Toxicity in children

Reviews on the occurrence, biochemical basis, and treatment of lead toxicity in children (11) and workers (3,12,13) have been pubhshed. Approximately 17% of all preschool children in the United States have blood lead levels >10 //g/dL. In inner city, low income minority children the prevalence of blood lead levels >10 //g/dL is 68%. It has been estimated that over two million American workers are at risk of exposure to lead as a result of their work. PubHc health surveillance data document that each year thousands of American workers occupationally exposed to lead develop signs and symptoms indicative of... 

Zidenberg-Cherr S University of California, Davis, CA The relationship between nutritional status and lead toxicity in children U. S. Department of Agriculture... 

Rosen JF. 1985. Metabolic and cellular effects of lead A guide to low-level lead toxicity in children. 

No information is available as to whether the mechanism of action of -hexane toxicity in children differs from that of adults. Weanling rats (21 days old) were more resistant to the development of -hexane peripheral neuropathy than young adults (80 days old) during an exposure to 1,000 ppm -hexane (Howd et al. 1983). The authors suggested that the relative resistance of the weanling rats may have been due to shorter, smaller-diameter axons, or to a greater rate of growth and repair in their peripheral nerves compared to those of adults. 

Miscellaneous Intra-arterial injection —> crystallization Fit threshold Toxic in children (metabolic acidosis and bradycardia) Salivation dissociative anaesthesia Adrenal suppression... 

The adverse effects of TCAs are also similar to those reported in adults (see Chapter 7). The secondary amine TCAs (e.g., desipramine, nortriptyline) are generally as well tolerated as newer antidepressants. Increased blood pressure may be more likely to occur in children than in adults but hypertension per se is rare ( 135). The most common cardiovascular effect is mild tachycardia. Despite their generally favorable adverse effect profile, secondary amine TCAs can cause serious toxicity in children and adolescents just as in adults when a taken in an overdose or when a high TCA plasma level occurs as a result of slow metabolism ( 136). For that reason, most clinicians reserve TCAs for the child or adolescent who has at least a moderate depressive disorder unresponsive to a trial of one or more newer antidepressants. In such instances, TDM should be done at least once to ensure plasma concentrations greater than 450 ng/mL do not develop ( 137). Such levels are associated with an increased risk of the following ... 

Shimasaki N, Mori T, Samejima H et al. Effects of methylenetetrahydrofolate reductase and reduced folate earrier 1 polymorphisms on high-dose methotrexate-induced toxicities in children with acute lymphoblastic leukemia or lymphoma. JPediatr Hematol Oncol 2006 28 64-68. 

Finally, use of OTC cough and cold preparations in the pediatric population has been under scrutiny by the FDA based on a lack of efficacy data in children less than 12 years of age and reports of serious toxicity in children. In October 2007, many pharmaceutical manufacturers recalled OTC cough and cold preparations marketed for children less than 2 years of age. In... 

Polinsky MS, Gruskin AB. 1984. Aluminum toxicity in children with chronic renal failure. JPediatr 105 758-761. 

Reproductive toxicity studies in animals provide important information for evaluating the potential developmental toxicity in children. Developmental toxicity effects assessed in reproductive toxicity studies include fetal growth retardation, malformations, fetal loss, decreases in peri- and postnatal growth and survival, retarded... 

While decontamination and supportive therapy are the mainstays of treatment, antidotes to counteract HD vapor, aerosol, or liquid exposures do not exist (Yu et al, 2003). Adult decontamination may include bleach solutions however, this method can cause greater toxicity in children. Soap and water are the preferred agents to use for decontamination in children. Supportive care consists of the management of pulmonary and skin manifestations such as the use of cough suppressants and/or topical silver sulfadiazine for bums (Yu et al, 2003 Sidell et al, 1997 Azizi and Amid, 1990). Pediatric dosage and treatment recommendations for vesicant exposures are displayed in Table 61.5. 

Szasz, G., Gruber, W., and Bernt, E., Creatine kinase in serum. I. Determination of optimum reaction conditions, Clin. Chem. 22, 650-656, 1976 Holdiness, M.R., Clinical pharmacokinetics of W-acetylcysteine, Clin. Pharmacokinet. 20, 123-134, 1991 Kelley, G.S., Clinical applications of W-acetylcysteine, Altem. Med. Rev. 3, 114-127, 1998 Schumann, G., Bonora, R., Ceriotti, F. et ah, IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37°C. Part 2. Reference procedure for the measurement of catalytic concentration of creatine kinase, Clin. Chem. Lab. Med. 40, 635-642, 2002 Zafarullah, M., Li, W.Q., Sylvester, J., and Ahmad, M., Molecular mechanisms of A -acetylcysteine actions. Cell. Mol. Life Sci. 60, 6-20, 2003 Marzullo, L., An update of A-acetylcysteine treatment for acute aminoacetophen toxicity in children, Curr. Opin. Pediatr. 17, 239-245, 2005 Aitio, M.L., A-acetylcysteine — passepartout or much ado about nothing Br. J. Clin. Pharmacol. 61, 5-15, 2006. 

Specific information is not available on whether children are more susceptible than adults to the effects of uranium. No reports were located describing toxicity in children as the result of uranium exposure. It is probable, however, that if exposure levels were high enough, signs of renal toxicity would be observed similar to those seen in adults exposed accidentally (Zhao and Zhao 1990) or intentionally (Pavlaikis 1996). No reports are available of studies where toxic responses of young animals to uranium were directly compared to those of adults. 

Reyes-Jacang A, Wenzl JE. Antihistamine toxicity in children. Clin Pediatr (Phila) 1969 8(5) 297-9. 

The available data suggest that the incidence of arthro-toxicity in children taking ciprofloxacin is the same as in adults the use of other fluoroquinolones is too rare to obtain clear information about the risks in children (51). In 12 children with sickle cell disease treated successfully for acute osteomyelitis with oral ciprofloxacin, transient bilateral Achilles tendon tendinitis occurred in one 5-year old (52). Another case was reported in a hemodialysis patient with a ciprofloxacin-associated Achilles tendon rupture (53). 

Centers for Disease Control and Prevention (CDC). Jin bu huan toxicity in children—Colorado, 1993. MMWR Morb Mortal Wkly Rep 1993 42(33) 633-6. 

Horowitz RS, Gomez H, Moore LL, Fulton B, Feldhaus K, Brent J, Stermitz FR, Beck JJ, Alessi JR, De Smet PAGM Centers for Disease Control and Prevention (CDC). Jin bu huan toxicity in children—Colorado, 1993. MMWR Morb Mortal Wkly Rep 1993 42(33) 633-6. 

Jick SS, Jick H, Habakangas JA, Dinan BJ. Co-trimoxazole toxicity in children. Lancet 1984 2(8403) 631. 

Levin TL, Berdon WE, Seigle RR, Nash MA. Valproic-acid-associated pancreatitis and hepatic toxicity in children with endstage renal disease. Pediatr Radiol 1997 27(2) 192-3. 

Coghlan D, Cranswick NE. Complementary medicine and vitamin A toxicity in children. Med J Aust 2001 175(4) 223. ... 

Suarez A, McDowell El, NIaudet P, Comoy E, and Flamant F. Long term follow up of Ifosfamide renal toxicity in children treated for malignant mesenchymal tumors an International society of pediatric oncology report. J Clin Oncol, 9 2177-2182,1991... 

There is a broad spectrum of signs and symptoms associated with acute short-acting barbiturate toxicity. Lethargy, ataxia, nystagmus, diplopia, amnesia, slurred speech, confusion, hypotonia, hypotension, hypothermia, hypoglycemia, coma, respiratory depression, and death have been reported. Comatose patients may develop erythematous or hemorrhagic bullous skin lesions primarily over areas of pressure (e.g., elbows and knees). These lesions are commonly referred to as barb burns . Doses of 3-5 mg kg of most short-acting barbiturates will cause toxicity in children. The estimated potentially fatal dose in nondependent adults is 3-6 g. 

One distinction between many of the studies of behavioral toxicity in children and adults is that while the former have tended to be primarily longitudinal in nature, following the effects of toxicant exposures to children across the course of development, most of the occupational exposure studies are cross-sectional studies that encompass only a single time point of measurement of behavioral function. 

As little as 0.1 mg of clonidine has produced toxicity in children determination of adult toxicity is based on observation as there is no milligram per kilogram toxic dose established. Clonidine levels are not clinically useful. Toxicity can result from ingestion of used clonidine transdermal patches as residual clonidine remains after full therapeutic use. Symptoms generally begin within 30-90 min and include hypotension, central nervous system depression, bradycardia, and... 

Briassoulis G, Narlioglou M, Hatzis T. Toxic encephalopathy associated with use of DEET insect repellants A case analysis of its toxicity in children. Hum Exp Toxicol2m 20(1) 8—14. 

FeU JM, Reynolds AP, Meadows N, Khan K, Long SG, Quaghebeur G et al. Manganese toxicity in children receiving long-term parenteral nutrition. Lancet 1996 347 1218-21. 

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