Epidemiological and Clinical Characteristics of Pediatric Intoxications: A Retrospective Study

This retrospective study of 59 pediatric poisoning cases at an Algiers hospital reveals that accidental ingestions of medications and caustic agents are the primary causes of emergency admissions, with caustic ingestions leading to the most severe outcomes and prolonged hospitalizations, thereby underscoring the urgent need for improved household safety measures and caregiver education in Algeria.

The Gist

Imagine a busy hospital emergency room in Algiers, Algeria, as a fire station. Usually, we think of fire stations dealing with flames, but in this study, the "fires" are poisons that children accidentally swallow or breathe in.

Dr. Mohamed Boulahia, the lead researcher, looked back at the "incident reports" from the last year and a half (January 2024 to June 2025) to see what kinds of "fires" were happening, who was getting hurt, and how the "firefighters" (the doctors) put them out.

Here is the story of what they found, explained simply:

1. The Main Culprits: The "Household Hazard Zone"

Out of 59 children who came in with poisoning, almost all of them (95%) did it by accident. They weren't trying to get hurt; they were just curious little explorers.

Think of a child's house as a treasure chest. Unfortunately, some of the "treasures" are actually dangerous. The study found two main types of "treasures" causing the most trouble:

• The Medicine Cabinet (24 cases): Kids found pills like painkillers or blood pressure meds. It's like finding a shiny candy that isn't actually candy.
• The Cleaning Closet (25 cases): This was actually the biggest group! Kids drank things like drain openers, toilet cleaners, or rat poison. Imagine a child finding a bottle of bright blue liquid that looks like juice but is actually a chemical that burns.

There was also a third, invisible danger: Carbon Monoxide (8 cases). This is like an invisible ghost that sneaks into the house from a heater or a car exhaust. It can hurt anyone, from a baby to a teenager.

2. Who Got Hurt? The "Toddler Trap"

The study found that the most vulnerable group was the toddlers (ages 0 to 3).

• Why? Think of a toddler as a tiny, fearless explorer with no sense of danger. They see a bottle, they grab it, and they put it in their mouth. They are too small to reach high shelves, so if parents leave dangerous things on low counters, the kids find them easily.
• The older kids (teens) mostly got into trouble with carbon monoxide or, in a few rare cases, took medicine on purpose (suicide attempts), but the little ones were the main victims of accidents.

3. The Damage: "The Burn vs. The Sleep"

The doctors had to treat these kids differently depending on what they swallowed:

• The "Sleepy" Poison (Medicines): Most kids who swallowed pills were just a bit groggy or sick to their stomach. The doctors watched them for a day or two, made sure they were okay, and sent them home. It was like a minor scratch that heals quickly.
• The "Burning" Poison (Caustics/Chemicals): This was the scary part. When kids drank drain cleaners or acids, it was like pouring hot lava down their throat. It burned the inside of their mouth and stomach.
  • The doctors had to use a tiny camera (an endoscope) to look inside and see how bad the burns were.
  • These kids had to stay in the hospital much longer (up to two weeks) because they couldn't eat, needed special medicine to stop the burning, and had to heal slowly.

4. The Invisible Ghost (Carbon Monoxide)

Eight kids were poisoned by carbon monoxide. This is unique because it doesn't leave a bottle behind. It happens when a heater isn't working right or a car is running in a closed garage.

• The good news: The doctors treated them with oxygen (like giving them a super-breath), and they all recovered fully without staying in the hospital for long.

5. The Big Lesson: Prevention is the Best Medicine

The study concludes that this is a preventable tragedy.

• The Problem: The "treasure chest" (the house) is too easy to open. Medicines and cleaning chemicals are sitting out where curious hands can reach them.
• The Solution:
  1. Lock it up: Put medicines and cleaners in high cabinets or locked boxes.
  2. Teach the parents: Parents need to know that a bottle of "Eau de Parfum" (perfume) or "Thinner" can be just as dangerous as bleach.
  3. Check the air: Make sure heaters are working and install detectors to catch that invisible "ghost" (Carbon Monoxide).

Summary

In short, this paper is a warning label for parents and a call to action for the community. It tells us that while most children who get poisoned are just curious toddlers who accidentally find a dangerous bottle, the damage can range from a minor tummy ache to a serious burn. The best way to stop this isn't just better doctors; it's better storage and smarter habits at home.

The takeaway: If you treat your house like a fortress against curious toddlers, you can keep the "fire" from ever starting.

Technical Summary

1. Problem Statement

Pediatric poisonings represent a significant global public health burden, frequently driving emergency department (ED) admissions. While global data exists, there is a scarcity of comprehensive, hospital-based epidemiological data regarding pediatric intoxications in Algeria. The lack of localized data on the burden, clinical outcomes, and management strategies hinders the development of targeted prevention policies and clinical protocols specific to the North African context. This study aims to fill that gap by analyzing patterns, clinical presentations, and management outcomes at a tertiary care hospital in Algiers.

2. Methodology

• Study Design: Retrospective descriptive analysis.
• Setting: Department of Pediatrics, Faculty of Medicine, University of Algiers (Hassen Badi Hospital), serving a diverse urban population.
• Study Period: January 2024 to June 2025.
• Population:
  • Inclusion Criteria: Children aged 0–15 years with confirmed accidental or intentional poisoning (based on clinical history, observation, or lab evidence) with complete medical records.
  • Exclusion Criteria: Incomplete documentation, uncertain diagnosis, transfers without data, chronic intoxication, or poisoning secondary to metabolic disorders.
  • Sample Size: 59 pediatric cases.
• Data Collection: Systematic extraction of anonymized data including demographics, intent (accidental vs. voluntary), toxic agents, route of exposure, endoscopic findings (EGD), hospitalization duration, management strategies, and outcomes.
• Ethics: Conducted in accordance with the Declaration of Helsinki; formal ethics approval was waived due to the retrospective nature and use of anonymized data.

3. Key Contributions

• First Detailed Algerian Analysis: This is the first hospital-based study providing a granular breakdown of pediatric intoxications in Algeria.
• Dual Burden Characterization: It highlights a specific epidemiological profile in North Africa characterized by a dual burden of medication and caustic/household chemical ingestions.
• Carbon Monoxide (CO) Insights: The study identifies CO poisoning as a risk factor affecting a broad age spectrum, including infants (as young as 10 months), challenging the assumption that it is primarily an adolescent/older child issue in this setting.
• Clinical Protocol Validation: It validates the necessity of endoscopic evaluation for caustic ingestions and supports the use of supportive care as the primary management strategy for most pediatric cases.

4. Key Results

Epidemiological Profile:

• Intent: Overwhelmingly accidental (94.9%, n=56); only 5.1% (n=3) were intentional (all medication-related).
• Age Distribution: The 0–3 years age group was the most vulnerable (59.3%, n=35), followed by 4–10 years (25.4%) and 11–15 years (15.3%).
• Gender: Males accounted for 54.2% (n=32) and females for 45.8% (n=27).

Toxic Agents:

• Caustics & Household Products (n=25): The most frequent category. Included drain openers, hydrochloric acid ("spirit of salt"), formalin, rodenticides, and insecticides.
• Medications (n=24): Included paracetamol, neuroleptics, and antihypertensives.
• Carbon Monoxide (n=8): Affected a wide age range, including infants and adolescents.
• Others: 1 electrical injury, 1 plant ingestion.

Clinical Management & Endoscopy:

• Endoscopy (EGD): Performed in 7 suspected corrosive cases. Three patients (all caustic ingestions) showed Grade IIA esophagitis/gastritis, indicating moderate mucosal injury.
• Medication Cases: Generally mild; 66.7% discharged after short observation; 29.2% underwent gastric lavage.
• Caustic Cases: Required intensive management (antibiotics, PPIs, NPO status). 48% received combined therapy.
• CO Cases: Managed with oxygen therapy; all recovered fully.

Outcomes & Hospitalization:

• Duration: Most patients (89.8%) were discharged without complications.
  • Medication cases: 1–4 days (J0–J4).
  • Caustic cases: Up to 14 days (J0–J14), reflecting the severity of mucosal injury.
  • CO, electricity, and plant cases: Discharged after supportive management without prolonged admission.
• Mortality: No deaths reported in the cohort.

5. Significance and Implications

• Preventability: The study confirms that pediatric poisonings in this setting are largely preventable, driven primarily by unsafe storage of medications and household chemicals and limited caregiver awareness.
• Public Health Policy: The findings advocate for:
  • Implementation of child-resistant packaging for pharmaceuticals.
  • Public education campaigns on the safe storage of caustic agents (e.g., drain cleaners, acids).
  • Installation of carbon monoxide detectors and improved domestic ventilation.
• Clinical Protocols: The data supports the establishment of standardized clinical protocols, particularly for the early endoscopic evaluation of caustic ingestions to manage mucosal injury and prevent long-term sequelae (e.g., strictures).
• Resource Allocation: Understanding that caustic ingestions drive the longest hospital stays allows for better resource planning in pediatric emergency and inpatient units.

In conclusion, the study underscores the critical need for coordinated efforts between healthcare providers, public health authorities, and families to mitigate the risk of pediatric poisoning in Algeria through education, environmental safety measures, and optimized clinical management.