Toxicology Services at Norton Children’s

Norton Children’s provides toxicology care for infants, children and teens with acute and chronic poison exposure. We provide emergency care and consultations for potential poison exposures, including ingestion, overdose and environmental exposures.

Potential poison ingestion and overdose exposures we treat

Children can accidentally or intentionally ingest, inhale or overdose many toxic substances. Here are some common toxins that children and teens may have access to and could potentially ingest:

  • Analgesics, sedatives and antipyretics
    • Acetaminophen (N-acetyl-p-aminophenol, APAP, paracetamol): Accounts for a significant proportion of accidental and intentional toxic ingestions that can lead to liver injury or death.
    • Benzodiazepines: Used to treat seizures, anxiety, hyperactivity, insomnia and drug withdrawal.
    • Caustic agents: Ingredients in drain cleaner, household cleaners, hair relaxers and automatic dishwasher soaps. Young children may accidentally ingest small amounts, but older children and teens may intentionally ingest larger amounts that can have great risks.
    • Hydrocarbons and inhalation abuse: Gasoline, kerosene, lamp oils, diesel fuels, mineral oils, naphtha, lighter fluids, carbon tetrachloride, mineral spirits, turpentine, lubricating oils and many other commercially available products. Younger children may accidentally ingest or aspirate (breath in) these, but older children and teens may intentionally abuse these products.
    • Iron: Continues to be a significant exposure in children, especially younger children. Iron is essential to health: You can find it naturally in many foods, as a supplement in some fortified food products. Ingestion of 40 to 60 mg/kg of elemental iron by a child places them at risk for significant toxicity.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Used to help decrease pain and inflammation. Examples include aspirin, ibuprofen, naproxen and celecoxib.
    • Opioids: Common opioids are codeine, morphine, fentanyl, methadone, heroin, hydrocodone, oxycodone and meperidine.
    • Organophosphates and carbamates: Found in insecticides commonly used in rural areas. These products are readily absorbed through the skin, lungs, mucous membranes and gastrointestinal tract.
    • Salicylates: Over-the-counter oral and topical formulations that may be in aspirin, antidiarrheal preparations (e.g. Pepto-Bismol, Kaopectate), pain relievers (in combination with codeine, opiates or caffeine), antihistamines, cough/cold combination medicines with aspirin and acetaminophen, topical wart removers and oil of wintergreen (methyl salicylate). Many medicated lotions and ointments contain methyl salicylate and are used as rubefacients (medications that open the capillaries to increase blood circulation).
  • Anticonvulsants
    • Barbiturates:
    • Carbamazepine
    • Levetiracetam
    • Oxcarbazepine
    • Phenytoin
    • Valproic acid (VPA)
  • Antihistamines (overdose is rarely serious)
    • Brompheniramine (Dimetane
    • Cetirizine (Zyrtec)
    • Chlorpheniramine (Chlor-Trimeton)
    • Clemastine (Tavist)
    • Diphenhydramine (Benadryl)
    • Fexofenadine (Allegra)
    • Loratadine (Alavert, Claritin)
  • Antihypertensives
    • Beta-blockers: Acebutolol, atenolol, bisoprolol, metoprolol, nadolol, nebivolol, propranolol
    • Calcium channel blockers (CCBs): Prescribed for hypertension, migraine headaches, angina and other health conditions
    • Clonidine: A high blood pressure medicine but may be used for children with opioid withdrawal or managing attention deficit/hyperactivity disorder (ADHD) or Tourette syndrome
  • Psychoactive drugs
    • Antipsychotics: Thioridazine, trifluoperazine, perphenazine, fluphenazine, haloperidol, olanzapine, risperidone, ziprasidone, aripiprazole, pimozide
    • Selective serotonin reuptake inhibitors (SSRIs): Sertraline, paroxetine, fluvoxamine, fluoxetine, and citalopram
    • Tricyclic antidepressants (TCAs): Amitriptyline, clomipramine, desipramine, dosulepin, doxepin, imipramine, lofepramine, nortriptyline, protriptyline and trimipramine.
  • Recreational drugs
    • 2C phenethylamines
    • “Bath salts”
    • Cocaine
    • Dextromethorphan
    • Gamma-hydroxybutyrate (GHB)
    • Ketamine
    • Methylenedioxymethamphetamine (MDMA)
  • Smoke, cyanide and carbon monoxide
    • Carbon monoxide exposure most commonly occurs due to faulty furnaces, automobile fumes, space heaters, portable generators or from smoke exposure in a fire.
    • Cyanide exposure happens most often when plastics or fabrics are burned, producing hydrocyanic acid gas — one of the leading causes of death in patients with smoke exposure and the most common cause of cyanide toxicity.
    • Smoke exposure may result in a range of signs and symptoms based on the type and length of exposure.
  • Toxic alcohols
    • Ethanol: Alcoholic beverages, mouthwash containing ethanol, aftershave, cologne and perfume allow children access to ethanol in the home.
    • Ethylene glycol: Ethylene glycol is found in antifreeze and de-icing solutions.
    • Isopropyl alcohol (isopropanol): A bitter alcohol used in automotive, cleaning products and rubbing alcohol.
    • Methanol: Found in windshield wiper fluid, cleaning solutions, paint removers, some antifreeze agents, fuel additives and moonshine.

Treatments

Treating a poisoning, ingestion or overdose depends on the type of toxin and exposure, how much was ingested and how long ago the ingestion happened. Some treatments may include:

  • Activated charcoal: Traps toxins and chemicals in the gut. The toxin attaches to the charcoal, is not absorbed by the body and is expelled in feces.
  • Gastric lavage: Commonly referred to as stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach.
  • Hemodialysis: May be used to treat patients whose kidneys cannot sufficiently clear the toxin because of kidney injury, severity of the symptoms or the type of toxin.
  • Surface decontamination: This may include removing clothes and washing with copious amounts of water to prevent corrosive agents from injuring the skin and to minimize absorption and exposure. A thorough cleansing with soap and water to all exposed areas, including behind the ears, under nails and in skin folds, is critical to prevent ongoing skin injury and absorption with subsequent systemic exposure. Eye wash with saline may be used to irrigate the eyes.
  • Urine alkalinization: A treatment regimen that increases poison elimination by administering intravenous sodium bicarbonate to produce urine with a pH greater than or equal to 7.5.
  • Whole bowel irrigation: A treatment in which large amounts of a bowel preparation solution are administered into the gut with the goal of completely cleansing the GI tract by physically expelling all of its contents, including the ingested toxin, prior to absorption into the body.
Toxicology – KPCC

Norton Children’s Toxicology

If you suspect a poisoning or ingestion of a toxic substance, call the Kentucky Poison Control Center. All calls and consultations are free and confidential.

(800) 222-1222

Learn how to protect your children from poisoning at

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