POISONING MOHW August 2020

(Adapted from the European Association of Poison Centres and clinical Toxicologists)

1. Identify agent used.

2. Assess severity and mental status

3. Determine supportive care required

4. Prevent further absorption in specific cases.

5. Use of antidotes if available

Poisoning Severity Score(PSS)EAPCTT (European Association of Poison Centres and Clinical

Toxicologists)

Grade 0 – No symptoms or signs related to poisoning

Grade 1 (MINOR) – Mild, transient and spontaneous resolving symptoms, vomiting, diarrhea and pain.

Grade 2 (MODERATE)- Pronounced or prolonged symptoms

Grade 3 – (SEVERE) – Severe or life-threatening conditions, delusions, hallucinations, arrhythmias,

respiratory depressions

Grade 4 – (FATAL) – Death

DIAGNOSTIC WORK-UP

- Full blood count

- Renal function test and electrolytes
- Liver Function Test and liver enzymes
- Coagulation profiles (INR, PT and PTTK)
- Blood, urine and stomach washout for toxicology
- Drugs e.g paracetamol levels
- Electrocardiography
- CXR
TREATMENT
Secure IV access

Rehydrate accordingly

Secure airway

Control seizure with IV benzodiazepine (Diazepam 10 mg slowly IV)

May require intubation and ventilator support

Gastric Lavage is indicated if ingestion within 1 – 2 hours

Gastric lavage is contraindicated in corrosive poisoning

Activated charcoal – In adults, a single dose of 50g is administered.

Activated charcoal is contraindicated in unconscious patients with no swallowing reflex, gastrointestinal

corrosions, ingestion of gasolines/oil.

Treatment of Organophosphorus poisoning include the following

- Initial dose with IV Atropine 1 – 3mg , to repeat in 5 minutes if no clinical response

- Pralidoxime – 2 by IV infusion over 30 minutes, then repeat in 1 hour if necessary and then 12
hourly if required.

In corrosive poisoning ( Caustic soda poisoning)

- Nil orally or sips of water if not vomiting, IV Fluids ++/ Parenteral feeding via central venous
access
- IV Proton pump inhibitors 40mg 12 hourly
- IV Solumedrol 40 mg 12 – 8 hourly
- IV Antibiotics

Some antidotes in poisoning

Paracetamol poisoning

● Activated charcoal if < 1 hour.

● N - Acetylcysteine (NAC) – To start if > 75mg/kg of paracetamol is ingested

 ● NAC protocol in paracetamol poisoning - 150mg/kg in 200ml Dextrose 5% over 1 hour, then
50mg/kg in 500mlof 5% dextrose over 4 hours and finally 100mg/kg in 1000ml 5%Dextrose over
16 hours.

Benzodiazepines – Flumazenil 0.2mg IV 15-30 seconds, if no response , to administer 0.3mg over 30

seconds

Morphine - Naloxone IV 0.4 - 2mg, to repeat 2 -3 minutes PRN, not exceeding 10 mg.