Pediatric emergency care · 2026
Accidental Ingestion of Highly Toxic Drugs in Young Children: A Multicenter Study From Spanish Pediatric Emergency Departments.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ramírez-Romero Johanna, Mintegi Santiago, Santibañez Beatriz Azkunaga, Surveillance System of the Intoxications Working Group of the Spanish Society of Pediatric Emergencies
Аннотация
OBJECTIVES: Highly toxic medications are thought to lead to fatal overdose even after single-dose ingestions. Recent evidence has questioned some of the assumptions underlying this concept. In this context, this study aimed to evaluate the incidence, management, and outcomes of accidental ingestions involving highly toxic drugs in young children presenting to pediatric emergency departments (EDs).
METHODS: We performed a descriptive and analytical study using a prospective, nationwide, multicenter pediatric poisoning registry including 58 Spanish EDs from 2008 to 2024. We analyzed accidental ingestions of therapeutic drugs in children under 8 years of age with a predefined subgroup of infants under 1 year. Highly toxic drugs were defined according to established pediatric toxicology criteria. Clinical presentation, ED management, hospital disposition, and outcomes were compared with other therapeutic drug ingestions.
RESULTS: Among 3577 poisoning episodes, 1189 (33.2%) involved accidental ingestion of therapeutic drugs in children under 8 years; 61 cases (5.1%) involved highly toxic drugs. Median age was 3 years (interquartile range 1 to 6), and 26 children (46.6%) were under 1 year. Cardiovascular drugs (37.7%) and opioids (24.5%) were the most frequent agents. Only 4 patients (6.8%) were symptomatic at presentation. No child required advanced airway or circulatory support, and no fatalities occurred. Hospital admission was more frequent after ingestion of highly toxic drugs.
CONCLUSIONS: Accidental ingestion of highly toxic medications represents a small proportion of pediatric poisonings in EDs and is generally associated with favorable short-term outcomes. This supports a more evidence-based approach to risk stratification in the management of exploratory ingestions.
METHODS: We performed a descriptive and analytical study using a prospective, nationwide, multicenter pediatric poisoning registry including 58 Spanish EDs from 2008 to 2024. We analyzed accidental ingestions of therapeutic drugs in children under 8 years of age with a predefined subgroup of infants under 1 year. Highly toxic drugs were defined according to established pediatric toxicology criteria. Clinical presentation, ED management, hospital disposition, and outcomes were compared with other therapeutic drug ingestions.
RESULTS: Among 3577 poisoning episodes, 1189 (33.2%) involved accidental ingestion of therapeutic drugs in children under 8 years; 61 cases (5.1%) involved highly toxic drugs. Median age was 3 years (interquartile range 1 to 6), and 26 children (46.6%) were under 1 year. Cardiovascular drugs (37.7%) and opioids (24.5%) were the most frequent agents. Only 4 patients (6.8%) were symptomatic at presentation. No child required advanced airway or circulatory support, and no fatalities occurred. Hospital admission was more frequent after ingestion of highly toxic drugs.
CONCLUSIONS: Accidental ingestion of highly toxic medications represents a small proportion of pediatric poisonings in EDs and is generally associated with favorable short-term outcomes. This supports a more evidence-based approach to risk stratification in the management of exploratory ingestions.