title: Poisonings requiring admission to the pediatric intensive care unit: A 5-year review.
abstract: BACKGROUND
  Poisonings represent a significant number of preventable admissions to the pediatric intensive care unit (PICU), but data about poisonings requiring PICU-level care are limited.
  
  
  OBJECTIVE
  To identify the demographics of patients admitted with poisonings and characterize their clinical courses related to their poisoning.
  
  
  METHODS
  All poisonings over a 5-year period (2008-2012) at an academic medical center in New England were retrospectively reviewed using electronic medical records in an observational case series. Poisonings were identified using key search terms within an admissions database.
  
  
  RESULTS
  There were 273 admissions for poisonings, which represent 8% of total PICU admissions over this time period. The poisonings were unintentional in 148 (54%) cases and intentional in 125 (46%). The vast majority of poisonings occurred in patients either 3 years or below (N = 121, 44%) or 13 years or above (N = 124, 45%). Most (96%) admissions were for less than 48 h and 41% were for less than 24 h. Mean PICU length of stay was 1.2 + 0.7 days. A total of 468 substances were ingested in 54 different drug classes, with analgesics and antidepressants being the most common. Eighty-five (31%) poisonings were polypharmaceutical. The most commonly used therapies were naloxone, activated charcoal, and benzodiazepines. Twenty-seven patients (10%) received mechanical ventilation. There was one fatality, an adolescent with a polypharmacy overdose in a suicide attempt.
  
  
  CONCLUSIONS
  Pediatric poisonings are a significant percentage of admissions to the PICU. The majority of poisonings are non-fatal, require supportive care, close monitoring, and some specific treatment. Drug classes causing poisonings have changed to a higher percentage of opioids in younger patients and atypical antidepressants in adolescents.
authors.affiliation: University of Massachusetts Medical School , Worcester, MA , USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Even
authors.forename: C C
authors.initials: CC
authors.lastname: Armsby
authors.forename: S T
authors.initials: ST
authors.lastname: Bateman
mesh_terms: D000046:Academic Medical Centers; D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D000931:Antidotes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D009511:New England; D011041:Poisoning / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000706:statistics & numerical data
chemical_list: D000931:Antidotes
keywords: Drug overdose; Pediatric intensive care unit; Poisoning; Polypharmacy; Suicide