| Agent | Clinical Findings | Onset | Decontamination | Managementa |
|---|---|---|---|---|
| Strong acids/bases. | Eye: caustic injury Skin: chemical burns GI: chemical burns of mouth, larynx, esophagus, stomach. |
Rapid. | Eye, skin: immediate copious water irrigation GI: defer, immediate emergency department referral. |
Supportive care, early endoscopy for significant ingestion; antibiotics and steroids controversial, should be individualized, consult Poison Control Centera. |
| Respiratory tract irritants (e.g., ammonia, HCl and HF gases). | EENT and respiratory tract irritation with cough, chest pain, dyspnea, wheeze (possible pulmonary edema in severe cases). | Rapid. | Move to fresh air. | Supportive respiratory care (consider nebulized calcium gluconate solution for HF, consult Poison Control Center). |
| Fentanyl and other opioids. | CNS and respiratory depression, miosis. | Rapid. | Move to fresh air (for aerosol exposure), consider AC for ingestion, consult Poison Control Center. | Supportive care, naloxone (0.01-0.1 mg/kg). |
| Cellular asphyxiants (e.g., phosphine, sodium azide). | Cough, dyspnea, headache, dizziness, vomiting, tachycardia, hypotension, severe metabolic acidosis; may progress to coma, seizures, death; may have delayed onset pulmonary edema with phosphine. | Rapid (except pulmonary edema with phosphine). | Move to fresh air (consider AC for ingested sodium azide—caution with vomitus, which may emit toxic hydrazoic acid fumes; consult Poison Control Center). | Airway, breathing, and circulatory support; 100% oxygen. |
| Arsine. | Severe hemolysis. | 2-4 hr. | Move to fresh air. | Supportive care, enhance urine flow, consider alkalinization, consult Poison Control Center. |
a Monitor respiratory status and blood pressure.
Note: Remember airway, breathing, circulation, decontamination/drugs. Consider oxygen, bronchodilators, nasogastric tube/drainage, ophthalmic analgesia, mydriatics, temperature control. If prolonged impairment of consciousness, electroencephalogram (EEG) (to rule out nonconvulsive status epilepticus) and imaging.
Source: Adapted from Rotenberg JS, Newmark J. Pediatrics 2003;112:648-58.