Pediatric poisoning management: How clinical practice can benefit from forensic approach.
biological specimen
diagnostic algorithm
diagnostic workup
drug intoxication
pediatric accidental poisoning
toxicology
Journal
Journal of forensic sciences
ISSN: 1556-4029
Titre abrégé: J Forensic Sci
Pays: United States
ID NLM: 0375370
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
revised:
21
03
2024
received:
28
02
2024
accepted:
25
03
2024
medline:
1
4
2024
pubmed:
1
4
2024
entrez:
1
4
2024
Statut:
aheadofprint
Résumé
Pediatric population represents the most vulnerable and at risk for unintentional poisoning, with children younger than 6 years old accounting for nearly half of poison exposures. Poisoning is a time-dependent emergency. The need to reach a scientific agreement on diagnostic protocol and treatment seems to be crucial to reduce morbidity and mortality. Starting from a buprenorphine pediatric intoxication case, this article highlights the limits and pitfalls of the traditional diagnostic approach. Diagnosis of drug intoxication was achieved after several days when an in-depth diagnostic investigation became necessary and complete forensic toxicological analyses were performed. Results evidenced an alarming lack of an unequivocal diagnostic protocol in case of suspect intoxication in structures not provided with a forensic toxicological service/unit. Collection of biological specimens according to forensic protocols at hospitalization plays a paramount role in the definitive diagnosis of intoxication. A diagnostic algorithm that focuses on medical history and biological specimen collection timing is herein proposed, in order to unify emergency approaches to the suspected poisoned child.
Identifiants
pubmed: 38558455
doi: 10.1111/1556-4029.15517
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 American Academy of Forensic Sciences.
Références
WHO World Health Statistics. Monitoring health for the SDGs. 2023 Sustainable Development Goals 2023. Accessed October 03, 2023. Available from: https://www.who.int/publications/i/item/9789240074323
Madden MA. Pediatric toxicology: emerging trends. J Pediatr Intensive Care. 2015;4:103–110. https://doi.org/10.1055/s‐0035‐1556753
National Capital Poison Center. 2001. Accessed October 03, 2023. Available from: https://www.poison.org/poison‐statistics‐national
WHO, Peden M, Oyegbite K, Ozanne‐Smith J, Hyder AA, Branche C, et al. (Eds.)World report on child injury prevention. 2008 Accessed October 03, 2023. Available from: https://apps.who.int/iris/handle/10665/43851
Taft C, Paul H, Consunji R, Miller T. Childhood unintentional injury worldwide: meeting the challenge. Washington, DC: Safekids Worldwide; 2002 Accessed October 03, 2023. Available from: http://www.safekids.org/pdf/WW‐Study‐Ltr.pdf
Avau B, Borra V, Vanhove AC, Vandekerckhove P, De Paepe P, De Buck E. First aid interventions by laypeople for acute oral poisoning. Cochrane Database Syst Rev. 2018;12:CD013230. https://doi.org/10.1002/14651858.CD013230
Calello DP, Henretig FM. Pediatric toxicology: specialized approach to the poisoned child. Emerg Med Clin North Am. 2014;32:29–52. https://doi.org/10.1016/j.emc.2013.09.008
Osterhoudt KC. The lexiconography of toxicology. J Med Toxicol. 2006;2:1–3. https://doi.org/10.1007/BF03161004
Bacha T, Tilahun B. A cross‐sectional study of children with acute poisoning: a three‐year retrospective analysis. World J Emerg Med. 2015;6(4):265–269. https://doi.org/10.5847/wjem.j.1920‐8642.2015.04.003
Madden MA. Pediatric poisonings: recognition, assessment, and management. Crit Care Nurs Clin North Am. 2005;17:395–404. https://doi.org/10.1016/j.ccell.2005.07.004
Hauptman M, Woolf AD. Childhood ingestions of environmental toxins: what are the risks? Pediatr Ann. 2017;46:e466–e471. https://doi.org/10.3928/19382359‐20171116‐01
Funk RS, Brown JT, Abdel‐Rahman SM. Pediatric pharmacokinetics: human development and drug disposition. Pediatr Clin N Am. 2012;59:1001–1016. https://doi.org/10.1016/j.pcl.2012.07.003
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. 2018 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th annual report. Clin Toxicol (Phila). 2019;57:1220–1413. https://doi.org/10.1080/15563650.2019.1677022
Bond GR, Woodward RW, Ho M. The growing impact of pediatric pharmaceutical poisoning. J Pediatr. 2012;160:265–270.e1. https://doi.org/10.1016/j.jpeds.2011.07.042
Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatric deaths from prescription and illicit opioids, 1999‐2016. JAMA Netw Open. 2018;1:e186558. https://doi.org/10.1001/jamanetworkopen.2018.6558
Ross JA, Eldridge DL. Pediatric toxicology. Emerg Med Clin North Am. 2022;40:237–250. https://doi.org/10.1016/j.emc.2022.01.004
Elsohly MA, Gul W, Feng S, Murphy TP. Hydrolysis of conjugated metabolites of buprenorphine II. The quantitative enzymatic hydrolysis of norbuprenorphine‐3‐β‐d‐glucuronide in human urine. J Anal Toxicol. 2005;29:570–573. https://doi.org/10.1093/jat/29.6.570
Seldén T, Roman M, Druid H, Kronstrand R. LC‐MS‐MS analysis of buprenorphine and norbuprenorphine in whole blood from suspected drug users. Forensic Sci Int. 2011;209:113–119. https://doi.org/10.1016/j.forsciint.2011.01.011
Hayes BD, Klein‐Schwartz W, Doyon S. Toxicity of buprenorphine overdoses in children. Pediatr Dent. 2008;121:e782–e786. https://doi.org/10.1542/peds.2007‐1774
de Wildt SN, Kearns GL, Leeder JS, van den Anker JN. Cytochrome P450 3A: ontogeny and drug disposition. Clin Pharmacokinet. 1999;37:485–505. https://doi.org/10.2165/00003088‐199937060‐00004
Boyer EW, McCance‐Katz EF, Marcus S. Methadone and buprenorphine toxicity in children. Am J Addict. 2010;19:89–95. https://doi.org/10.1111/j.1521‐0391.2009.00002.x
Geib AJ, Babu K, Ewald MB, Boyer EW. Adverse effects in children after unintentional buprenorphine exposure. Pediatrics. 2006;118:1746–1751. https://doi.org/10.1542/peds.2006‐0948
Lo Re M, Chaplin M, Aronow B, Modesto‐Lowe V. Buprenorphine overdose in young children: an underappreciated risk. Clin Pediatr (Phila). 2019;58:613–617. https://doi.org/10.1177/0009922819829038
Franchitto N. Buprenorphine poisoning in children: a 10‐year experience of Marseille poison center. Fundam Clin Pharmacol. 2020;34:263–264. https://doi.org/10.1111/fcp.12547
von Fabeck K, Boulamery A, Glaizal M, de Haro L, Simon N. Buprenorphine poisoning in children: a 10‐year‐experience of Marseille poison center. Fundam Clin Pharmacol. 2020;34(2):265–269. https://doi.org/10.1111/fcp.12518