الفهرس 
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Abstract
According to WHO, childhood is defined as the period between birth and18 years divided to five developmental stages: newborn (ages 0–4 weeks); infant (ages 4 weeks–1 year); toddler (ages 1–3 years); preschooler (ages 4–6 years); school-aged child (ages 6–12 years); adolescent (ages 12–18).
Poisoning is the third most common emergencies of pediatrics leading to high social and economic burden.
Poisonings and toxic exposures are among the most prevalent public health problems affecting children in the world today.
Poisoning in children is relatively frequent and is the result of the reaction of combination of substances, a child, a family and child’s environment.
Due to fast industrialization and the urban way of living , more frequent usage of drugs, vast usage of chemical materials in households and a geotechnical materials in the villages, yet children are more exposed to the chemical agents and as such they are the potential causes of poisoning which before were not that frequent.
Poisoning can have long term psychological and physical consequences for children and may result in large societal costs. In low and middle income countries, poisoning accounts for 10% of the total burden of unintentional injuries, and 6% of disability adjusted life years.
In Egypt, Regarding the PCC of Ain Shams University Hospitals, Children younger than three years of age were involved in 36.2% of exposures and children younger than 6 years accounted for approximately half of all human exposures (48.9%).
This work aimed to study the pattern and outcome of poisoning among children patients admitted to pediatric and internal medicine ER in Sohag University Hospitals during the period from the beginning of October 2013 till the end of September 2014.
The obtained data was documented and recorded in a special sheet constructed for each patient.
The sheets recorded the following data for each patient:
o Sociodemographic data.
o Clinical data.
o Investigational data.
o Therapeutic interventions.
o Outcome and severity.
After statistical analysis, the results were as follows:
During the study period, the total number of poisoned children was 91 cases.
Toddler (ages 1 – 3 years) and adolescent (ages 12 – 18) constituted about 38.46% and 37.36% respectively of whole children population with mean age 8.290 ± 6.225.
The female percentage was higher than male one (61.54% and 38.46% respectively). There was statistical significant difference between sex as regards age group as females were more than males in all age groups except in preschool.
72.53% of patients came from rural areas and the rest of patients were from urban.
In the current study accidental poisoning constitutes about 71.43% followed by accidental poisoning 23.08 %. There was statistical significance between age and mode of poisoning as suicide more in adolescents.
The main route of poisoning was ingestion 92.31 % followed by inhalation 6.59%. There were no differences in route of exposure as regard age.
The most prevalent toxins involved in acute poisoning among children were pesticides (25.27%) followed by CNS drugs and CVS drugs by the same percentage (17.58%). There were no differences in toxic agents as regard age and sex.
The highest incidence of poisoning was in the summer months (29.67%). There was statistical significance between toxic agents and season as pesticides poisoning was more in summer.
The majority of the patients arrived the hospital in the first six hours (63.7%) and the least number of patients came after 24 hours.
61.54 % of cases did not received any prehospital management. 12.09% of patients had associated diseases (CVS, CNS, & psychiatric diseases)
The majority of patients were normotensives (94.51%).Regarding pulse, 18.68% presented with tachycardia with mean 106.626. Respiratory rate was abnormal in 5.49% and temperature was abnormal in 3.3%.
Pesticides were the main cause of tachycardia while CVS drugs were the cause of bradycardia.
Hypotention observed in pesticides poisoning cases. While tachypnea was due to pesticides and hydreocarbons.
Regarding complexions (2.2%) presented with cyanosis and only (1.1%) of cases were pallored at time of presentation mainly due to pesticides and analgesics.
Sweating was the most common skin manifestation in the present study owing to the prevalence of OPC which was almost the only cause of sweating among patients.
Vomiting was the most common GIT manifestation (47.25%) followed by diarrhea (9.89%) and colic (7.69%). Pesticides were the main causes of vomiting, colic and diarrhea.
Palpitation was present in only four cases; two of them were with acute theophylline poisoning.
Crepitations were present in 15.38% of cases.12.09% of them were due to pesticides poisoning.
Coma was the most common neurological manifestation and coma grade I was the most prevalent (24.18%) while grade II was (6.59%) and fasiculations were (4.4%).Pesticides and CNS drugs were the main cause of coma.
19.78% of cases presented with constricted pupil and 8.79% with dilated puipl. Constricted pupil was almost caused by pesticide poisoning including OPC or carbamates.
2.2% of cases presented with dark urine and the cause was PPD poisoning.
The most common specific toxicological investigation done was pseudocholine esterase (6.59%) followed by carbamazepine level 5.49%.
Gastric lavage was done in 36.26% and 40.66% received single dose activated charcoal. Multidose activated charcoal was given in 18.68 % of cases. Intravenous fluids were required in 60.44% of patients and 18.68% required antidote.
Most of patients (52.75%) were admitted to ED and discharged either directly or after an observational period not exceeding six hours while 39.56% were admitted to inpatient and only 7.69% were admitted to ICU. Majority of patient were discharged with complete recovery (79.12%), 2.2% recovered with development of complications, 13.19% escaped, 1.1% AMA, 2.2% died and 2.2 % were transferred to another hospital.
28.57% of patients admitted to ICU were due to cardiac monitoring while others were due to pulmonary edema, arrhythmia and organ failure.
There was no statistically significant difference between age of children and the outcome.
As regard mode of poisoning complete recovery was more with accidental poisoning while escape was more with suicidal poisoning.
There were statistical significance differences between outcome as regard delay time of arrival to hospital and the duration of hospitalization.
There were no statistical significance differences between outcome and gastric lavage, activated charcoal & MDAC. While there was significance with the intake of antidote as the two cases of organophosphorus poisoning who died did not received atropine.
Conclusion
• from this study toddlers and adolescents are the risky ages and females are more predominant.
• Poisoning more to occur at rural areas.
• Accidental poisoning is the most common manner of poisoning and mostly among toddlers while suicide more in adolescents
• Pesticides followed by therapeutic drugs were the most common causes of poisoning in children and mostly during summer.
• GIT manifestations followed by Coma were the most common presentations of cases.
• Investigations were not done for most of cases and there is more need to increase the awareness about the available toxicological tests.
• Most of cases of child poisoning were mild cases denoted by majority of patients were discharged from ED either directly or after an observational period for not more than 6 hours while lesser number of patients were admitted either to inpatient ward or ICU. Most of patients recovered completely. Mortality rate was 2.2%.
• Manner of poisoning, delay time, duration of hospital stay and intake of antidote were factors affecting the outcome while gastric lavage was not significant.