In this section
Poisoning – Acute guidelines for initial management Resuscitation Anticholinergic Syndrome
For 24 hour advice, contact Victorian Poisons Information Centre 131126
Clinical features of toxicity generally develop within 1-2 hours for immediate release preparations and 4-8 hours in sustained release. Symptoms are dose-dependent and monitoring drug concentrations can be helpful.
Clinical features include drowsiness, nausea and vomiting, anticholinergic effects, seizures, coma and life-threatening arrhythmias. Large carbamazepine ingestions can result in prolonged or delayed (>48hours) symptoms due to slow and erratic absorption due to the anticholinergic effects causing ileus and on-going absorption.
All children with deliberate self-poisoning or significant (>20mg/kg OR >20mg/kg greater than the child’s usual daily dose if on a regular dose) accidental ingestion. Any symptomatic child. Acute ingestion of unknown quantity. Any child where the developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.
Intentional overdose or accidental
Stated or likely dose taken
Presented as syrup, immediate or modified-release tablets
If possible determine the exact name and tablet size.
Calculate the maximum possible dose per kg
Co-ingestants e.g. paracetamol
Always check for Medicalert bracelet in any unconscious patient, or any other signs of underlying medical condition (fingerprick marks etc.)
Consider the possibility of co ingestions, either accidental or deliberate
ECG: (initially and repeat at 6 hours until normal).
Paracetamol concentration in all intentional overdoses
Children Requiring Treatment
Mild symptoms (e.g. ataxia, blurred vision)
Moderate-to-severe or persistent symptoms after 8 hours of observation (e.g. Depressed conscious state or cardiac arrhythmias)
Management of seizures
Admission should be considered for all children and young people with an intentional overdose or in children with persisting symptoms after 8 hours observation
Consult Contact Victorian Poisons Information Centre 131126 for advice
Children with severe symptoms with the potential to require intensive care review
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Period of observation as above
For deliberate ingestion a risk assessment should indicate that the child is at low risk of further self-harm in the discharge setting
prevention for children Parent
Victorian Poisons Information Centre: 13 11 26 www.austin.org.au/poisons
Intentional self –harm: Referral to local mental health services e.g. Orygen Youth Health: 1800 888 320
Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685
Last Updated December 2017