Poisons in children – one pill can kill

This week’s experts:
Dr Rose Cairns, Lecturer, School of Pharmacy, The University of Sydney; Senior Poisons Specialist, New South Wales Poisons Information Centre

Drawn from Dr David Lim’s interview with Dr Rose Cairns on the Healthed Podcast, ‘Clinical Takeaway’.

– The Australian Poisons Information Centre (131126) operates 24/7 taking more than 200,000 calls a year

– About 30% of call to the Poisons Information line come from health professionals (the rest come from the general public)

– The Poisons Information Line is staffed by people with a background in pharmacy, pharmacology or medicine who have been specifically trained for the role of adviser. Complicated cases (usually involving polypharmacy and self-harm) are referred to an on-call consultant clinical toxicologist. Approximately 3% of calls are referred to the consultant toxicologist

– Approximately 50% of calls are related to potential poisoning in children aged less than five years

– Of most concern are the cases where young children have ingested adult pharmaceuticals, in particular those medicines which even n small amounts can cause life-threatening toxicity (‘one pill can kill’)

– Drugs that can potentially cause serious toxicity in young children if ingested include:

  • opioids – especially high dose, slow release formulations
  • calcium channel blockers – in particular the higher strength slow-release formulations of verapamil and diltiazem
  • sulfonylureas – can cause life-threatening hypoglycaemia. This is also a risk in adults who are euglycaemic
  • sotolol and flecainide
  • tricyclic antidepressants
  • antimalarials – drugs like hydroxychloroquine (touted as a COVID-19 preventative) can be toxic to children
  • antipsychotics – particularly clonidine which is now being used off-label for ADHD. As there is no paediatric formulation , children may be being given a half or quarter tablet. If a child ingests a full tablet they are at risk of bradycardia, CNS depression and hypotension
  • iron – especially high dose formulations. Ingestion of a couple of tablets by a toddler can be toxic and necessitates transfer to hospital
  • paracetamol – most common pharmaceutical causing concern. Children at risk of drinking the liquid paracetamol. Not a problem if treatment (n-acetyl cysteine)administered early – however there is a widespread misconception that paracetamol is harmless and therefore there can be a potentially dangerous delay in seeking help. In adults – toxicity can be experienced by people accidentally taking too much paracetamol over long periods, commonly for chronic pain. By the time they present, the toxicity may be irreversible.


In cases of poisoning in young children, the most common scenario is the child has found and taken the prescribed medication of a visiting relative or when visiting another household ie not in their usual environment

Common myths regarding poisons:
– silica gel sachets are poisonous. Fact: Despite large ‘do not ingest’ labelling, these sachets are harmless
– ingesting cosmetics/moisturisers is harmful Fact: in most cases ingesting cosmetics, moisturisers, crayons, bubble-blowing mixture, sucking pens is completely harmless but may cause GI upset
– white tail spiders cause necrotic skin lesions Fact: white-tailed spiders are no more likely than any other stinging insect to cause an infected ulcer
– examining the bite site will help identify the biter Fact: no it won’t
– using household tweezers is the best way to remove ticks Fact: freezing the tick, using a product available at chemists (eg Medi Freeze Tick Off spray), is the best way of safely removing a tick outside of the surgery.

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