Poisoning & Its Management
Poisoning & Its Management
Poisoning & Its Management
Poison
A poison is any substance that is harmful to
the body
Many poisonous substances are products
people have around the house. Even
medicines that aren't taken as directed can
be harmful.
Poisoning
Poisoning is a common
medical emergency in any
country
Poisoning occurs when any
substance interferes with
normal body functions after
it is swallowed, inhaled,
injected, or absorbed.
Types of Poisoning
1. Deliberate
2. Accidental
3. Environmental
4. Industrial exposures.
Poisoning Causes
Substances that may act as poisons include the
following:
Cleaning products
Household products, such as nail polish remover and other
personal care products
Pesticides
Metals, such as lead ,Mercury, which can be found in old
thermometers and batteries
Prescription and over-the-counter drugs when combined or
taken the wrong way
Contaminated food
Plants, such as poison ivy and poison oak
Venom from certain snake
Symptoms of Poisoning
Vomiting
Diarrhea
Nausea
Redness or sores around the mouth
Drooling or dry mouth
Dilated pupils or constricted pupils
Rash
Confusion
Shaking or seizures
Trouble breathing
Management of Poisoning
The holistic management of toxic exposures should
include the following considerations based on a risk
assessment approach:
Resuscitation and stabilization
Toxic diagnosis
Therapeutic interventions
• Decontamination
• Enhanced elimination of absorbed toxins
• Antidotes
IV. Supportive care
Resuscitation & Stabilization
First priorities are ABC’s (Airways, Breathing
& Circulation)
Vital sign including pulse and hypoglycemia
must be corrected
Unresponsive patients treated empirically with
coma cocktail
Oxygen, naloxone, dextrose 50W (D50W), and
100mg thiamine
50 ml of D50W for adults and 1g/kg glucose for
children (4ml/kg D25W of 10ml/kg of D10W)
Thiamine not usually given to children
Toxicological Diagnosis
History
Need to obtain as much information as possible about exposure
i.e. number of exposed persons, type of exposure, amount or
dose, route
Patients intent must be determined
Examination
Undress patient completely for thorough examination
Check clothing for objects or substances
Assess general appearance of patient
Examine skin for bruising, cyanosis, flushing
Assess ABCDE (Airways, Breathing, Circulation, Disability,
Exposure)
Toxicological Diagnosis
Toxicological Investigation
In the acute care setting toxicological screen is very
limited and does not contribute significantly
Toxicological screens may play a role in evaluation of
children
Gastric Emptying
Emesis: achieved by using syrup of ipecac
Dosing: 15 ml for 1-12 yo and 30 ml for adults;
may repeat once if no emesis in 12 hr
90% vomit within 20 minutes of first dose and
97% vomit with second dose
Usually 3-5 episodes of emesis and resolve
in two hours; if protracted emesis occurs
consider toxin as etiology
Gastric Emptying
Orogastric lavage: 36-40 French tube used in
adults and 22-24 French tube in children.
Measure from chin to xiphoid and confirm with air
insufflation
Lavage with room temperature water until it
runs clear
Charcoal should be used before withdrawal of
tube
Toxin Adsorption in Gut
Activated Charcoal
Multiple-Dose Activated Charcoal
Cathartics
Whole-Bowel Irrigation
Activated Charcoal
Most appropriate agent to decontaminate GI tract
Adsorbs toxin in gut lumen
Safety proven in adults and children
Dose 1g/kg
Indications: any drug known to absorb it or after
unknown ingestions by patient’s with protected
airways
Multi-Dose Charcoal
One dose usually sufficient
Indications for multi-dose activated charcoal:
ingestion of large doses, substances that form
bezoars, slow release toxins, toxins that slow
gut function, toxins with enterohepatic or
enteroenteric circulation
Repeat dose is 0.25-0.5 g/kg
Cathartics
Osmotic cathartic usually given with activated
charcoal
70% sorbitol (1 g/kg) or 10% magnesium
citrate
Shown to decrease transit time of activated
charcoal
No definitive clinical human data suggest that
a cathartic limits toxins bioavailability or
changes patient’s outcome
Enhanced Elimination
Alkalinization
Forced diuresis
Hemodialysis/Hemoperfusion
Alkalinization
Beneficial in certain ingestions: 2-4-D
(herbicide), phenobarbital, chlorpropamide,
salicylates, methanol
Alkalinization achieved by IV dose of
bicarbonate at 1-2 mEq/kg, followed by
intermittent boluses or continuous
bicarbonate drip for urine pH 7.5-8.0
Profound hypokalemia may result, must
aggressively replace
Hemodialysis/Hemoperfusion
Dialysis reserved for specific toxins:
salicylates, methanol, ethylene glycol, lithium,
theophylline, amanita (mushrooms)
Benefits: removal of toxins already absorbed
by gut, ability to remove parent compound
and active metabolite,
Less effective when toxin has large volume of
distribution (>1 L/kg), has large molecular
weight, or highly protein bound
Hemoperfusion
Used for decontamination of patient’s
systemic circulation
Involves placing a filter filled with activated
charcoal into dialysis circuit
Alleviates constraints of protein binding and
molecular size
Toxins must be well absorbed by charcoal
and have small volume of distribution
Poison Prevention
Only take prescription medications that are
prescribed by a healthcare professional.
Never take larger or more frequent doses of
your medications, particularly prescription
pain medications, to try to get faster or more
powerful effects.
Never share or sell your prescription drugs.
Follow directions on the label when you give
or take medicines.
Poison Prevention
Turn on a light when you give or take
medicines at night so that you know you have
the correct amount of the right medicine.
Keep medicines in their original bottles or
containers.
Monitor the use of medicines prescribed for
children and teenagers, such as medicines
for attention deficit hyperactivity disorder, or
ADHD.
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