Poisonings by illegal drugs are rarely seen in paediatric emergency departments (PEDs) and constitute approximately 1.5% of the total cases of poisoning.1 They usually occur in older patients that are exposed to these drugs in a recreational context, and cannabis is the substance most frequently involved.2

However, on rare occasions, PEDs manage young children that have been exposed to illegal drugs. These cases usually involve unintentional drug exposure resulting from the drive to explore characteristic of this age group.

Although it has been described that the use of psychoactive substances in society at large carries the risk of minors being exposed to them, there are few published studies on the subject.3 It is likely that contact with health care services occurs in cases in which the minor exhibits significant symptoms,4 but the actual number of poisonings may exceed the documented number, as in some cases the symptoms may be minimal or short-lived.

This study analyses the prevalence of this type of poisonings in the PEDs, as well as their characteristics and the way in which they are managed in these settings, based on the data of a prospective register of poisoning cases made by the Toxicology Surveillance System of the Spanish Society of Paediatric Emergency Care (Observatorio Toxicológico de la Sociedad Española de Urgencias de Pediatría) between October 2008 and June 2015. The study was approved by the Committee on Ethics and Clinical Research of the Basque Country. Appendix A lists the participating hospitals.

The data collection protocol applied to each patient included the following variables: age and sex; toxic substance; poisoning setting; family history of substance abuse; potential for exposure to the substance; previous outpatient assessment and/or treatment; circumstances leading to transfer to the PED; signs and symptoms; diagnostic testing and/or treatments in the PED; patient destination after discharge and outcome.

In the period under study, 413461 emergency visits were managed in the participating PEDs, of which 1139 corresponded to poisonings (0.27%). Of the latter, 32 cases (2.8%) corresponded to poisonings by illegal substances: 23 involving a single substance and 9 involving a combination of substances. Of the poisonings involving a single substance, 10 (43.5%) corresponded to unintentional exposures in children aged less than 3 years.

Fig. 1 shows the distribution of poisonings by illegal drugs by reason for exposure and patient age. There is a gap in this distribution between ages 3 and 11 years, probably due to an overall decline in the frequency of unintentional exposures at these ages, which at the same time are below the usual age band at which intoxications are due to recreational drug use.

Figure 1.

Distribution of poisonings by illegal drugs by age, reason for exposure and number of involved substances.

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Table 1 summarises the characteristics of unintentional poisonings. The ten cases of unintentional poisoning in minors involved cannabis and cocaine, and the clinically significant manifestations consisted of central nervous system symptoms, as reported in the literature.4 There are studies in the literature that report that accompanying individuals fail to provide information regarding the exposure to the substance.5 However, in our case series this information was provided by a significant number, which facilitated the management of the child's presenting problem and prevented the performance of unnecessary tests. In three cases, ancillary tests other than those used for detecting the toxic substance were performed due to the severity of the clinical manifestations and/or to assess for potential complications. Management in the PEDs mainly consisted of supportive measures and/or gastrointestinal decontamination, in adherence with clinical practice guidelines.6 All of these patients were admitted to the hospital, and while the final outcome was good in all, 40% were initially admitted to critical care units. In addition, with the exception of one case in which this datum was not documented, local social services and legal authorities were notified in all cases.

Based on this case series, nearly half of poisoning cases in Spanish PEDs involving illegal drugs as the only detected substances corresponded to young children, and usually involved cannabis. Although outcomes are generally good, these children are generally unstable on arrival at the PED and at times require treatment and follow-up care in critical care units.