REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)
Organophosphate Toxicity - StatPearls (NCBI Bookshelf NBK470430) - https://www.ncbi.nlm.nih.gov/books/NBK470430/
Almost every childhood ingestion in Cairo is kerosene, a pesticide, or something from the family's own medicine shelf, and each of those three is a different emergency. What follows is how to tell them apart and what must not be done on the way to hospital.
- NEVER MAKE THE CHILD VOMIT, AND NEVER WASH THE STOMACH OUT. Neither appears anywhere in the cached articles as treatment, and the charcoal article gives the reason vomiting is itself the danger: what comes back up can go into the lungs, and the pneumonitis that follows is the gravest of the risks. Inhaled material - from vomit, or from a nasogastric tube misplaced while giving charcoal - can wreck breathing badly enough to kill. Salt water, milk and finger-in-the-throat all end in the lungs.
- KEROSENE AND SOLVENTS ARE A LUNG PROBLEM, NOT A STOMACH PROBLEM - the charcoal article contraindicates it wherever giving it would make inhalation more likely or more severe, and names hydrocarbons that are readily inhaled as exactly that case. A child who has swallowed kerosene, paraffin, petrol, thinner or lamp oil is sent to hospital and given nothing by mouth.
- PESTICIDES - THE SMELL AND THE PUPILS GIVE IT AWAY. The usual picture is pinpoint pupils, heavy sweating and difficulty breathing. Some organophosphates carry a smell of garlic or of petroleum that points to the diagnosis.
- THE PESTICIDE SIGNS, IN THE ARTICLE'S OWN MNEMONIC - D for defecation and sweating, U for passing urine, M for pinpoint pupils, B for wheeze and a wet chest, E for vomiting, L for watering eyes, S for drooling; and on the nicotinic side, wide pupils, a fast pulse, weakness, a high blood pressure and muscle twitching.
- AND PESTICIDE POISONING KILLS THROUGH THE CHEST - death, where it comes, comes from respiratory failure: the airways tighten and fill with secretions, the drive to breathe is depressed centrally, and the breathing muscles weaken or stop altogether.
- UNDRESS AND WASH THE CHILD, AND PROTECT YOURSELF WHILE DOING IT - take off everything the child is wearing and dispose of it, then clean the skin with soap and water, and do that 3 times. Handle vomit and diarrhoea with care, since the pesticide is present in them too. None of this may delay getting the child treated.
- ATROPINE IS THE PESTICIDE ANTIDOTE AND IT IS GIVEN IN HOSPITAL - the article notes a hospital may get through very large amounts of it, running into hundreds of milligrams. It also describes a diagnostic trial: if the child improves after 0.6 mg to 1 mg of atropine, that points towards poisoning by a cholinesterase inhibitor. Those are resuscitation-room numbers.
- PARACETAMOL - A CHILD WHO LOOKS COMPLETELY WELL MAY STILL BE POISONED. Most children who have taken too much have no symptoms at first, or nothing beyond nausea and vomiting. The article's first stage covers the 30 minutes to 24 hours after the dose, and may be silent throughout. Looking well on the first day is the rule, not reassurance.
- HOW MUCH PARACETAMOL IS TOO MUCH - one dose of 150 mg/kg is the threshold for toxicity, and 200 mg/kg the figure the article gives in an otherwise healthy child aged 1 to 6. For comparison it puts the safe dose at 10 to 15 mg/kg a dose, every 4 to 6 hours, with a ceiling of 75 mg/kg in a day.
- THE PARACETAMOL ANTIDOTE IS TIME-CRITICAL - acetylcysteine, usually intravenous, is the antidote that matters in paracetamol poisoning, and it works best started inside the first 8 hours of an acute overdose. The blood paracetamol level is taken 4 hours after the ingestion. Waiting to see whether the child becomes unwell wastes the window.
- IF NOBODY KNOWS WHEN IT WAS TAKEN, THE HOSPITAL TREATS ANYWAY - where the poison went down more than 8 hours before arrival, acetylcysteine is given empirically; where the timing is simply unknown, it is started straight away and the blood tests follow.
- SEND THE CONTAINER WITH THE CHILD. The paracetamol article stresses a detailed history - exactly when, which preparation, how much, and what else was swallowed alongside it - and the bottle answers all four questions faster than a frightened parent can.
- AND IT IS WORTH PHONING AHEAD - the charcoal article suggests it is reasonable to speak to a regional toxicologist or a poison control centre before starting repeat-dose treatment.
- PREVENTION IS THE PART A CLINIC CAN ACTUALLY CHANGE - the paracetamol article records that 50% of cases are accidental overdoses, and draws from that a need for clinicians to teach patients how the drug is dosed and how many preparations, prescribed and over-the-counter, already contain it. Kerosene kept in a soft-drink bottle under the sink is the Egyptian version of the same failure.