# Poisoning in Children

> Poisoning for FMGE Paediatrics: kerosene rules, activated charcoal timing, organophosphate atropine and pralidoxime, iron and paracetamol antidotes.

- Canonical URL: https://prepelephant.com/topics/fmge/paediatrics/poisoning-children-fmge
- Exam / course: FMGE · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Poisoning in Children", PrepElephant, https://prepelephant.com/topics/fmge/paediatrics/poisoning-children-fmge

## Direct answer

Kerosene stored in a soft-drink bottle is the prototype of Indian childhood poisoning — a boy under five, a household hydrocarbon, and two forbidden treatments: no induced vomiting, no gastric lavage, because reflux into the lungs causes the pneumonitis that actually kills. Airway, breathing, circulation and glucose come first in every ingestion; activated charcoal 1 g/kg helps only within about an hour and only for drugs it binds (it fails for hydrocarbons, corrosives, iron, lithium and alcohols). The antidote shelf earns its marks: atropine and pralidoxime for organophosphates, deferoxamine for iron, N-acetylcysteine for paracetamol, and 100 per cent oxygen for carbon monoxide — while aluminium phosphide, the grain-tablet poison of rural India, has no antidote and a grim mortality managed supportively.

## What you must remember

- **Epidemiology pattern:** boys under five, at home, oral route; Indian series lead with kerosene and hydrocarbons, then medicines (iron, paracetamol), pesticides, naphthalene and corrosives — the container travels with the child.
- **Decontamination doctrine:** activated charcoal 1 g/kg once within the first hour for bound drugs; gastric lavage only within an hour, for potentially lethal ingestions, with a protected airway — contraindicated for hydrocarbons, corrosives and the convulsing child.
- **Kerosene/hydrocarbon protocol:** observe for tachypnoea, cyanosis, fever; chest radiograph even if asymptomatic (infiltrates, typically right lower and mid-zone, lag hours); no prophylactic steroids or antibiotics.
- **Organophosphate poisoning:** muscarinic DUMBBELS (diarrhoea, urination, miosis, bronchorrhoea, bradycardia, excess secretions, lacrimation) plus nicotinic fasciculations and weakness; atropine 0.02-0.05 mg/kg intravenously every five minutes until secretions dry (pupils and tachycardia are not endpoints), then infusion; pralidoxime 25-50 mg/kg slow loading then infusion for nicotinic features; watch the intermediate syndrome of respiratory weakness at 24-96 hours.
- **Iron:** four-stage illness (gastrointestinal, quiescent, shock/acidosis, obstructive) — serum iron above roughly 350-500 micrograms/dL or symptoms warrant deferoxamine 15 mg/kg/hour intravenously; tablets are radiopaque on abdominal radiograph.
- **Paracetamol:** N-acetylcysteine is nearly completely protective within 8-10 hours of ingestion; use the four-hour level with the Rumack-Matthew nomogram — intravenous 150 mg/kg over one hour, then 50 mg/kg over four, then 100 mg/kg over sixteen.
- **Corrosives (acids and alkali):** dilute with water or milk, never neutralise (exothermic injury), no lavage, no emesis; endoscopy within 6-24 hours grades injury — alkali liquefaction causes deep oesophageal necrosis with later strictures.
- **Others worth one mark each:** aluminium phosphide (garlicky breath, refractory shock, no antidote — magnesium sulphate and supportive care); naphthalene haemolysis in G6PD deficiency; oesophageal button battery — endoscopic emergency; multiple magnets — perforation risk; lead (surma, paint) chelated with DMSA or CaNa2EDTA; carbon monoxide — 100 per cent oxygen.

## The toddler and the blue bottle

An 18-month-old is found coughing beside an open kerosene bottle; he smells of the solvent and vomited once spontaneously. Resist the reflex to "wash the stomach". Examine: rate 42, saturation 95 per cent, mild recession. Order the radiograph despite wellness, observe 24 hours, and treat falling saturation with oxygen — steroids and prophylactic antibiotics are not indicated. Counsel on storage — locked, high, never in drink bottles. The same hour, a farmer's child arrives dusky, drooling, with pinpoint pupils, bradycardia and crackles — organophosphate until proven otherwise: suction, oxygen, atropine 0.05 mg/kg intravenously immediately and five-minutely until the chest dries, pralidoxime slowly, then monitoring for the intermediate syndrome, with clothes bagged and skin washed to protect staff.

## Where students slip

The reflex punished hardest is "empty the stomach" — modern toxicology decontaminates rarely, and late lavage for hydrocarbons or corrosives converts a survivable ingestion into aspiration or perforation. Second slip: atropine endpoints — dosing to pupil dilation or heart rate causes atropine toxicity; the endpoints are drying of secretions and improved ventilation. Third: charcoal omniscience — charcoal does not bind iron, hydrocarbons, alcohols, acids or alkalis, and the question plants a kerosene or iron ingestion with a "give charcoal" option. Fourth: timing nihilism with paracetamol — the nomogram needs a four-hour level, and N-acetylcysteine still works, less perfectly, started late.

## Frequently asked questions

### Why is gastric emptying contraindicated in kerosene ingestion?

Kerosene has low systemic toxicity but high aspiration potential — vomiting or lavage risks chemical pneumonitis, the actual killer, so care is observation, radiography and respiratory support.

### What is the dosing of activated charcoal and when is it useless?

One gram per kilogram as a single dose within about an hour of ingestion; useless for hydrocarbons, corrosives, iron, lithium and alcohols, which charcoal does not adsorb.

### How is organophosphate poisoning treated?

Airway and suction first; atropine 0.02-0.05 mg/kg every five minutes titrated to dry secretions (not pupil size), then infusion, plus pralidoxime 25-50 mg/kg slow loading then infusion — watching for the intermediate syndrome.

### When is deferoxamine given in iron poisoning?

With symptomatic poisoning, serial levels above roughly 350-500 micrograms/dL, metabolic acidosis or radiopaque tablets — 15 mg/kg/hour intravenously, producing the vin rose urine when iron-chelate is excreted.

### What is the antidote and timing window for paracetamol poisoning?

N-acetylcysteine, virtually fully protective within 8-10 hours of ingestion, dosed by weight intravenously over 21 hours in three sequential infusions, guided by the four-hour Rumack-Matthew level.