Deadly pediatric poisons: nine common agents that kill at low doses

Emerg Med Clin North Am. 2004 Nov;22(4):1019-50. doi: 10.1016/j.emc.2004.05.004.


More than 97% of pediatric exposures reported to the AAPCC in 2001 had either no effect or mild clinical effects. Despite the large number of exposures, only 26 of the 1074 reported fatalities occurred in children younger than age 6. These findings reflect the fact that, in contrast to adolescent or adult ingestions, pediatric ingestions are unintentional events secondary to development of exploration behaviors and the tendency to place objects in the mouth. Ingested substances typically are nontoxic or ingested in such small quantities that toxicity would not be expected. As a result, it commonly is believed that ingestion of one or two tablets by a toddler is a benign act and not expected to produce any consequential toxicity. Select agents have the potential to produce profound toxicity and death, however, despite the ingestion of only one or two tablets or sips. Although proven antidotes are a valuable resource, their value is diminished if risk after ingestion is not adequately appreciated and assessed. Future research into low-dose, high-risk exposures should be directed toward further clarification of risk, improvements in overall management strategies,and, perhaps most importantly, prevention of toxic exposure through parental education and appropriate safety legislation.

Publication types

  • Review

MeSH terms

  • Alcohols / poisoning
  • Algorithms
  • Analgesics, Opioid / poisoning
  • Anti-Inflammatory Agents, Non-Steroidal / poisoning
  • Antidepressive Agents, Tricyclic / poisoning
  • Antidotes
  • Antihypertensive Agents / poisoning
  • Atropine / poisoning
  • Calcium Channel Blockers / poisoning
  • Camphor / poisoning
  • Child
  • Child, Preschool
  • Clonidine / poisoning
  • Decision Trees
  • Diagnosis, Differential
  • Diphenoxylate / poisoning
  • Drug Combinations
  • Emergency Medicine / methods*
  • Emergency Treatment / methods*
  • Gastrointestinal Agents / poisoning
  • Humans
  • Infant
  • Pediatrics / methods
  • Poisoning / diagnosis*
  • Poisoning / epidemiology
  • Poisoning / etiology
  • Poisoning / therapy*
  • Salicylates / poisoning
  • Sulfonylurea Compounds / poisoning
  • United States / epidemiology


  • Alcohols
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antidepressive Agents, Tricyclic
  • Antidotes
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Drug Combinations
  • Gastrointestinal Agents
  • Salicylates
  • Sulfonylurea Compounds
  • atropine sulfate-diphenoxylate hydrochloride drug combination
  • Diphenoxylate
  • Camphor
  • Atropine
  • Clonidine