Last updated on 20 Jun 2017 at 10:12 AM (Paed23)

Overdose in a child or adolescent
A 2 year old NZ European girl is brought to Emergency Department. She has been drowsy since her mother found her with an empty bottle of paracetamol syrup at home.

 

Applied Science for Medicine
Biochemistry, physiology and pharmacology of paracetamol and iron supplements when taken in overdose
Drug absorption, metabolism and excretion
Drug dosing and calculations
Genetic polymorphisms that alter individual responses to drugs
Prescribing for children
Clinical toxicology in the paediatric population

Clinical and Communication Skills
Understand the principles of triage with children presenting with poisoning
Basic resuscitation if depressed level of consciousness
Elicit history of ingestion (time, amount, calculate maximum quantity), and consider multiple drug ingestion
Signs and symptoms suggesting toxicity such as cholinergic: (organophosphates) salivation, sweating, bronchospasm or anticholinergic: dry flushed skin, mydriasis, seizures, ECG changes
Manage poisoning (e.g. paracetamol) overdose including first aid, blood and urine toxicology assessment, interpretation of levels, identify relevant end organs that may be affected, use of antidotes (use of paracetamol nomogram and N-acetylcysteine)
Calculate appropriate drug doses for individual patients by weight and body surface area
Access the New Zealand National Poisons Centre website for advice
Assessment of household risks and safety in case of younger children
Understanding of interventions; role child proof lids, home medicines safety
Assessment of adolescent in case of intentional overdose (HEADSS assessment and full psychiatric evaluation)
Management of deliberate self harm/suicidal behaviour in children and adolescents

Personal and Professional Skills
Communicate empathetically with child and caregivers
Evaluation of social and school history (any emotional or family/whānau stressors)
Recognise risk behaviour in adolescence and depression
Non-judgemental approach to caregivers
Discuss with family safety around the home and storage of medicines and poisons

Hauora Māori
Incidence of suicide and accidental death for New Zealand Māori
Identify and cater for differential health literacy needs of Māori patients and whānau
Acknowledgement of the disproportionate impact of illness on whānau employment/income, and therefore availability and models of caregiving
Consideration of access to cultural/spiritual support for patient and whānau

Population Health
Knowledge of New Zealand National Poisons service/ website
Evaluation of risks to children in New Zealand household (child-proof containers)
Alcohol and recreational drug use in young people in New Zealand
Youth health and suicide
Preventative strategies in the home

 

Conditions to be considered relating to this scenario

Common

accidental ingestion in young child, intentional overdose in older child or adolescent, staggered overdose of 'therapeutic' paracetamol in children (accidental parental excess administration/lack of health literacy)