Poisoning: First aid

By Mayo Clinic staff Many conditions mimic the signs and symptoms of poisoning, including seizures, alcohol intoxication, strokes and insulin reactions. So look for the signs and symptoms listed below and if you suspect poisoning, call your regional poison control center or, in the United States, the National Capital Poison Center at 800-222-1222 before giving anything to the affected person. Signs and symptoms of poisoning Common signs and symptoms to look for include:

Burns or redness around the mouth and lips, from drinking certain poisons Breath that smells like chemicals, such as gasoline or paint thinner Burns, stains and odors on the person, on clothing, or on furniture, floor, rugs or other objects in the surrounding area Empty medication bottles or scattered pills Vomiting, difficulty breathing, sleepiness, confusion or other unexpected signs

When to call for help Call 911 or your local emergency number immediately if the person is:

Drowsy or unconscious Having difficulty breathing or has stopped breathing Uncontrollably restless or agitated Having seizures

If the person seems stable and has no symptoms, but you suspect poisoning, call your regional poison control center or, in the United States, the National Capital Poison Center at 800-222-1222. Provide information about the person's symptoms, age and weight, and any information you have about the poison, such as amount and how long since the person was exposed to it. It helps to have the pill bottle or poison container on hand when you call. What to do while waiting for help Some things you can do for the person until help arrives:

If the person has been exposed to poisonous fumes, such as carbon monoxide, get him or her into fresh air immediately. If the person swallowed the poison, remove anything remaining in the mouth. If the suspected poison is a household cleaner or other chemical, read the label and follow instructions for accidental poisoning. If the product is toxic, the label will likely advise you to call the poison center at 800-222-1222. Also call this 800 number if you can't identify the poison, if it's medication or if there are no instructions. Follow treatment directions that are given by the poison control center. If the poison spilled on the person's clothing, skin or eyes, remove the clothing. Flush the skin or eyes with cool or lukewarm water, such as by using a shower for 20 minutes or until help arrives. Make sure the person is breathing. If not, start CPR and rescue breathing. Take the poison container (or any pill bottles) with you to the hospital.

What NOT to do Don't give ipecac syrup or do anything to induce vomiting. The American Academy of Pediatrics advises discarding ipecac in the home, saying there's no good evidence of effectiveness and that it can do more harm than good.
http://www.mayoclinic.com/health/first-aid-poisoning/FA00029

Poisons
Introduction to poisons
A poison - also called a toxin - is a substance which, if taken into the body in sufficient quantity, may cause temporary or permanent damage. Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes, or injected. Once in the body, they may enter the bloodstream and be carried swiftly to all organs and tissues. Recognition features vary with the poison - they may develop quickly or over a number of days. See the individual tips for recognition features and treatment of specific poisions.

Swallowed poisons
Introduction
Chemicals that are swallowed may harm the digestive tract, or cause more widespread damage if they enter the bloodstream and are transported to other parts of the body. Hazardous chemicals include common household substances. For example, bleach, dishwasher detergent, and paint stripper are poisonous or corrosive if swallowed. Drugs, whether they are prescribed or bought over the counter, are also potentially harmful if they are taken in overdose. The effects of poisoning depend on the substance that has been swallowed.

Recognition features
Depends on the poison, but there may be:

vomiting, sometimes bloodstained impaired consciousness pain or burning sensation empty containers in the vicinity history of ingestion/exposure.

Treatment
Your aims:

To maintain the airway, breathing, and circulation To remove any contaminated clothing To identify the poison

To arrange urgent removal to hospital.

If the casualty is conscious:

Ask them what they have swallowed Try to reassure them Dial 999 for an ambulance Give as much information as possible about the swallowed poison. This information will assist doctors to give appropriate treatment once the casualty reaches hospital.

If the casualty becomes unconscious:

Open the airway and check breathing Be prepared to give chest compressions and rescue breaths if necessary Place them into the recovery position if the casualty is unconscious but breathing normally Use a face shield or pocket mask for rescue breathing if there are any chemicals on the casualty's mouth.

Drug poisoning
Introduction
Poisoning can result from an overdose of either prescribed drugs or drugs that are bought over the counter. It can also be caused by drug abuse or drug interaction. The effects vary depending on the type of drug and how it is taken (see table below). When you call the emergency services, give as much information as possible. While waiting for help to arrive, look for containers that might help you to identify the drug.

Recognition features
Category Drug

Effects of poisioning upper abdominal pain nausea & vomiting ringing in the ears sighing when breathing confusion and delirium dizziness. little effect at first, but abdominal pain, nausea and vomiting may develop irreversible liver damage may occur within 3 days (malnourishment and alcohol increase the risk). lethargy and sleepiness, leading to unconsciousness shallow breathing

Painkillers

Asprin (swallowed)

Paracetamol (swallowed)

Nervous system depressants and tranquillisers

Barbiturates and benzodiazepines (swallowed)

Category

Drug

Effects of poisioning weak, irregular, or abnormally slow or fast pulse. excitable, hyperactive behaviour, wildness and frenzy sweating tremor of the hands hallucinations. small pupils sluggishness and confusion, possibly leading to unconsciousness slow, shallow breathing which may stop altogether needle marks, which may be infected. nausea and vomiting headaches hallucinations possibly, unconsciousness rarely, cardiac arrest.

Stimulants and hallucinogens

Amphetamines (including Ectasy) and LSD (swallowed); cocaine (inhaled)

Narcotics

Morphine, heroin (commonly injected)

Solvents

Glue, lighter fuel (inhaled)

Treatment
Your aims:

To maintain breathing and circulation To arrange removal to hospital.

If the casualty is conscious:

Help them into a comfortable position Ask them what they have taken Reassure them while you talk to them Dial 999 for an ambulance Monitor and record vital signs - level of response, pulse and breathing - until medical help arrives Look for evidence that might help to identify the drug, such as empty containers. Give these samples and containers to the paramedic or ambulance crew.

If the casualty becomes unconscious:

open the airway and check breathing be prepared to give chest compressions and rescue breaths if necessary place them into the recovery position if the casualty is unconscious but breathing normally

dial 999 for an ambulance.

DO NOT induce vomiting.

Poisonous plants and fungi

Introduction
Many young children eat plant leaves or brightly coloured berries, but serious poisoning as a result rarely occurs. However, ingesting even small amounts of foxglove or wild arum can cause nausea, vomiting, and stomach cramps; and large amounts are potentially fatal. Seizures may occur after ingesting laburnum seeds. Serious poisoning as a result of eating mushrooms is also rare. Mushrooms found in the garden may cause nausea, vomiting, and occasionally, hallucinations. Death cap mushrooms cause vomiting and severe watery diarrhoea between 6 and 12 hours after ingestion and can be fatal.

Recognition features
There may be:

nausea and vomiting cramping abdominal pains diarrhoea seizures impaired consciousness.

Treatment
Your aims:

To identify the poisonous plant, if available To manage any seizures To seek medical aid if necessary.

If the casualty is conscious:

Ask them what they have eaten and reasure them Try to identify the poisonous plant, and find out which part of it has been eaten Get medical advice at once so that the appropriate treatment can be given Keep any small pieces of the plant that you have found to show to the doctor or send with the casualty to hospital.

If the casualty becomes unconscious:

open the airway and check breathing be prepared to give chest compressions and rescue breaths if necessary

place them into the recovery position if the casualty is unconscious but breathing normally dial 999 for an ambulance.

Do not induce vomiting.

Alcohol poisoning
Introduction
Alcohol (chemical name, ethanol) is a drug that depresses the activity of the central nervous system - in particular, the brain. Prolonged or excessive intake can severely impair all physical and mental functions, and the person may sink into deep unconsciousness. There are several risks to the casualty from alcohol poisoning:

An unconscious casualty risks inhaling and choking on vomit Alcohol widens (dilates) the blood vessels. This means that the person loses heat, and hypothermia may develop A casualty who smells of alcohol may be misdiagnosed and not receive appropriate treatment for an underlying cause of unconsciousness, such as a head injury, stroke, or heart attack.

Recognition features
There may be:

a strong smell of alcohol empty bottles or cans impaired consciousness: the casualty may respond if roused, but will quickly relapse flushed and moist face deep, noisy breathing full, bounding pulse unconsciousness.

In the later stages of unconsciousness:

Dry, bloated appearance to the face Shallow breathing Weak, rapid pulse Dilated pupils that react poorly to light.

Treatment
Your aims:

to maintain an open airway

to assess for other conditions to seek medical help if necessary.

If the casualty is conscious:

cover a casualty with a coat or blanket to protect them from the cold assess the casualty for any injuries, especially head injuries, or other medical conditions monitor and record vital signs - level of response, pulse and breathing - until the casualty recovers or is placed in the care of a responsible person.

If the casualty becomes unconscious:

open the airway and check breathing be prepared to give chest compressions and rescue breaths if necessary place them into the recovery position if the casualty is unconscious but breathing normally dial 999 for an ambulance.

DO NOT induce vomiting.

Food poisoning
Introduction
Food poisoning is usually caused by consuming food or drink that is contaminated with bacteria or viruses. Some food poisoning is caused by poisons (toxins) from bacteria already in the food. The salmonella or E. coli group of bacteria, which are found mainly in meat, are common causes of food poisoning. Symptoms may develop rapidly (within hours), or they may not occur until a day or so after eating contaminated food. Toxic food poisoning is frequently caused by poisons produced by the staphylococcus group of bacteria. Symptoms usually develop rapidly, possibly with two to six hours of eating the affected food. One of the dangers of food poisoning is loss of body fluids. The dehydration that results from this fluid loss can be serious if the fluids are not replaced quickly enough. Dehydration is especially serious in the very young and the very old, and, in some cases, treatment may be required in hospital.

Recognition features
There may be:

nausea and vomiting cramping abdominal pains diarrhoea (possibly bloodstained) headache or fever features of shock impaired consciousness.

Your aims

to encourage the casualty to rest to give the casualty plenty of bland fluids to drink to seek medical help if necessary.

Treatment

Advise the casualty to lie down and rest. Help them if necessary Give the casualty plenty of bland fluids to drink and a bowl to use if they vomit Call a doctor for advice.

If the casualty's condition worsens:

Dial 999 for an ambulance.

http://www.sja.org.uk/sja/first-aid-advice/poisoning.aspx

Poisoning Overview
If you or someone you know has swallowed or breathed in a poison, and you or they have serious signs or symptoms (nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin color), then you must either call an ambulance for transport to a hospital emergency department or call a poison control center for guidance. The National Poison Control Center phone number in the U.S. is 1-800-2221222. If the person has no symptoms but has taken a potentially dangerous poison, you should also call a poison control center or go to the nearest emergency department for an evaluation. Poison is anything that kills or injures through its chemical actions. Most poisons are swallowed (ingested). The word poison comes from the Latin word - potare - meaning to drink. But poisons can also enter the body in other ways:

By breathing Through the skin By IV injection From exposure to radiation Venom from a snake bite

Poisoning Causes
Poisons include highly toxic chemicals not meant for human ingestion or contact, such as cyanide, paint thinners, or household cleaning products. Many poisons, however, are substances meant for humans to eat, including foods and medicines. Foods

Some mushrooms are poisonous Drinking water contaminated by agricultural or industrial chemicals

Food that has not been properly prepared or handled

Drugs Drugs that are helpful in therapeutic doses may be deadly when taken in excess. Examples include:

Beta blockers: Beta blockers are a class of drugs used to treat heart conditions (for example, angina, abnormal heart rhythms) and other conditions, for example, high blood pressure, migraine headache prevention, social phobia, and certain types of tremors. In excess, they can cause difficulty breathing, coma, and heart failure. Warfarin (Coumadin): Coumadin is a blood thinner used to prevent blood clots. It is the active ingredient in many rat poisons and may cause heavy bleeding and death if too much is taken. Vitamins: Vitamins, especially A and D, if taken in large amounts can cause liver problems and death.

Poisoning Symptoms
The signs and symptoms seen in poisoning are so wide and variable that there is no easy way to classify them.

Some poisons enlarge the pupils, while others shrink them. Some result in excessive drooling, while others dry the mouth and skin. Some speed the heart, while others slow the heart. Some increase the breathing rate, while others slow it. Some cause pain, while others are painless. Some cause hyperactivity, while others cause drowsiness. Confusion is often seen with these symptoms.

When the cause of the poisoning is unknown A big part of figuring out what type of poisoning has occurred is connecting the signs and symptoms to each other, and to additional available information.

Two different poisons, for example, may make the heart beat quickly. However, only one of them may cause the skin and mouth to be very dry. This simple distinction may help narrow the possibilities. If more than one person has the same signs and symptoms, and they have a common exposure source, such as contaminated food, water, or workplace environment, then poisoning would be suspected. When two or more poisons act together, they may cause signs and symptoms not typical of any single poison.

Toxidromes Certain poisons cause what toxicologists call toxidromes - a contraction of the words toxic and syndrome. Toxidromes consist of groups of signs and symptoms found together with a given type of poisoning.

For example: Jimson weed, a plant smoked or ingested for its hallucinogenic properties, produces the anticholinergic toxidrome: Rapid heart rate, large pupils, dry hot skin, retention of urine, mental confusion, hallucinations, and coma. Most poisons either have no associated toxidrome or have only some of the expected features of the toxidrome.

Delayed onset of symptoms

A person can be poisoned and not show symptoms for hours, days, or months. Cases of poisoning with a prolonged onset of symptoms are particularly dangerous because there may be a dangerous delay in obtaining medical attention.

Acetaminophen (Tylenol) is considered one of the safest drugs but is toxic to the liver when taken in large quantities. Because it acts so slowly, 7-12 hours may pass before the first symptoms begin (no appetite when normally hungry, nausea, and vomiting). The classic example of a very slow poison is lead. Before 1970, most paints contained lead. Young children would eat paint chips and, after several months, develop abnormalities of the nervous system.

When the illness may be poisoning - or may not be poisoning Some signs and symptoms of poisoning can imitate signs and symptoms of common illnesses.

For example, nausea and vomiting are a sign (vomiting) and symptom (nausea) of poisoning. However, nausea and vomiting can also be found in many illnesses that have nothing to do with poisoning. Examples include: o stroke,
o o o o o o o

heart attack, stomach ulcers, gallbladder problems, hepatitis, appendicitis, head injuries, and many others.

Almost every possible sign or symptom of a poisoning can also be caused by a nonpoison-related medical problem.

When to Seek Medical Care

Call the U.S. National Poison Control Center at 1-800-222-1222 if you have questions about possible poisoning. You can also go directly to your hospital's emergency department.

Don't assume over-the-counter medications are safe even if taken in excess. Call the poison control center for advice. With many pills, it may take several hours or longer for symptoms to develop. Do not wait for symptoms to develop, call the poison control center for advice.

Go to your hospital's emergency department if any of the following occurs:

If someone looks ill after a poisoning or possible poisoning. An infant or toddler who may have ingested a poison, even if the child looks and feels fine. Anyone who has taken something in an attempt to harm himself or herself, even if the substance used is not known to be harmful.

When you go to the hospital's emergency department, take all the medicine bottles, containers (household cleaners, paint cans, vitamin bottles), or samples of the substance (such as a plant leaf) with you.

Exams and Tests

A combination of history, physical examination, and laboratory studies will help reveal the cause of most poisonings. Frequently, treatment must begin before all information is available. History: As a family member or friend of a poisoned person, you can greatly assist the doctor and provide valuable clues by telling the doctor about these details:

Everything the person ate or drank recently Names of all prescription and over-the-counter medications the person is taking Exposure to chemicals at home or at work Whether others in the family or at work have been similarly ill or exposed Whether the person has any psychiatric history to suggest an intentional ingestion (suicide attempt)

Testing: Many poisons can be detected in the blood or urine. However, a physician cannot order "every test in the book" when the diagnosis is unclear. The tests ordered will be based on information revealed in the history and physical exam.

A toxicology screen or "tox" screen looks for common drugs of abuse. Most toxicology screens will detect: o acetaminophen,
o o o o o o o

aspirin, marijuana, opioids (heroin, codeine), benzodiazepines (Valium, Librium), amphetamines (uppers), cocaine, and alcohol.

A specific blood test will give serum levels of some drugs, including phenytoin (Dilantin), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), digoxin (Lanoxin), lithium (Lithobid), and acetaminophen. Some drugs affect the electrical activity of the heart. An electrocardiogram (ECG) may reveal toxicity. Sometimes a person is unconscious for no obvious reason. A CT scan of the brain will help tell if there has been a structural change in the brain, such as a stroke.

Poisoning Treatment Self-Care at Home

If you or someone you know has swallowed or breathed a poison and you or they have signs or symptoms, such as nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin color,

then you must call either an ambulance or the U.S. National Poison Control Center at 1-800-222-1222 for guidance. This number is routed to the poison control center that serves your area.

Post the telephone number (along with police, fire, and 911 or equivalent) near your home phones. Do not induce vomiting or give syrup of Ipecac.
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Ipecac was previously used to induce vomiting in poisoned patients where there was a chance to get the toxin out of the body. Several advisory bodies such as the American Association of Poison Control Centers and the American Academy of Pediatrics have recommended that Ipecac NOT be used and that it should not even be kept in the household. For more information on this subject go to: http://www.poison.org/prepared/ipecac.asp

Do not give activated charcoal at home. Allow medical personnel to decide if this treatment is appropriate. The poison control center will instruct you what to do or if an antidote is readily available.

Medical Treatment
Elimination: Get rid of the unabsorbed poison before it can do any harm.

If the person is unconscious, the doctor will put a flexible, soft, plastic tube into the windpipe to protect the person from suffocating in his or her own vomit and to provide artificial breathing (intubation). Once the poison has moved past the stomach, other methods are needed.
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Activated charcoal acts as a "super" absorber of many poisons. Once the poison is stuck to the charcoal in the intestine, the poison cannot get absorbed into the bloodstream. Activated charcoal has no taste, but the gritty texture sometimes causes the person to vomit. To be effective, activated charcoal needs to be given as soon as possible after the poisoning. It does not work with alcohol, caustics, lithium (Lithobid), or petroleum products. Whole bowel irrigation requires drinking a large quantity of a fluid called Golytely. This flushes the entire gastrointestinal tract before the poison gets absorbed.

Antidotes: Some poisons have specific antidotes. Antidotes either prevent the poison from working or reverse the effects of the poison.

Atropine is an antidote for certain nerve gases and insecticides. During Operation Desert Storm, all military personnel were issued atropine injectors when it was feared that the enemy would use nerve gas. A common antidote is N-acetylcysteine (Mucomyst), which is used to neutralize acetaminophen (Tylenol) overdoses. Acetaminophen, in normal doses, is one of the safest medications known, but after a massive overdose, the liver is damaged, and hepatitis and liver failure develop. Mucomyst works as an antidote by bolstering the body's natural detoxification abilities when they are overwhelmed. It may also be possible to reverse the harmful effect of a drug even if no antidote exists.
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If a person with diabetes takes too much insulin, a dangerously low blood sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death. Sugar given by mouth or IV is an effective treatment until the insulin wears off. When the poison is a heavy metal, such as lead, special medicines (chelators) bind the poison in the bloodstream and cause it to be eliminated in the urine.

Another "binder" is sodium polystyrene sulfonate (Kayexalate), which can absorb potassium and other electrolytes from the bloodstream.

General supportive measures: When there are no specific treatments, the physician will treat signs and symptoms as needed.

If the person is agitated or hallucinating, a sedative can be given to calm the person until the drug wears off. A ventilator can be used to breathe for anyone who has stopped breathing from a poisoning. Antiseizure medicines can be used to treat or prevent seizures.

Next Steps Outlook

The key to a good outcome is rapid recognition that a poisoning has occurred and rapid transport to a qualified medical facility when indicated.

When medical care (and use of the U.S. National Poison Control Center-1-800-222-1222) is provided promptly, the vast majority of people survive poisonings. Poor outcomes can occur when these are the cause of the poisoning:
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Highly toxic substances such as cyanide Substances that injure body tissues immediately (lye or acids, for example) Poisoning as a result of exposure over time, often unrecognized (examples include polluted water, workplace exposures, and lead)

http://www.emedicinehealth.com/poisoning/.htm

Poisoning
Introduction
Alcohol poisoning
Drinking too much alcohol in a short space of time can lead to poisoning. Read more about alcohol poisoning.

Plant dangers in the garden and countryside

Keep your family safe with this guide to plant hazards, and find out what to do if someone is affected Poisoning is when a person is exposed to a substance that can damage their health or put their life in danger. Poisoning is a common health problem, resulting in around 120,000 hospital admissions each year in England. Most cases of poisoning happen at home and children under five have the highest risk of accidental poisoning.

The most common way a person becomes poisoned is by swallowing a harmful substance, although you can also be poisoned by:

inhaling a harmful substance such as carbon monoxide injecting a harmful substance such as heroin harmful substances, such as pesticides, splashing on your skin or eyes being poisoned by an insect or animal bite, such as a snake, though this is rare in England overdosing on an illegal drug or medication

The symptoms of poisoning will depend on the type of poison and the amount taken in, but general things to look out for include:

being sick stomach pains high temperature drowsiness and fainting fits

If a child has a sudden, unexplained illness, they may have been poisoned, especially if they are drowsy and confused.

What to do
If you suspect that someone has taken an overdose or has been poisoned do not try to treat them yourself. Get medical help immediately. If they do not appear to be seriously ill then call NHS Direct on 0845 46 47 for advice. If they are showing signs of being seriously ill, such as vomiting, loss of consciousness, drowsiness or seizures (fits) call 999 for an ambulance, or take the person to your local A&E department. Read more about what to do if you think someone has been poisoned.

Types of poisons
In England the most common way a person is poisoned is by taking an overdose of medication. This can include both over-the-counter medications such as paracetamol and prescription medications such as antidepressants. Other potential poisons include:

household products such as bleach cosmetic items such as nail polish some types of plants and fungi certain types of chemicals and pesticides

In around one in four reported cases of poisoning the person intentionally poisoned themselves as either an act of self-harm or an attempt at suicide. Read more about the causes of poisoning.

Treatment
A person who is poisoned is normally admitted to hospital for observation. A substance known as active charcoal may be given to stop the poison being absorbed into the blood. There are also several medications known as antidotes that can act against the harmful effect of a specific poison. For example, the antidote to paracetamol poisoning is called N-acetylcysteine, which protects the liver against the harmful effects of paracetamol. Of those people who are admitted to hospital for poisoning, fewer than 1 in 100 dies. Read more about treating poisoning.

Prevention
There are several steps you can take to reduce your (or your childs) risk of poisoning. These include carefully reading the patient information leaflet that comes with your medication and making sure any poisonous substances are locked away out of the sight and reach of your children.

Symptoms of poisoning
The symptoms of poisoning depend on the substance and the amount that you take in. Some poisonous substances, such as carbon monoxide, interfere with the blood's ability to carry oxygen. Others, such as bleach, burn and irritate the digestive system. Parents and carers should be aware of sudden, unexplained illness in young children, particularly if they are drowsy or unconscious, as poisoning could be the cause. If you suspect that someone has swallowed a poisonous substance, seek immediate medical advice. Read more about what to do if you think someone has been poisoned.

General symptoms
General symptoms of poisoning can include:

feeling sick being sick diarrhoea stomach pain drowsiness, dizziness or weakness high temperature of 38C (100.4F) or above chills (shivering) loss of appetite headache irritability difficulty swallowing (dysphagia) producing more saliva than normal

skin rash burns around the nose or mouth double or blurred vision seizures (fits) coma (in severe cases)

Symptoms of medication overdose

If you take a medication overdose, you may experience any of the specific symptoms below, as well as the more general symptoms above. The most common medications involved in cases of poisoning are listed below. Paracetamol Paracetamol is a widely used over-the-counter painkiller. Specific symptoms of paracetamol poisoning include:

jaundice (yellowing of the skin and the whites of the eyes)

Aspirin Aspirin was used as a painkiller in the past but is now increasingly used for its blood-thinning properties to prevent blood clots. Specific symptoms of aspirin poisoning include:

rapid breathing tinnitus (ringing in the ears)

Tricyclic antidepressants Tricyclic antidepressants are used to treat depression as well as a number of other mental health conditions such as panic disorder and obsessive compulsive disorder (OCD). Some types of tricyclic antidepressants can also be used to treat nerve pain. Specific symptoms of poisoning with tricyclic antidepressants include:

excitability dry mouth large pupils irregular heartbeat low blood pressure a rapid heart rhythm

Selective serotonin reuptake inhibitors (SSRIs) SSRIs are a newer type of antidepressant that are also used to treat a number of other mental health conditions such as OCD and anxiety disorder.

Specific symptoms of SSRI poisoning include:

feeling agitated tremor (shaking) uncontrolled movement of the eyes (nystagmus)

In severe cases it can also cause:

high blood pressure and a rapid heart rhythm confusion severe muscle tension

Beta-blockers Beta-blockers are used to treat a number of conditions that affect the heart or blood such as high blood pressure, angina and heart failure. Specific symptoms of poisoning with beta-blockers include:

low blood pressure a low pulse rate (below 60 beats a minute)

Calcium-channel blockers Calcium-channel blockers are used in the treatment of high blood pressure and angina. Specific symptoms of calcium-channel blocker poisoning include:

chest pain low blood pressure a low pulse rate (below 60 beats a minute) blue skin breathing problems

Benzodiazepines Benzodiazepines are a type of tranquiliser that are often used on a short-term basis to treat anxiety and sleeping problems (insomnia). Specific symptoms of poisoning with benzodiazepines include:

co-ordination and speech difficulties low blood pressure hypothermia (where body temperature drops below 35C/95F) shallow breathing

Opioids Opioids are a type of stronger painkillers that are used to treat moderate to severe pain. Opioids include codeine and morphine as well as the illegal drug heroin.

Specific symptoms of opioid poisoning include:

small pupils shallow breathing blue skin fluid on the lungs

Stimulant overdose If you take too much of a stimulant-like drug such as cocaine, amphetamine, crack or ecstasy, overdose symptoms can include:

anxiety and paranoia (feeling that people are out to get you) chest pain high temperature high blood pressure rapid breathing and heartbeat mental confusion hallucinations (seeing or hearing things that are not real) stomach cramps

Cannabis overdose If you smoke (or eat) too much cannabis then you may experience the following symptoms:

paranoia hallucinations numbness in your arms and legs

Causes of poisoning
In England, medications are the most common cause of poisoning and are responsible for more than half of all cases. The medications most commonly linked to poisoning are:

paracetamol aspirin tricyclic antidepressants selective serotonin reuptake inhibitors (SSRIs) beta-blockers calcium-channel blockers benzodiazepines opioids

However, all medications have the potential to be harmful if taken at too high a dose or taken by someone who has not been prescribed them, such as a child.

Household products
The second most common cause of poisoning is household products, which account for around one in five cases. These can include:

cleaning products, such as bleach, caustic soda and disinfectant cosmetics, such as baby oil, shampoo and nail varnish remover DIY products, such as paint, glue and wallpaper paste garden products, such as weedkiller and rat poison

Insects and snakes

Bees and wasps inject poison into your skin when they sting you, which can cause pain, swelling and itchiness. Bites from poisonous snakes can cause diarrhoea and sickness. The adder is the only poisonous snake that lives in the UK. How severely you are affected by a poisonous bite or sting depends on the amount of venom (poison) injected and whether you are allergic to it. Read more about insect stings and snake bites.

Food
Food can sometimes cause poisoning if:

it goes mouldy it becomes contaminated with bacteria from raw meat it has not been prepared or cooked properly

Read more about food poisoning.

Carbon monoxide
Carbon monoxide is a poisonous, odourless gas that is produced by the incomplete burning of fuels, such as gas, wood or petrol. These types of fuels are used in many household appliances, such as heaters and cookers. If appliances are not regularly serviced and well maintained, carbon monoxide can leak from them without you realising, which can cause loss of consciousness and death. Read more about carbon monoxide poisoning.

Younger children
Younger children under the age of six who are able to walk have an increased risk of poisoning. This is because they often put things in their mouth without realising they are harmful. Also, as their bodies are smaller they are more vulnerable to the harmful effects of certain substances.

The most common substances involved in cases of child poisoning are:

cosmetics cleaning products painkillers medications that come in cream, lotion or ointment form foreign bodies, such as small coins or batteries cough and cold medications plants vitamins antibiotics

What to do if someone has been poisoned

Being poisoned can be life threatening. If someone has swallowed a poisonous substance, do not try to treat them yourself. Get medical help immediately. If they are showing signs of being seriously ill then call 999 for an ambulance, or take them to your local A&E department. Symptoms associated with serious poisoning include:

being sick abdominal pain drowsiness or reduced levels of consciousness breathing difficulties seizures (fits)

But if a person does not appear to be seriously ill then telephone NHS Direct on 0845 46 47 for advice.

How to help
If you think someone has swallowed poison and they appear to be unconscious, try to wake them and encourage them to spit out any pills. Do not put your hand into their mouth and do not try to make them sick. If you are waiting for medical help to arrive, lie the person on their side with a cushion behind their back and their upper leg pulled slightly forward, so they do not fall on their face or roll backwards. Wipe any vomit away from their mouth and keep their head pointing down to allow any vomit to escape without them breathing it in or swallowing it. Do not give them anything to eat or drink.

Poisonous fumes
If you think someone has inhaled poisonous fumes, assess the situation first and do not put yourself in danger. Call for help and, if it is safe to do so, remove the person from the contaminated area.

Before entering the area, take two or three deep breaths and hold your breath until you come out. As soon as you are out of the affected area, call 999. Check that the person's airway is open. To do this lift their chin with one hand and gently tilt the head back. Then check that they are still breathing by placing your cheek close to their mouth to feel their breath. If they are not breathing, begin cardiopulmonary resuscitation (CPR) if you know how to (read more about how to perform CPR). If the person is breathing and conscious, cover them with a blanket and check them every 10 minutes to make sure they are still breathing until the ambulance arrives.

How to help medical staff

Medical staff will need to take a detailed history to effectively treat a person who has been poisoned. When the paramedics arrive or when you arrive at A&E, give them as much information as you can, including:

What substances you think the person may have swallowed. When the substance was taken (how long ago). Why the substance was taken whether it was an accident or deliberate. How it was taken (for example, swallowed). How much was taken (if you know).

Give details of any symptoms that the person has had, such as whether they have been sick. If they have been sick, collect a sample of their vomit as it may help medical staff to identify the poison. Medical staff may also want to know:

The person's age and estimated weight. Whether they have any existing medical conditions. Whether they are taking any medication (if you know).

If possible, give medical staff the container that the substance came in to give them a clear idea of what it is. If you do not know what caused the poisoning, blood tests may be needed to identify the cause.

Hospital treatment
Some people who have swallowed a poisonous substance or have overdosed on medication will be admitted to hospital for examination. Possible treatments that can be used to treat poisoning include:

Activated charcoal - healthcare professionals sometimes use activated charcoal (charcoal that has been treated so that it is pure carbon) to treat someone who has been poisoned. The charcoal binds to the poison and stops it from being further absorbed into the blood. Antidotes - these are substances that either prevent the poison from working or reverse the effects of the poison. Sedatives - these may be given if the person is agitated. A ventilator (breathing machine) - this may be used if the person stops breathing. Anti-epileptic medicine - this may be used if the person has seizures.

Tests and investigations

Investigations may include blood tests and an electrocardiogram. A blood test can be used to check the levels of chemicals and glucose in a persons blood. They may be used to perform a toxicology screen (tests to determine how many drugs or medication a person has taken) and a liver function test (which indicates how damaged the liver is). Go to the Lab Tests Online website for more information on liver function tests. An electrocardiogram (ECG) is an electrical recording of the heart to check that it is functioning properly.

Preventing poisoning in children Preventing accidents at home

Katrina Phillips of the Child Accident Prevention Trust explains how to make your home childproof and prevent avoidable accidents. The most common form of poisoning is from medication. The following advice should help prevent accidental poisoning by medication:

Always read the patient information leaflet that comes with your medication carefully and take your dosage exactly as recommended. If you are unsure about any of the instructions or have further questions, ask your pharmacist or GP for advice. Some medications should not be taken with alcohol or certain types of food. Check if this is the case for your medication. Some medications can react unpredictably if taken with other medications, including herbal remedies. Always check before combining different medications. Never take a medication that has been prescribed for somebody else. Keep all medication out of reach of children.

Children
The points provided below should help prevent accidental poisoning in your children.

Make sure all medicines, cleaning products, chemicals and potentially harmful cosmetics, such as nail varnish, are locked away out of the sight and reach of children. Do not store medicines, cleaning products or chemicals near food. Keep all chemicals in their original containers and never put medicines or chemicals, such as weedkiller, in soft-drinks bottles. When encouraging children to take medicine (when they are sick), do not refer to tablets as sweets. Do not leave old medicines lying around. Take them to your local pharmacist to dispose of safely. Keep cigarettes and tobacco out of the reach of children and do not smoke in front of children. Small batteries, such as those used for television remote controls, can be easily swallowed, so keep them out of the reach of children.

Whenever possible, buy medicines that come in child-proof containers. Rinse out medicine or cosmetic containers and dispose of them in a place where children cannot reach them. Do not take or give medicines in the dark to avoid taking an incorrect dosage.

If you have young children, be extra careful when you have guests to stay or when you go to visit other people. If your friends and relatives do not have children, they may not think to keep certain items out of the reach of children and their home is unlikely to be childproof. Keep an eye on your children at all times and politely ask guests to keep items such as alcohol and cigarettes out of their reach.
http://www.nhs.uk/Conditions/Poisoning/Pages/Prevention.aspx

Poisoning - First Aid and Emergency Treatment Guide

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Poisoning
Overview Causes Symptoms Treatment Steps to Avoid Prevention Overview Poisons are substances that cause injury, illness or death These events are caused by a chemical activity in the cells Poisons can be injected, inhaled or swallowed Poisoning should be suspected if a person is sick for unknown reason Poor ventilation can aggravate Inhalation poisoning First aid is critical in saving the life of victims

Causes Medications Drug overdose Occupational exposure Cleaning detergents/paints Carbon mono oxide gas from furnace, heaters Insecticides Certain cosmetics

Certain household plants, animals Food poisoning (Botulism) Symptoms

Blue lips Skin Rashes Difficulty in breathing Diarrhea Vomiting/Nausea Fever Head ache Giddiness/drowsiness Double vision Abdominal/chest pain Palpitations/Irritability Loss of appetite/bladder control Numbness Muscle twitching Seizures Weakness Loss of consciousness Treatment

Seek immediate medical help

Meanwhile, Try and identify the poison if possible Check for signs like burns around mouth, breathing difficulty or vomiting Induce vomiting if poison swallowed In case of convulsions, protect the person from self injury If the vomit falls on the skin, wash it thoroughly Position the victim on the left till medical help arrives

For inhalation poisoning Seek immediate emergency help Get help before you attempt to rescue others Hold a wet cloth to cover your nose and mouth

Open all the doors and windows Take deep breaths before you begin the rescue Avoid lighting a match Check the patient's breathing Do a CPR, if necessary If the patient vomits, take steps to prevent choking

Steps to Avoid Avoid giving an unconscious victim anything orally Do not induce vomiting unless told by a medical personnel Do not give any medication to the victim unless directed by a doctor Do not neutralize the poison with limejuice/honey Prevention Store medicines, cleaning detergents, mosquito repellants and paints carefully Keep all potentially poisonous substances out of children's reach Label the poisons in your house Avoid keeping poisonous plants in or around house Take care while eating products such as berries, roots or mushrooms Teach children the need to exercise caution

http://www.medindia.net/patients/Firstaid_Poisoning.htm

Poisoning first aid

Poisoning is caused by swallowing, injecting, breathing in, or otherwise being exposed to a harmful substance. Most poisonings occur by accident. Immediate first aid is very important in a poisoning emergency. The first aid you give before getting medical help can save a person's life. This is for information only and not for use in the treatment or management of an actual poison exposure. In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions.

Considerations
Millions of poisonings are reported to United States poison control centers every year, with many deaths. It is important to note that just because a package does not have a warning label doesn't mean it is safe. You should consider poisoning if someone suddenly becomes sick for no apparent reason, or if the person is found near a furnace, car, fire, or in an area that is not well ventilated.

Symptoms of poisoning may take time to develop. However, if you think someone has been poisoned, do not wait for symptoms to develop before getting that person medical help.

Causes
Items that can cause poisoning include:

Carbon monoxide gas (from furnaces, gas engines, fires, space heaters) Certain foods Chemicals in the workplace Drugs, including over-the-counter and prescription medicines (such as an aspirin overdose) and illicit drugs such as cocaine Household detergents and cleaning products Household and outdoor plants (eating toxic plants) Insecticides Paints

Symptoms
Symptoms vary according to the poison, but may include:

Abdominal pain Bluish lips Chest pain Confusion Cough Diarrhea Difficulty breathing Dizziness Double vision Drowsiness Fever Headache Heart palpitations Irritability Loss of appetite Loss of bladder control Muscle twitching Nausea and vomiting

Numbness or tingling Seizures Shortness of breath Skin rash or burns Stupor Unconsciousness Unusual breath odor Weakness

First Aid
Seek immediate medical help. For poisoning by swallowing:

Check and monitor the person's airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. Try to make sure that the person has indeed been poisoned. It may be hard to tell. Some signs include chemical-smelling breath, burns around the mouth, difficulty breathing, vomiting, or unusual odors on the person. If possible, identify the poison. Do NOT make a person throw up unless told to do so by poison control or a health care professional. If the person vomits, clear the person's airway. Wrap a cloth around your fingers before cleaning out the mouth and throat. If the person has been sick from a plant part, save the vomit. It may help experts identify what medicine can be used to help reverse the poisoning. If the person starts having convulsions, give convulsion first aid. Keep the person comfortable. The person should be rolled onto the left side, and remain there while getting or waiting for medical help. If the poison has spilled on the person's clothes, remove the clothing and flush the skin with water.

For inhalation poisoning:

Call for emergency help. Never attempt to rescue a person without notifying others first. If it is safe to do so, rescue the person from the danger of the gas, fumes, or smoke. Open windows and doors to remove the fumes. Take several deep breaths of fresh air, and then hold your breath as you go in. Hold a wet cloth over your nose and mouth. Do not light a match or use a lighter because some gases can catch fire. After rescuing the person from danger, check and monitor the person's airway, breathing, and pulse. If necessary, begin rescue breathing and CPR. If necessary, perform first aid for eye injuries (eye emergencies) or convulsions ( convulsion first aid). If the person vomits, clear the person's airway. Wrap a cloth around your fingers before cleaning out the mouth and throat.

Even if the person seems perfectly fine, get medical help.

DO NOT

Do NOT give an unconscious person anything by mouth. Do NOT induce vomiting unless you are told to do so by the Poison Control Center or a doctor. A strong poison that burns on the way down the throat will also do damage on the way back up. Do NOT try to neutralize the poison with lemon juice or vinegar, or any other substance, unless you are told to do so by the Poison Control Center or a doctor. Do NOT use any "cure-all" type antidote. Do NOT wait for symptoms to develop if you suspect that someone has been poisoned.

When to Contact a Medical Professional

In the United States, call 1-800-222-1222 to speak with a local poison control center. This hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible.

Prevention
Be aware of poisons in and around your home. Take steps to protect young children from toxic substances. Store all medicines, cleaners, cosmetics, and household chemicals out of reach of children, or in cabinets with childproof latches. Be familiar with plants in your home, yard, and vicinity. Keep your children informed, too. Remove any poisonous plants. Never eat wild plants, mushrooms, roots, or berries unless you very familiar with them. Teach children about the dangers of substances that contain poison. Label all poisons. Don't store household chemicals in food containers, even if they are labeled. Most nonfood substances are poisonous if taken in large doses. If you are concerned that industrial poisons might be polluting nearby land or water, report your concerns to the local health department or the state or federal Environmental Protection Agency.

References
Hack JB, Hoffman RS. General management of poisoned patients. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH: McGrawHill; 2006:chap 156. Bronstein A, Spyker D, et al .2009 Annual Report of the American association of Poison Control Centers' National Poison Data System (NPDS). Clinical Toxicology 2010: 48; 979-1178.
http://www.nlm.nih.gov/medlineplus/ency/article/000003.htm