Traps for the unwary

November 2010

FocusTraps for the unwary

Small dose...

Big poison

Volume 39, No.11, November 2010 Pages 826-833

George Braitberg

Ed Oakley

All substances are poisons; There is none which is not a poison. The right dose differentiates a poison from a remedy. Paracelsus (1493–1541)1


It is not possible to identify all toxic substances in a single journal article. However, there are some exposures that in small doses are potentially fatal. Many of these exposures are particularly toxic to children. Using data from poison control centres, it is possible to recognise this group of exposures.


This article provides information to assist the general practitioner to identify potential toxic substance exposures in children.


In this article the authors report the signs and symptoms of toxic exposures and identify the time of onset. Where clear recommendations on the period of observation and known fatal dose are available, these are provided. We do not discuss management or disposition, and advise readers to contact the Poison Information Service or a toxicologist for this advice.

Poisoning is a frequent occurrence with a low fatality rate. In 2008, almost 2.5 million human exposures were reported to the National Poison Data System (NPDS) in the United States, of which only 1315 were thought to contribute to fatality.2 The most common poisons associated with fatalities are shown in Figure 1. Polypharmacy (the ingestion of more than one drug) is far more common.

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