CHAPTER 102 ■ TOXICOLOGIC EMERGENCIES MADELINE H RENNY, KATHERINE A O’DONNELL, DIANE P CALELLO PEDIATRIC POISONINGS CLINICAL PEARLS Poisoning in the young child is usually exploratory and more likely to involve household products, whereas adolescents more commonly are intentionally self-poisoned by pharmaceuticals or drugs of abuse Initial stabilization of a poisoned patient with altered mental status, in addition to standard resuscitation measures, may include blood glucose determination and empiric naloxone therapy Naloxone dosing can be higher in young children without concern for opioid withdrawal, from 0.4 to mg initially In adolescents with concern for chronic opioid use, a much smaller initial dose of 0.04 mg is appropriate Consultation with the regional poison control center can be extremely helpful in managing the poisoned child In the United States, a single phone number, 1-800-222-1222, will reach the nearest center Standard urine toxicology screens are seldom essential to evaluate poisoned patients The history and focused physical examination are more valuable to determine the nature of exposure in the majority of cases Pertinent diagnostic evaluation in the unknown exposure patient may include serum chemistries, blood gas analysis, serum osmolarity, an electrocardiogram, and quantitative serum acetaminophen, salicylate, and ethanol concentrations Current Evidence Poisoning represents one of the most common medical emergencies encountered by young children and accounts for a significant fraction of emergency department (ED) visits in the adolescent population Estimates of poisoning episodes annually in the United States range in the millions Poisonings may be unintentional or intentional Unintentional or