Emergency Department, ICU and Inpatient Clinical Pathway
for Children with Known or Presumed Toxic Ingestion
Child, any age, with known or
suspected toxic ingestion
suspected toxic ingestion
- Consider early Poison Control Center (PCC) consultation 1-800-222-1222
FLOC/RN Team Assessment
Primary Survey — Identify critical illness
Primary Survey — Identify critical illness
Critically Ill
- NPO, IV access, POC glucose, Consult PCC
- Administer naloxone, antidotes and medications, as indicated
- EKG, urine studies, serum studies imaging, as indicated
- Collect both CHOP and HUP Expanded Urine Studies
- Indications for decontamination, enhanced elimination, hemodialysis
- History
- Toxicology Physical Exam
- Evaluate for toxidrome, consider naloxone
- Substances Causing Nystagmus
- Odors and Causative Substances
- Identify Ingestion Red Flags
Toxic Ingestion Testing Guidance
Ingestion Red Flags
- Intentional ingestion
- Substances Lethal at Low Doses
- Polysubstance Ingestion
- Altered mental status
- Arrhythmia on EKG
Symptomatic
or
Asymptomatic with Ingestion Red Flags
or
Asymptomatic with Ingestion Red Flags
- Consider
- Early Save Our Specimen urine collection
- POC glucose
- EKG
Asymptomatic
and
No Ingestion Red Flags
and
No Ingestion Red Flags
Ingestion with intent of self-harm
or
Ingestion of unknown substance
or
Symptoms not consistent with expected toxidrome and substance effects
or
Ingestion of unknown substance
or
Symptoms not consistent with expected toxidrome and substance effects
- Consider PCC consult
- As clinically indicated
- Consider PCC consult
- Consider
- As clinically indicated
- Consult PCC
- Obtain
- Review Urine Test Selection Guide
- As clinically indicated
Management
- Supportive Care
- Toxicology therapies
- Screen for Social/Behavioral Concerns
- Social Work consultation, if concerns identified
- Indications for SCAN Consultation
- Behavioral Health Consult, as indicated
- Social Work consultation, if concerns identified
Disposition
- Identify appropriate admitting service
- Collect urine for a Save Our Specimen sample, if not previously collected
- Request Social Work consultation upon arrival to observation/inpatient unit
- Behavioral Health consult recommended for
- Intentional ingestions, regardless of stated intent to self-harm
- Known or suspected risk of alcohol, benzodiazepine or opioid withdrawal
Posted: October 2022
Last Revised: March 2024
Authors: M. Prieto, MD; C. Gaw, MD; F. Henretig, MD; H. Wolfe, MD; B. Chaiyachati, MD; C. Bennett, MD; C. Kerman, MD; K. White, MD; C. Cummings, MD; A. Grachen, PharmD; MK. Abbadessa, ACCNS-P; A. Koenigsberg, CRNP
Evidence
- The Poisoned Pediatric Patient
- Acute Poisoning: Understanding 90% of Cases in a Nutshell
- Toxidromes
- Pediatric Toxicology: Specialized Approach to the Poisoned Child
- Urine Drug Screening: Practical Guide for Clinicians
- False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review
Educational Media
- CHOP Poison Control Center: Common Exposures
- Introduction to Medical Toxicology: Acute Pediatric Poisonings — PEM Core Curriculum
CHOP Program