optimal therapeutic recommendations. Based on the data presented in this review, the following general recommendations can be made for gastric decontamination in children: If it is necessary to remove an ingested toxin, ipecac syrup is the preferred method if contraindications to its use are not present. ⋯ Patients with significant symptoms from ingestion requiring hospitalization should receive repeat doses of charcoal and cathartic until symptoms resolve. Activated charcoal should be given in conjunction with other appropriate therapies. Although the data to substantiate this recommendation are limited, particularly in pediatric patients, it is a benign therapy that holds promise of increasing drug elimination.