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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Poisoning and accidental ingestion

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Toxic physiological compromise

Reduced consciousness, apnoea, seizure, severe agitation, shock, arrhythmia, QRS or QT abnormality, severe acidosis, hypoglycaemia, hyperthermia or rapidly progressive organ injury requires immediate resuscitation and specialist toxicology support.

Action: Protect staff from contamination, use ABCDE, give oxygen and early ventilatory support when required, check glucose and temperature, attach ECG and establish IV or IO access. Identify the product and maximum possible dose, consult current TOXBASE guidance, contact NPIS for a severe or complex case, and give a time-critical antidote or decontamination only when the substance-specific pathway supports it.

Synopsis

Stabilise a child with possible poisoning, obtain a precise exposure history without delaying care, use TOXBASE and the National Poisons Information Service as the UK decision standard, recognise toxidromes and high-risk substances, and integrate mental-health, medication-safety and safeguarding assessment.

  • Scene safety comes first for fumes, powders, pesticides and corrosives; remove contaminated clothing and use specialist decontamination advice without exposing staff.
  • First-line assessment is ABCDE, bedside glucose, core temperature, continuous observations and an early 12-lead ECG when consciousness, pulse or blood pressure is abnormal or a cardiotoxic agent is possible.
  • Record exact product, strength, formulation, time, maximum missing quantity, route, co-ingestants, symptoms, child's weight and pre-hospital treatment; bring packaging or a photograph.
  • TOXBASE is the first-line UK clinical toxicology resource for healthcare professionals; call NPIS for severe, unusual, mixed or uncertain cases.
  • Do not induce vomiting, give food or milk as a universal antidote, or attempt chemical neutralisation.
  • Activated charcoal is not routine: consider it only for a relevant toxic dose, usually within about one hour, after TOXBASE or NPIS advice and with a protected or reliably maintained airway.
  • Use substance-specific quantitative tests rather than a broad toxicology screen; many important poisons are missed by routine urine panels.
  • For a single acute paracetamol ingestion, measure plasma concentration at 4 hours or later; earlier levels cannot be interpreted safely.
  • Give acetylcysteine without delay for a staggered or uncertain-time paracetamol overdose or when the current treatment pathway indicates it; do not wait for liver injury.
  • Treat airway loss, seizures, hypoglycaemia, hyperthermia, electrolyte disturbance and shock while elimination occurs, and use a specific antidote only with a confirmed indication and dose.
  • Observation length and discharge are agent specific; a normal first examination does not override a delayed-toxicity window.
  • After stabilisation assess intent, developmental access, medicine storage, caregiver understanding, mental health, exploitation and safeguarding for the child and siblings.

Key red flags

A single tablet of some adult medicines can be dangerous to a small child; apparent small quantity is not reassurance until product strength and weight-based dose are confirmed.

Bradycardia or tachycardia, hypotension, broad QRS, prolonged QT, ventricular ectopy or syncope requires continuous cardiac monitoring and toxin-specific advice.

Pinpoint pupils with slow breathing, anticholinergic agitation, serotonergic clonus, cholinergic secretions or sympathomimetic hyperthermia provides a toxidrome clue but does not prove one agent.

A child can initially appear well after paracetamol, modified-release medicine, sulfonylurea, calcium-channel blocker or some toxic alcohol exposures; disposition follows the substance, dose and observation window.

Staggered, uncertain-time or delayed paracetamol ingestion cannot be interpreted on the standard timed nomogram and may need acetylcysteine before results return.

Unexpected access in a non-mobile child, repeated episodes, an unsuitable explanation, unexplained drug levels or deliberate administration requires safeguarding action.

Any intentional ingestion needs a compassionate psychosocial and suicide-risk assessment after medical stabilisation, including access to medicines and immediate safety.

Investigation priorities

01
First-line bedside glucose, observations and temperatureFirst stepFirst line

Find immediate reversible physiological threats and provide a toxicity trend.

02
First-line 12-lead ECGFirst line

Detect sodium-channel blockade, QT prolongation, bradyarrhythmia or ischaemic and electrolyte effects.

Management branches

Unknown exposureStabilise and reconstruct

A child has unexplained altered physiology or a possible ingestion without reliable details.

  1. Use ABCDE, glucose, temperature and ECG and treat immediate threats.
  2. Gather packaging, scene and collateral history and calculate the maximum dose.
  3. Consult TOXBASE and send targeted rather than indiscriminate tests.
  4. Keep sepsis, trauma, metabolic and neurological disease in the differential.
Prevention and safetyClose the access route

The child is medically stable after accidental, erroneous or intentional exposure.

  1. Assess developmental access, supervision, storage and caregiver dose technique.
  2. Complete mental-health and suicide-risk assessment for intentional ingestion.
  3. Follow safeguarding procedures for unsuitable or repeated explanations or deliberate administration.
  4. Give a written medicine and household safety plan and arrange follow-up ownership.

Key medicines

Intravenous acetylcysteineUnder the authorised 21-hour regimen give 150 mg/kg IV over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours, total 300 mg/kg; continue at the third-infusion rate when the clinical and laboratory stopping criteria are not met.Use the current TOXBASE and local weight-based table, one complete regimen and an independent check. Monitor for anaphylactoid reaction and fluid volume in small children; previous reaction is not an absolute contraindication when treatment is required. Some services use an approved SNAP regimen only in defined eligible patients.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • National Poisons Information Service TOXBASEUK first-line clinical toxicology database, scope, access and escalation to specialist telephone advice.
  • Resuscitation Council UK 2025 Paediatric Life SupportABCDE toxicology support, ECG and laboratory assessment, shock care, poison-centre consultation and prolonged resuscitation principles.
  • MHRA intravenous acetylcysteine regimenAuthorised three-infusion 21-hour dosing and criteria to consider continued treatment.
  • NICE CG89 child maltreatment alerting featuresPoisoning, access, unsuitable explanation, repetition, deliberate administration and supervision-related safeguarding indicators.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom