Ingested (Swallowed) Poisons

Definition :
Poisoning is a substance that injures the body by its chemical action when ingested inhaled
absorbed applied to the skin or product within the body in a relatively small amount

Injested
Swallowed poisons may be corrosive. Corrosive poisons include alkaline and acid agents that
can cause tissue destruction after coming in contact with mucous membranes.

Alkaline products include lye, drain cleaners, toilet bowl cleaners, bleach, nonphosphate
detergents, oven cleaners, and button batteries (batteries used to power watches, calculators,
hearing aids, or cameras).
Acid products include toilet bowl cleaners, pool cleaners, metal cleaners, rust removers, and
battery acid.

Clinical Manifestations
● Such as pain or burning sensations,
● Any evidence of redness
● Burn in the mouth or throat,
● Pain on swallowing
● An inability to swallow,
● Vomiting, or drooling;

Diagnostic
Assessment findings vary with type of poison; if poison is consumed: burns or redness of mouth
or lips, odor to breath if chemical consumed; if contact with clothing or skin occurs: burns,
stains, or odors present correlating with type of chemical.

Nursing Management:
Measures are instituted to remove the toxin or decrease its absorption. The patient who has
ingested a corrosive poison, which can be a strong acid or alkaline substance, is given water or
milk to drink for dilution. However, dilution is not attempted if the patient has acute airway
edema or obstruction or if there is clinical evidence of esophageal, gastric, or intestinal burn or
perforation. The following gastric emptying procedures may be used as prescribed:

• Gastric lavage for the obtunded patient

gastric aspirate is saved and sent to the laboratory for
testing (toxicology screens)
▪︎ Perform cardiopulmonary resuscitation if needed.
▪︎ Induce emesis if recommended.
▪︎ Provide supplemental oxygen as ordered and needed.
▪︎ Send vomitus and aspirate for analysis.
▪︎ In severe poisoning, provide peritoneal dialysis or hemodialysis.
▪︎ Monitor vital signs, level of consciousness, respiratory status,
and suicidal ideations if indicated.

Medical Management
If there is a specific chemical or physiologic antagonist (antidote), it is administered as early as
possible to reverse or diminish the effects of the toxin. If this measure is ineffective, procedures
may be initiated to remove the ingested substance. These procedures include administration of
multiple doses of charcoal, diuresis (for substances excreted by the kidneys), dialysis, or
hemoperfusion. Hemoperfusion involves detoxification of the blood by processing it through an
extracorporeal circuit and an adsorbent cartridge containing charcoal or resin, after which the
cleansed blood is returned to the patient.
• Syrup of ipecac to induce vomiting in the alert patient (never use with corrosive poisons)
• Activated charcoal administration if the poison is one that is absorbed by charcoal
• Cathartic, when appropriate

Pharmacological
• For hypoglycaemia
Glucose, IV,25-50 ml of 50% over 1-3 minutes
• For opioid overdose
Naloxone, IV,
• Adult= 0.4-2 mg, repeat every 2-3 minutes (maximum of 10 mg)
• Children= 10 micrograms/kg stat, subsequent dose of 100 microgram/kg if no response to
initial dose
Then,
• Naloxone, SC or IM, only if IV route is not feasible

Antidotes
• Used 5-10% because of less available.
• According to WHO
• " Antidote is defined as a therapeutic substance used to counteract the toxic actions of a
specific xenobiotic"
Supportive therapy + correct antidote = Increase Pt.Survival

Physical Antidote:
Agent use to interfere with poison through physical properties, not change their nature
a) Adsorbing: The main example is activated charcoal
b) Coating: A mixture of egg & milk make a coat over the mucosa.
c) Dissolving: 10% alcohol or glycine for carbolic acid

Lead Poisoning
Lead poisoning occurs when lead builds up in the body, often over months or years. Even small
amounts of lead can cause serious health problems. Children younger than 6 years are
especially vulnerable to lead poisoning, which can severely affect mental and physical
development. At very high levels, lead poisoning can be fatal.

Lead-based paint and lead-contaminated dust in older buildings are common sources of lead
poisoning in children. Other sources include contaminated air, water and soil. Adults who work
with batteries, do home renovations or work in auto repair shops also might be exposed to lead.

Symptoms:
Lead poisoning symptoms in children
Signs and symptoms of lead poisoning in children include:
● Developmental delay
● Learning difficulties
● Irritability
● Loss of appetite
● Weight loss
● Sluggishness and fatigue
● Abdominal pain
● Vomiting
● Constipation
● Hearing loss
● Seizures
● Eating things, such as paint chips, that aren't food (pica)

Lead poisoning symptoms in newborns

Babies exposed to lead before birth might:
● Be born prematurely
● Have lower birth weight
● Have slowed growth

Lead poisoning symptoms in adults

Although children are primarily at risk, lead poisoning is also
dangerous for adults. Signs and symptoms in adults might include:
● High blood pressure
● Joint and muscle pain
● Difficulties with memory or concentration
● Headache
● Abdominal pain
Exposure to even low levels of lead can cause damage over time,
especially in children. The greatest risk is to brain development, where
irreversible damage can occur. Higher levels can damage the kidneys
and nervous system in both children and adults. Very high lead levels
may cause seizures, unconsciousness and death.

Prevention
Simple measures can help protect you and your family from lead
poisoning:
● Wash hands and toys. To help reduce hand-to-mouth transfer
of contaminated dust or soil, wash your children's hands after
outdoor play, before eating and at bedtime. Wash their toys
regularly.
● Clean dusty surfaces. Clean your floors with a wet mop and
wipe furniture, windowsills and other dusty surfaces with a damp
cloth.
● Remove shoes before entering the house. This will help keep
lead-based soil outside.
● Run cold water. If you have older plumbing containing lead
pipes or fittings, run your cold water for at least a minute before
using. Don't use hot tap water to make baby formula or for
cooking.
● Prevent children from playing on soil. Provide them with a
sandbox that's covered when not in use. Plant grass or cover
bare soil with mulch.
● Eat a healthy diet. Regular meals and good nutrition might help
lower lead absorption. Children especially need enough calcium,
vitamin C and iron in their diets to help keep lead from being
absorbed.
 ● Keep your home well maintained. If your home has lead-based
paint, check regularly for peeling paint and fix problems promptly.
Try not to sand, which generates dust particles that contain lead.

References:

Brunner, L. S., Suddarth, D. S., & O’Connell, S. S. C. (2008). Brunner & Suddarth’s textbook of
Medical-Surgical Nursing. Lippincott Williams & Wilkins.

Lippincott Manual of Nursing Practice Pocket Guide: Critical Care Nursing. Ovid - Lippincott
Manual of Nursing Practice Pocket Guide: Critical Care Nursing | Wolters Kluwer. (n.d.).
https://www.wolterskluwer.com/en/solutions/ovid/lippincott-manual-of-nursing-practice-pocket-g
uide-critical-care-nursing-5213