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☠️ Poisoning & Lead Exposure

What to do first, what never to induce, and why lead damages the nervous system silently.

🚨 Acute poisoning — the first actions

The first five actions in order, then the two reasons vomiting is never induced drawn out - a caustic burning the esophagus a second time on the way back up, and a petroleum product going down the airway instead. — The two reasons never to induce vomiting are different reasons, and drawing them keeps them apart. Swipe it sideways if it is cut off, or tap to open it full size.

Toddlers explore by mouth, so poisoning peaks around age 2.

1Assess the child — ABC first

2Remove any remaining substance from the mouth

3Call Poison Control — before giving anything

4Take the container with you to hospital

5Treat as directed — activated charcoal, antidote, supportive care

🚨 The absolute nevers

Never induce vomiting. Syrup of ipecac is no longer recommended.
Never induce vomiting with a caustic substance - lye, drain cleaner, oven cleaner. It burns the esophagus a second time on the way back up.
Never induce vomiting with a petroleum product - petrol, paraffin, furniture polish. Aspiration causes chemical pneumonitis.

Take the container. Identifying the substance and its concentration changes the treatment entirely, and a frightened parent’s description is often wrong.

Substance	Antidote / treatment
Acetaminophen (acetaminophen)	N-acetylcysteine — most effective within 8 hours
Opioids	Naloxone
Iron	Deferoxamine; iron tablets look like candy and are a classic pediatric poisoning
Benzodiazepines	Flumazenil (used cautiously)
Organophosphates	Atropine; look for SLUDGE and pinpoint pupils

✅ Prevention teaching

Locked cupboards, high shelves — child-resistant is not child-proof
Keep everything in its original container — never in a drinks bottle
Do not call medicine “candy” to get a child to take it
Handbags and visitors’ bags are a common source — tablets in a pocket
Poison Control number saved in the phone and on the fridge

🧲 Lead exposure

Lead damages the developing nervous system, and it does it silently. Most children with raised levels have no symptoms at all — which is why screening exists.

The commonest source is deteriorating lead paint in housing built before 1978 - chips and, more importantly, the dust.

🧠 Where it comes from

Old paint — chips, and dust from friction on windows and doors
Contaminated soil near old buildings or busy roads
Old plumbing — run the tap and use cold water for drinking and formula
Imported pottery, cosmetics, some traditional remedies, some toys
A parent’s work or hobby — brought home on clothing

Pica — eating non-food items — raises the risk considerably.

When there are symptoms
Neurological	Irritability, poor attention, developmental delay or regression, learning problems
GI	Abdominal pain, vomiting, constipation, poor appetite
Blood	Microcytic anemia — lead interferes with hem production
Severe	Seizures, altered consciousness, encephalopathy

✅ Management

Find and remove the source — this is the definitive treatment; treating the child while they return to the same house achieves nothing
Chelation for high levels — succimer, EDTA, dimercaprol. Ensure good hydration and monitor renal function
Iron and calcium-rich diet — a well-nourished gut absorbs less lead. Deficiency increases absorption
Frequent wet mopping and damp dusting; wash hands and toys often
Developmental follow-up — effects can appear later as school difficulties

There is no known safe blood lead level. Prevention is the only reliable protection.

🎯 NCLEX traps

Never induce vomiting — especially caustics and petroleum products
Take the container to hospital
Call Poison Control before giving anything
Acetaminophen antidote is N-acetylcysteine
Lead is usually asymptomatic — screening finds it
Remove the source; good iron and calcium reduce absorption

Sources. Written from CDC, NIDCD, National Eye Institute, HealthyChildren.org (AAP) and MedlinePlus.