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Intoxicaciones en pediatria
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Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
1
Epidemiologa y Tratamiento general de las intoxicaciones.
Urgencias y Emergencias.
Tiempo es Vida Dr.Enrique Paris M. Director Centro Informacin Toxicolgica Pontificia Universidad Catlica de Chile CITUC.
The price of life
Acute respiratory infection 18%
Other24%
Diarrhoea 15%
Malaria 11%
Measles 5%
Human Immunodeficiency Virus (HIV) 4%
Perinatal diseases(within 7 days of birth) 23%
Deaths associated with malnutrition:
54% Annual expenditure on pet food in North America and Europe
1998
Annual cost of scaling-up vaccination, malaria prevention and
essential treatment to reach every child in the developing world
2001
US$ 7.5 billion
US$ 17 billionAUSTRALIA
REP.KOREA
DPRKOREA
TIMOR-LESTE
MICRONESIA,FED. STATES OF
ANTIGUA & BARBUDA
BARBADOSST LUCIA
TRINIDAD & TOBAGO
PALAU
ST KITTS & NEVIS
ST VINCENT & GRENADINES
BAHAMAS
ZIMBABWE
UGANDA
TURKMENISTAN
UZBEKISTAN
TAJIKISTAN
KYRGYZSTANGEORGIAAZERBAIJAN
ARMENIA
MADAGASCAR
SRI LANKA
JAMAICA
CUBA
DOMINICANREP.
BRUNEI DAR.
M A L A Y S I A
SAUDI ARABIA
C H I N A
M O N G O L I A
VIET NAM
CAMBODIA
LAOPDR
THAILAND
I N D I A
BHUTAN
BANGLADESH
ISL . REP .IRAN
PAKISTAN
AFGHANISTAN
T U R K E Y
IRAQ
CYPRUS SYRIAN ARAB REPUBLIC
LEBANONISRAEL JORDAN
BAHRAIN
QATAR
UAE
OMAN
KUWAIT
YEMEN
NEPAL
K A Z A K H S T A N
U S A
C A N A D A
ALGERIA
NIGER CHADS U D A N
NIGERIACENTRAL AFRICAN
REPUBLIC
DEM. REP.CONGO
ETHIOPIA
ANGOLA
E G Y P T
MOROCCO
LIBYANARAB
JAMAHIRIYA
MAURITANIA
SENEGALGAMBIA
CAPE VERDE
SAO TOME & PRINCIPE
GUINEA-BISSAUGUINEA
LIBERIA
CTE DIVOIRE
BURKINA FASO
GH
AN
A
BEN
IN
CAMEROONEQUATORIALGUINEA
GABON
CONGO
NAMIBIABOTSWANA
SOUTH AFRICA
MOZAMBIQUE
MALAWIZAMBIA
UNITED REP.TANZANIA
BURUNDI
RWANDAKENYA
DJIBOUTI
SOMALIA
TOG
O
SIERRA LEONE
SWAZILAND
MALI
LESOTHO
ERITREAGUATEMALA
EL SALVADOR
MEXICO
HAITI
BOLIVIA
PARAGUAY
B R A Z I L
VENEZUELA
COLOMBIA
HONDURAS
NICARAGUA
COSTA RICA
PANAMA
ECUADOR
PERU
GUYANASURINAME
BELIZE
ARGENTINA
URUGUAY
CHILE
PHILIPPINES
NEW
ZEALAND
PAPUANEW
GUINEAI N D O N E S I A
JAPAN
R U S S I A N F E D E R A T I O N
MAURITIUS
MALDIVES
COMOROS
SEYCHELLES
SINGAPORE
DOMINICA
GRENADA
MYANMAR
SOLOMONISLANDS
TUVALU
MARSHALL ISLANDS
NAURU
TONGA
SAMOA
NIUE
COOKISLANDS
KIRIBATI
FIJIVANUATU
TUNISIA
CROATIAITALY
REP.MOLDOVA
UKRAINE
FYR MACEDONIA
LITHUANIA
LATVIA
ESTONIA
ALBANIA
AUSTRIA HUNGARY
BULGARIA
ROMANIA
GREECE
SERBIA &MONTENEGRO
POLAND
SLOVENIA
BELARUS
RUSSIANFED.UNITED
KINGDOM
IRELAND
DENMARK
FRANCE
SPAIN
ANDORRA
S. MARINO
PORTUGAL
GERMANY
SWITZ.
BELGIUM
LUX.
NETH.
ICELAND
NORWAY
FINLAND
SWEDEN
SLOVAKIACZECHREPUBLIC
MALTA
MONACO
BOSNIA & HERZEGOVINA
Under-five mortality rate per 1000 live births2000
Beacons of hope
greatest improvement in child mortality rate 19702000
over 175
101 175
26 100
11 25
10 and under
no data
Child mortality rate
Main causes of child mortality 2002
The biggest killers of children under five
Produced by M
yriad Editions
O
The Worlds Forgotten Children
ver 10 million children under five die every year
98 per cent of them in developing countries. Widespread malnutrition hampers childrens growth and development, opening the door to the biggest killers of children under five: perinatal diseases, pneumonia, diarrhoea, and malaria. This presents a sharp contrast to the situation in the industrialized world, where junk food and a sedentary lifestyle have triggered an unprecedented epidemic of obesity in children, leading to diabetes and heart disease in adult life.
The last three decades have witnessed an impressive decline in child mortality, from 17 million a year in the 1970s. Yet these gains have not been enjoyed everywhere. In some countries of sub-Saharan Africa, child mortality is rising as wars and the ravage of the AIDS epidemic undermine the medical, social and economic structures of society.
At the turn of the century, the world joined together in the fight against poverty, and committed itself to the Millennium Development Goals, adopted by the United Nations in 2000. To reduce by two-thirds the under-five mortality rate between 1990 and 2015 may be the most ambitious of these goals.
Aiko is safely delivered in Kumamoto, Japan, and can expect to live about 85 years. At the same time, Mariam comes
into this world in one of the poorest areas of Freetown, Sierra Leone. She is
underweight and vitamin-deficient, and has a 30% chance of dying before her
fifth birthday.
Today, 35% of Africas children are at higher risk of death than they were ten years ago.
From Inheriting the World: The Atlas of Children's Health and the Environment WHO
World Health Organization
"It is not enough to prepare our children for the world;
we must also prepare the world for our children.
Luis J. Rodriguez (1954 )
Nios y Medio Ambiente.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
2
A U S T R A L I A
REP.KOREA
DPRKOREA
TIMOR-LESTE
MICRONESIA,FED. STATES OF
ANTIGUA & BARBUDA
BARBADOSST LUCIA
TRINIDAD & TOBAGO
PALAU
ST KITTS & NEVIS
ST VINCENT & GRENADINES
DOMINICA
BAHAMAS
ZIMBABWE
UGANDA
TURKMENISTAN
UZBEKISTAN
TAJIKISTAN
KYRGYZSTANGEORGIAAZERBAIJAN
ARMENIA
MADAGASCAR
SRI LANKA
JAMAICACUBA DOMINICANREP.
BRUNEI DAR.
M A L A Y S I A
SAUDI ARABIA
C H I N A
M O N G O L I A
VIET NAM
CAMBODIA
LAOPDR
THAILAND
I N D I A
BHUTAN
BANGLADESH
ISL . REP .IRAN
PAKISTAN
AFGHANISTAN
T U R K E Y
IRAQ
CYPRUS SYRIAN ARAB REPUBLICLEBANON
ISRAEL
JORDAN
BAHRAINQATAR
UAE
OMAN
KUWAIT
YEMEN
NEPAL
K A Z A K H S T A N
U S A
C A N A D A
ALGERIA
NIGER
CHAD S U D A N
NIGERIA
CENTRALAFRICAN REPUBLIC
DEM. REP.CONGO
ETHIOPIA
ANGOLA
E G Y P T
MOROCCO
LIBYANARAB
JAMAHIRIYA
MAURITANIA
SENEGALGAMBIA
CAPE VERDE
SAO TOME & PRINCIPE
GUINEA-BISSAU GUINEA
LIBERIA
CTE DIVOIRE
BURKINAFASO
GHAN
A
BENIN
CAMEROONEQUATORIAL
GUINEA
GABON
CONGO
NAMIBIABOTSWANA
SOUTH AFRICA
MOZAMBIQUE
MALAWIZAMBIA
UNITED REP.TANZANIA
BURUNDI
RWANDAKENYA
DJIBOUTI
SOMALIA
TOGOSIERRA LEONE
SWAZILAND
MALI
LESOTHO
ERITREAGUATEMALA
EL SALVADOR
MEXICO
HAITI
BOLIVIA
PARAGUAY
B R A Z I L
VENEZUELA
COLOMBIA
HONDURAS
NICARAGUA
COSTA RICA
PANAMA
ECUADOR
PERU
GUYANA
SURINAME
BELIZE
ARGENTINA
URUGUAY
CHILE
PHILIPPINES
NEW
ZEALAND
PAPUANEW
GUINEAI N D O N E S I A
JAPAN
R U S S I A N F E D E R A T I O N
MAURITIUS
MALDIVES
COMOROS
SEYCHELLES
SINGAPORE
GRENADA
MYANMAR
SOLOMONISLANDS
WEST BANK AND GAZA
TUVALU
MARSHALL ISLANDS
NAURU
TONGA
TOKELAU
SAMOANIUE
COOKISLANDS
KIRIBATI
FIJI
VANUATU
TUNISIA
CROATIA
ITALY
REP.MOLDOVA
UKRAINE
FYR MACEDONIA
LITHUANIA
LATVIA
ESTONIA
ALBANIA
AUSTRIA HUNGARY
BULGARIA
ROMANIA
GREECE
SERBIA &MONTENEGRO
POLAND
SLOVENIAB-H
BELARUS
RUSSIANFED.UNITED
KINGDOM
IRELAND
DENMARK
FRANCE
SPAINPORTUGAL
GERMANY
SWITZ.
BELGIUM
LUX.
NETH.
ICELAND
NORWAY
FINLAND
SWEDEN
SLOVAKIACZECHREPUBLIC
MALTA
How children are injured
Causes of deaths worldwide due to unintentional injuries for children under 15 years 2002
Road traffic accidents boys girls
Poisoningsboys girls
Falls boys girls
111 559
71 261
19 818 15 79722 294
14 713
Fires boys girls
34 23839 969
Drowningboys girls
89 955
55 104
Deaths due to road traffic accidents of children aged 014 years per 100 000 2002by WHO sub-region
20.0 and over
10.0 19.9
5.0 9.9
2.5 4.9
under 2.5
no data
Dying on the roads
Produced by Myriad Editions
Child Injuries are Preventable
rowning is the most common cause of injuries
for infants, killing approximately 60 000 children under five every year and leaving roughly the same number permanently disabled. Children also suffer burns from open fires and kerosene stoves, and are injured in falls at home, at school and at playgrounds.
In older children, however, the overriding cause of injuries is road traffic accidents, killing approximately 180 000 children under 15 each year. Children are rarely the cause of road traffic accidents but suffer as pedestrians, cyclists and passengers. Boys, often given greater freedom to roam, are more likely to be injured than girls.
Injuries are unnecessary and avoidable. The use of seatbelts and child car seats, and the wearing of helmets are essential to prevent the death of child passengers or cyclists. Traffic measures such as checking vehicle roadworthiness, enforcing speed limits and prosecuting drunk drivers are particularly important in developing countries, where roads tend to be poorly maintained and the number of vehicles is growing rapidly.
Injuries from road traffic accidents already cost developing countries US$ 65 billion a year more than the annual amount of development assistance they receive.
D
Emeka slipped while drawing water from the river near her village in Nigeria and
did not return home . . .
From Inheriting the World: The Atlas of Children's Health and the Environment WHO
World Health Organization
Deaths from road accidents are projected to rise by 65%
by 2020, mostly in developing countries.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
3
LIFETIME EXPOSURES
Birth 6 m 1 yr 5 yr 16 yr 45 yr 65yr
Intrauterine
Breastfeeding Occupational exposure
Normal food
Soil: ingestion
Soil: dermal
Domestic environments
Drinking water
Air
www.cituc.cl
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
4
EPIDEMIOLOGIA
EPIDEMIOLOGIA
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
5
EPIDEMIOLOGIA
EPIDEMIOLOGIA
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
6
Intoxicaciones.
Primeros Centros Toxicolgicos 60. Formados por Pediatras. Campaas Masivas. Semana de la Prevencin. Uso Responsable del Medicamento.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
7
Intoxicaciones.
CITUC. 263 53 800 . Fundado 1992. Financiamiento: Ley de Donaciones. Llamadas diarias : prom. 90. Llamadas acumuladas : 410.000 www.cituc.cl
Intoxicaciones.
CITUC.
Entregar una informacin profesional, oportuna, adecuada y actualizada, para contribuir al manejo del Paciente Intoxicado.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
8
EPIDEMIOLOGIA
EPIDEMIOLOGIA
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
9
EPIDEMIOLOGIA
EPIDEMIOLOGIA
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
10
0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
Medicamentos
Prod. Ind. Y Qumicos
Productos Aseo
Fitosanitarios
Animales
Plaguicidas domsticos
Cosmticos
Metales
Cuerpo Extrao
Alimentos Gases
Plantas
Otro
SUSTANCIAS MAS FRECUENTES
Llamadas
0 1000 2000 3000 4000
Sistema Nervioso Central
AINES
Sistema Respiratorio
Antibiticos Sist. Hormonal
Sist. Nervioso Autnomo
Sistema Cardiovascular Vitaminas/Minerales
Antispticos/desinfectantes
Agentes gastrointestinales
Otros
MEDICAMENTOS MAS FRECUENTES
LLAMADAS
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
11
GRUPO MAS FRECUENTE SNC
0 200 400 600 800 1000
BENZODIAZEPINAS
ANTIDEPRESIVOS
FENOTIAZINAS Y DROGAS RELACIONADAS
ANTICONVULSIVANTES
ANFETAMINAS
OTRAS DROGAS SNC
LLAMADAS
PRODUCTOS DE ASEO
0 200 400 600 800 1000
CLORO
DETERGENTES
LAVALOZAS
OTROS AGENTES
LIMPIADORES
LLAMADAS
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
12
PRODUCTOS INDUSTRIALES
0 200 400 600 800 1000 1200
HIDROCARBUROS
ALCOHOLES
ACIDOS/ALKALIS
PEGAMENTOS
OTROS
LLAMADAS
OTRO 10%
ANTICOAGU-LANTE 35%
PIRETROIDES 25%
ORGANOFOSFORADOS 30%
PLAGUICIDAS DE USO DOMESTICO
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
13
Figure 1. A 21-year-old dental assistant a1empted suicide by injec8ng 10 ml (135 g) of elemental mercury (quicksilver) intravenously. She presented to the emergency room with tachypnea, a dry cough, and bloody sputum. While breathing room air, she had a par8al pressure of oxygen of 86 mm Hg. A chest radiograph showed that the mercury was distributed in the lungs in a vascular pa1ern that was more pronounced at the bases. The pa8ent was discharged aNer one week, with improvement in her pulmonary symptoms. Oral chela8on therapy with dimercaprol was given for nine months, un8l the pa8ent stopped the treatment;
Intoxicaciones.
Diagnstico.
- Sospechar el Diagnstico. - Anamnesis. - Examen Fsico . Sindromes Txicos. - Examenes de Laboratorio.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
14
Intoxicaciones.
Sindromes Txicos.
- Sindrome Anticolinrgico. - Sindrome Colinrgico. - Sindrome Opiode Alcohlico. - Sindrome Catecolaminrgico.
Intoxicaciones. Sndromes Txicos.
Sndrome Anticolinrgico. Causas. Antihistamnicos, antidepresivos tricclicos
antiespasmdicos, chamico, atropina.CBZ. Sintomatologa. Taquicardia, vasodilatacin, retencin
urinaria, silencio abdominal, alucinaciones y convulsiones.Midriasis.Mucosas secas.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
15
Intoxicaciones. Sndromes Txicos.
Sndrome Colinrgico. Causas. Hongos, carbamatos, rganofosforados,
fisostigmina. Sintomatologa. Depresin SNC, hipotona, salivacin,
lagrimacin, incontinencia urinaria y fecal, bradicardia y convulsiones.Miosis.
Intoxicaciones. Sndromes Txicos.
Sndrome Opioide alcohlico. Causas. Codena, morfina, barbitricos, BDZ,
etanol, clonidina. Sintomatologa. Coma, depresin respiratoria, hipotensin,
miosis, bradicardia, hipotermia, edema pulmonar, shock distributivo.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
16
Intoxicaciones. Sndromes Txicos.
Sndrome Catecolaminergico. Causas. Cocana, amfetaminas, efedrina, cafena,
pseudoefedrina, fenilpropanolamina. Sintomatologa. Taquicardia, hipertensin, hipertermia,
diaforesis, midriasis, convulsiones y arritmias.Dolor anginoso.
Intoxicaciones.
Tratamiento . Siempre tratar primero al Paciente: ABC de la Reanimacin. Despus tratar al Txico. ABC de la Intoxicacin.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
17
Intoxicaciones.
Tratamiento . Siempre tratar primero al Paciente: ABC de la Reanimacin. Via Aerea Permeable.Oxigenar. Asegurar una buena ventilacion. Dos vias venosas gruesas. Monitoreo Cardaco. Saturacin.
Intoxicaciones.
ABC de la Intoxicacin.
- evitar la absorcin. - favorecer la adsorcin. - favorecer la eliminacin. - antagonizar al txico.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
18
Intoxicaciones.
Evitar absorcin : Lavado Gstrico. Solo en la primera hora post ingestin. Proteger la va aerea si existe compromiso de
Conciencia. Indicado principalmente en Txicos que
comprometen gravemente la vida del paciente. Contraindicado en Casticos e Hidrocarburos.
Intoxicaciones.
Favorecer adsorcin :Carbn Activado. Muy Importante. Dosis Unica. 2 a 3 gr /kg Nios. Dosis Secuenciales. 0,5 a 1 gr/ kg c/4, 6 u 8 hrs. Contraindicado en Casticos y Obst.Intestinal Inutil en Litio y Fierro.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
19
Intoxicaciones.
Carbn Activado. Concomitantemente usar Lactulosa. 10 a 15 ml con cada dosis de Carbn.
Intoxicaciones.
Favorecer la Eliminacin. Ventilacin del lugar del accidente. Forzar diuresis. Alcalinizar o Acidificar
orina. Lavado Gastrointestinal total. Solucin de
Colon. Oxigenar . Cmara Hiperbrica.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
20
Intoxicaciones.
Antagonizar al Txico.
Usar un Antagonista no es la Panacea.
Lo importante es Tratar al Paciente.
Intoxicaciones.
Paradoja. Uso de flumazenil en Intoxicacin Mixta de BDZ y Antidepresivos Tricclicos. se debe usar flumazenil ?
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
21
Intoxicaciones. Antdotos. N-Acetilcistena. Atropina. Benztropina. Difenhidramina. Digibind. Etanol. Fitomenadiona Glucagn.
Flumazenil. Glucosa. Naloxona. Obidoxima. Oxgeno. Piridoxina. Succimer. Fomepizol.
Intoxicaciones.
Prevencin. - Educacin a toda la Familia. - almacenar correctamente los txicos. - Uso correcto del Medicamento. - Promover el Envase Seguro. - Promover los Centros de Informacin.
Educacin Mdica Continua SAVAL Formacin de competencias en pediatra SOCHIPE 2014
Dr.Enrique Paris
22
Intoxicaciones.
Gracias !