“ GENERAL TREATMENT OF

POISONING”
The first principle in the management of the poisoned patient is to treat the patient, not the poison.
Airway, breathing and circulation are addressed initially, along with any other immediately life-
threatening toxic effect.

Occupational Toxicology:
This deals with chemicals found in the workplace. The major emphasis of occupational toxicology is
to identify the agents of concern, identify the acute and chronic diseases that they cause, define the
conditions under which they maybe used safely and prevent absorption of harmful amounts of these
chemicals.

In a poisoned patient:

 Hypotension occurs due to depression of cardiac contractility

 Hypovolemia results due to vomiting and diarrhea
 Peripheral vascular collapse due to blockade of alpha adrenoceptor mediated vascular tone.
 Hypothermia or hyperthermia due to temperature dysregulation
 Cellular hypoxia may occurs especially in case of cyanide poisoning
 Seizure, muscular hyperactivity and rigidity may result in death

Initial Management Of The Poisoned Patient:

Supportive measures are the basic ABCD of poisoning treatment:

A
is for the Airways. It should be cleared. There should be no obstruction. Endo tracheal
tube is inserted if needed. For many patients simple poisoning in the lateral left side down
position is sufficient to clear the airways.

B
is for the breathing. It should be assessed by observation and pulse. patients with
respiratory insufficiency should be incubated and mechanically ventilated.

C
Is for circulation. It should be assessed by observation continuous monitoring of pulse rate,
blood pressure, urinary output and evaluation of peripheral perfusion.
D
. every patient with altered mental status should receive a challenge with concentrated
DEXTROSE, unless a rapid bedside glucose test demonstrates that the patient is not
hypoglycemic. Adults are given 25g (50ml of 50% dextrose solution)IV and children 0.5
g/kg (2ml.kg of 25% dextrose).

HELPING SOMEONE WHO IS CONSCIOUS:

If the person have swallowed something, try to get them to spit out anything that is remaining in
their mouth.

HELPING SOMEONE WHO IS UNCONSCIOUS:

Try to wake patient and encourage them to spit out anything left in their mouth. Lie the person on
their with the help of cushion behind their back and their upper leg pulled slightly forward, so that
they don’t fall on their face or roll backward. This is known as recovery position. If the person isn’t
breathing or their heart is stopped, begin CPR- cardiopulmonary resuscitation.

Hospital treatment

Some people who have swallowed a poisonous substance or overdosed on medication will be
admitted to hospital for examination and treatment.

Possible treatments that can be used to treat poisoning include:

 activated charcoal – sometimes used to treat someone who's been poisoned; the charcoal
binds to the poison and stops it being further absorbed into the blood
 antidotes – these are substances that either prevent the poison from working or reverse its
effects
 sedatives – may be given if the person is agitated
 a ventilator (breathing machine) – may be used if the person stops breathing
 anti-epileptic medicine – may be used if the person has seizures (fits)

“COMMON TOXIC SYNDROMES”

1. Acetaminophens:
Commonly involved in suicide attempts and accidental poisoning. Acute ingestion of more than 150-
200 mg/kg or 7g total (adults) is considered potentially toxic.

Initially, the patient is asymptomatic or mild GIT upset. After 24-36hrs liver injury appears. Levels of
aminotransferases and hypoprothrombinemia are elevated. The antidote is acetylcysteine acts as a
glutathione substitute, binding to toxic metabolites as it is produced.

2. Amphetamines and other stimulants:

These drugs are commonly abused. These are also used as metabolic enhancers or fat burners.
There over doze include agitation, confusion and seizures, diarrhea, urination, miosis and weakness.
Blood testing maybe used to document depressed activity of red cell and plasma enzymes. There is
no specific antidote. Seizures are managed with benzodiazepines. Temperature is reduced by
removing clothes.

3. Isopropanol (rubbing alcohol, isopropyl alcohol):

It is metabolized to acetone via alcohol dehydrogenase. Acetone cannot be further oxidized to
carboxylic acids and therefore, acidemia does not occur. IPA is a known CNS depressant and GIT
irritant.

ELIMINATION ENHANCEMENT:
1- Hemodialysis:
The elimination of some toxins maybe enhanced by hemodialysis if certain properties are met: low
protein binding, small volume distribution, small mol.wt and water solubility of toxins. Drugs like
methanol, salicylates, theophylline and lithium can be removed by hemodialysis.

2- Urinary alkalization:
Alkalization of urine enhances the elimination of salicylates or phenobarbital. Increasing the Ph with
IV sodium bicarbonate transforms the drug into an ionized form that prevents reabsorption. The
goal urine ph is within the range 7.5-8 while ensuring that the serum ph does not exceed 7.55.

3- Multiple-dose activated charcoal:

This therapy enhances the elimination of certain drugs eg theophylline, phenobarbital, digoxin etc.
by creating gradient across lumen of the gut. Medication transverse from areas of high
concentration to low concentration, promoting medication already absorbed to cross back into the
gut to be absorbed by the activated charcoal present.

4- Gastric emptying:
It does not clearly reduce overall morbidity or mortality and has risks. Gastric emptying is considered
if it can be done within 1 h of a life-threatening ingestion. However, many poisonings manifest too
late, and whether a poisoning is life threatening is not always clear. Thus, gastric emptying is seldom
indicated.

5- Whole-bowel irrigation:
This procedure flushes the GI tract and theoretically decreases GI transit time for pills and
tablets. Irrigation has not been proved to reduce morbidity or mortality. Irrigation is indicated
for any of the following:

 Some serious poisonings due to sustained-release preparations or substances that are

not adsorbed by charcoal (eg, heavy metals)
 Drug packets (eg, latex-coated packets of heroin or cocaine ingested by body packers)
 A suspected bezoar
A commercially prepared solution of polyethylene glycol (which is nonabsorbable) and
electrolytes is given at a rate of 1 to 2 L/h for adults or at 25 to 40 mL/kg/h for children until
the rectal effluent is clear; this process may require many hours or even days. The solution is
usually given via a gastric tube, although some motivated patients can drink these large
volumes.