Common Poisons

MANAGEMENT OF
COMMON
POISONING
DIGOXIN TOXICITY(>1.1ng/ml)
Extra cardiac Cardiac
Anorexia, nausea, vomiting Pulses bigeminus, Extrasystole
Abdominal pain due to gastric irritation Arrhythmia, Ventricular tachycardia
Fatigue, malaise, headache Partial/complete A-V block may be
associated with arrhythmias
Confusion, restlessness, psychosis Severe bradycardia

Hyperapnoea, visual disturbance Atrial extra systole
Rashes, gynacomastia Ventricular fibrillation
DIGOXIN TOXICITY
TREATMENT
• Further doses of Digoxin must be stopped at the earliest sign of
toxicity.
• Tachyarrythmias - Infuse KCl 20mmol/hr (max 100mmol/hr)
• Ventricular arrhythmias - Lidocaine IV, 50 – 100mg bolus, followed by
20 – 40mg every 10 – 20minutes. (1 – 3mg/min infusion)
• Supraventricular arrhythmias - Propranolol IV; 1mg/min. (max 5mg)
under close monitoring. Oral – 40 -80mg  2 – 4times/day.
• A-V block & bradycardia - Atropine 0.6 to 1.2mg IM
• Digoxin antibody (digibind)  38mg vial IV infusion.
SNAKE BITE
Symptoms:
• Mild - local findings only
• Moderate - Swelling that is clearly progressive
• Severe - Respiratory disturbance, neurological dysfunction, CVS
dysfunction & CNS instability, shock.
Treatment
• Don’t handle the limb too much
• Inj. TT 0.5ml I.M
• Administer -- anti snake venom
Moderate – 5 to 6 vials
Severe – 6-10 vials or more
• Mix reconstituted vials in 500ml of normal saline.
• Inj Hydrocortisone 100mg IM(If Hypersensitivity reaction see
• Inj Atropine and Inj Neostigmine if Cobra bite(to prevent neurotoxicity)
• Exchange transfusion if Russel viper to avoid hematotoxicity
Management of some common
Poisonings.
SCORPION STING
• Inj Tetanus Toxoid 0.5 cc IM
• Inj Chlorpheniramine Maleate 2cc im
• Inj Hydrocortisone 100mg IV stat
• Inj Tramadol / Inj Diclofenac 1 amp (SOS)
• Inj Rantac 50mg IV BD X 5 days
• Tab Prazosin 2.5 mg stat (Severe secondary HTN)
• Tab Chymoral forte TID (On discharge)
• Inj Taxim 1g IV BD X 5 days or Amoxicillin + Clavulinic acid TID for 5days (in
case of secondary infection of the affected site)
• Local infiltration of 1% Lignocaine if the pain is persists
Poisonings.
METHYL ALCOHOL
• Keep the patients in quiet dark room. Gastric lavage with sodium bicarbonate
if patient is brought within 2 hrs of ingestion of methanol.
• KCl infusion in hypokalemia.
• Ethanol 100mg/dl in blood saturate alcohol dehydrogenase and retards
methanol metabolism.
• Ethanol (10% in water)- through NGT loading dose-0.7 ml/kg followed by
0.15 ml/kg/hr.
• Fomepizole- specific inhibitor of alcohol dehydrogenase retards methanol
metabolism. loading dose 15mg/kg iv followed by 10mg/kg every 12hrs till
serum methanol fall below 20mg/kg.
• Folate therapy- calcium lecovorin 50mg 6th hrly.
Poisonings.
OP Poisoning management
• Termination of further exposure to poison, fresh air, wash the skin
and mucous membrane with soap water & gastric lavage .
• Maintain patent airway
• Maintain B.P.
• Inj Diazepam 5mg iv for convulsion
Specific antidote:
• Inj Atropine-2mg IV every 10 min till the signs of atropinization.
• Inj Pralidoxime-1 to 2g iv slowly.
Poisonings.
PARACETAMOL POISONING
Symptoms:-nausea, vomiting, abdominal pain, liver tenderness
after 12-18hrs - hepatic necrosis.
Treatment:
• Activated charcoal is given orally or through tube to prevent further
absorption
• B.P. respiration, heart rate & other vitals are monitored.
• N-acetyl cysteine 150 mg/kg iv over 15 min followed by 150 mg/kg iv
over next 20 hrs,75 mg/kg orally every 4-6 hrs for 2-3 days.
Poisonings.
TRICYCLIC ANTIDEPRESSANTS
Symptoms:- excitement ,delirium & other anticholinergic symptoms,
muscle spasm, convulsion, coma, respiration is depressed, body
temperature may fall, BP is low, tachycartdia.
TREATMENT: Gastric lavage
• Respiratory support, fluid infusion maintenance of BP and body
temperature.
• Acidosis corrected by bicarbonates infusion
• Diazepam injected iv to control convulsion and delirium.
• Propranolol/lidocaine used to treat cardiac arrhythmias.
BARBITURATE POISONING
Manifestations are due to excessive CNS depression :
• patient is flabby and comatose with shallow and failing respiration,
Fall in BP and cardiovascular collapse, Renal shut down, Pulmonary
complications, bullous eruptions.
• Lethal dose : 2–3 g for the more lipid-soluble agents (short-acting
barbiturates) and 5–10 g for less lipid-soluble phenobarbitone.
BARBITURATE POISONING
Treatment :
• There is no specific antidote for barbiturates.
1. Gastric lavage - to prevent absorption of the drug from intestine.
2. Supportive measures: airway, assisted respiration, oxygen, maintenance of blood
volume by fluid infusion and use of vasopressors—dopamine infusion may be
preferred for its renal vasodilating action.
3. Alkaline diuresis: with sodium bicarbonate 1 mEq/kg i.v. only in the case of long
acting barbiturates which are eliminated primarily by renal excretion.
4. Haemodialysis and haemoperfusion is highly effective in removing long-acting
as well as short-acting barbiturates.
Treatment of Acute iron poisoning :
1. Stomach wash with 1% NaHCO3 to render it insoluble and remove
undissolved iron tablets
2. Desferrioxamine Mesylate 5 to 10 g in 100 mL isotonic saline to retard
the absorption from GIT
3. Early replacement of fluids and electrolytes, correction of metabolic
acidosis and hypotension by using RL and vasopressors
4. Diazepam and other anticonvulsants if epileptic
DESFERRIOXAMINE MESYLATE
• Obtained - streptomyces pilosus
• Binds ferric iron to form ferrioxamine a stable water soluble chelate
• Ferrioxamine is excreted 2/3 in urine and 1/3 in bile colors urine
reddish brown
• Well tolerated, rapid I.V may cause hypotension, anaphylactic
reactions and tachycardia
• Contraindicated in renal disease and pregnancy

Common Poisons

Uploaded by

Copyright:

Available Formats

Common Poisons

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Common Poisons

Uploaded by

Copyright:

Available Formats

MANAGEMENT OF

Confusion, restlessness, psychosis Severe bradycardia

• Binds ferric iron to form ferrioxamine a stable water soluble chelate

• Ferrioxamine is excreted 2/3 in urine and 1/3 in bile colors urine

• Well tolerated, rapid I.V may cause hypotension, anaphylactic

reactions and tachycardia

• Contraindicated in renal disease and pregnancy

You might also like