Toxic ingestions in children

Most ingestions will not require medical monitoring after discharge. Patients with significant acetaminophen ingestions causing hepatotoxicity should have liver function tests and prothrombin time-international normalized ratio checked at weekly intervals until the liver function and coagulation parameters normalize. The coagulation parameters of children who have ingested long-acting warfarin products should be monitored until normal. Children with exposure to cholinesterase inhibitors should avoid any medications requiring metabolism by plasma or acetylcholinesterase for 6 to 12 weeks or until cholinesterase activity has returned to normal. These children are at risk for prolonged paralysis and drug interactions during surgery if they are given depolarizing muscle relaxants.