Definition

Poisoning is the state produced by the introduction of toxic substances; that is, any substance that produces an injurious or fatal effect, into the body.

Description
Poisoning commonly involves the introduction of poisonous elements from outside the body. The term also can apply to noxious material produced within the body that, because of a disease condition such as kidney or liver failure, cannot be removed; or toxins produced bybacteria, as in the case of food poisoning. Poisons can enter the body from multiple external sources. They can be swallowed; inhaled, as in the case of carbon monoxide or aerosol compounds; or they can enter via the skin, as in snake or insect bites; and even via radiation from the sun that we call sun poisoning. Some question exists regarding whether electro-magnetic fields (EMFs) also produce damaging effects within the body. Poisoning is a common occurrence. An estimated 10 million cases of poisoning occur in the United States each year. 2.24 million exposures to poisonous substances were reported to United States Poison Control Centers in 1998. In 50% of the cases, the victim is a child under the age of five. The most common toxic substances taken in are cosmetics and personal care products, followed by home cleaning products, medications and plants. Most poisonings, nearly 89%, occur in the home, and are accidental. About 50 children die each year in the United States from poisoning. Curiosity, inability to read warning labels, a desire to imitate adults, and inadequate supervision lead to childhood poisonings. The elderly are the second most likely group to be poisoned. Mental confusion, poor eyesight, and the use of multiple drugs are the leading reasons why this group has a high rate of accidental poisoning. A substantial numberpproximately eleven percent of all poisoningslso occur as suicide attempts. Poisons taken internally are common in the home and workplace. There are basically two major types. One group consists of products that were never meant to be ingested or inhaled, such as shampoo, paint thinner, pesticides, houseplant leaves, and carbon monoxide. The other group contains products that can be safely ingested in small quantities, but which are harmful if taken in large amounts. These include pharmaceuticals, medicinal herbs, or alcohol. Other types of poisons include the bacterial toxins that cause food poisoning, such asEscherichia coli; heavy metals, such as the lead found in the paint on older houses; and the venom found in the bites and stings of some animals and insects. The staff at a poison control center and emergency room doctors have the most experience diagnosing and treating poisoning cases.

Causes and symptoms
The effects of poisons are as varied as the poisons themselves. The exact mechanisms of only a few are understood. Some poisons interfere with the metabolism. Others destroy the liver or kidneys, such as heavy metals and some pain relief medications, including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs(Advil, Ibuprofen). A poison may severely depress the central nervous system, leading to coma and eventual respiratory and circulatory failure. Potential poisons in this category include anesthetics (e.g. ether and chloroform); opiates (e.g. morphine and codeine); and barbiturates. Some poisons directly affect the respiratory and circulatory systems. Carbon monoxide causes death by binding with hemoglobin that would normally transport oxygen throughout the body. Certain corrosive vapors trigger the body to flood the lungs with fluids, effectively drowning the person. Cyanide interferes with respiration at the cellular level. Another group of poisons interferes with the electrochemical impulses that travel between neurons in the nervous system. Another group, including cocaine, ergot, strychnine, and some snake venoms, causes potentially fatal seizures. Severity of poisoning symptoms can range from headache and nausea to convulsions and death. The type of poison; the amount and time of exposure; and the age, size, and health of the victim are all factors that determine the severity of symptoms and the chances for recovery.

Plant poisoning
There are more than 700 species of poisonous plants in the United States. Plants are second only to medicines in causing serious poisoning in children under age five. The appearance of a plant offers no determination of its poison. Some plants, such as the yew shrub, are almost entirely toxic: needles, bark, seeds, and berries. In other plants, only certain parts are poisonous. The bulb of the hyacinth and daffodil are toxic, but the flowers are not. It is the flowers of the jasmine plant that are the poisonous part. Some plants are confusing because portions of them are eaten as food while other parts are poisonous. For example, the fleshy stem (tuber) of the potato plant is nutritious; however, its roots, sprouts, and vines are poisonous. The leaves of tomatoes are poisonous, while the fruit is not. Rhubarb stalks are good to eat, but the leaves are poisonous. Apricots, cherries, peaches, and apples all produce healthful fruit, but their seeds contain a form of cyanide that can kill a child if chewed in sufficient quantities. One hundred milligrams (mg) of moist, crushed apricot seeds can produce 217 milligrams of cyanide. Common houseplants that contain some poisonous parts include: COMMON HOUSEHOLD, INDUSTRIAL, AND AGRICULTURAL PRODUCTS CONTAINING TOXIC SUBSTANCES Alcohol (rubbing) Fuel

COMMON HOUSEHOLD, INDUSTRIAL, AND AGRICULTURAL PRODUCTS CONTAINING TOXIC SUBSTANCES Antifreeze Arsenic Art and craft supplies Automotive fluids Batteries, automotive Batteries, household Building products Cleaning products Cosmetics/personal care products Cyanide Daffodil bulbs Dieffenbachia Disinfectants/air fresheners Drain openers English nightshade Ethanol (found in alcoholic beverages) Foxglove aloe amaryllis Boston ivy caladium cyclamen Floor/furniture polish Gasoline Glues/adhesives Hemlock Kerosene Mercury Metal primers Metalworking materials Mothballs Oven cleaners Paint strippers/thinners Paints, oil-based or alkyds Paints, water-based or latex Pesticides, flea collars, insect repellents Stains/finishes Strychnine Wood preservatives

dumb cane (also called Dieffenbachia)
philodendron Common outdoor plants that contain some poisonous part include:

azalea bird-of-paradise flower black cherry buttercup calla lilly castor bean chinaberry tree caffodil delphinium English ivy eucalyptus foxglove holly horse chestnut hydrangea iris jack-in-the-pulpit jimson weed (also called thornapple) larkspur lily-of-the-valley morning glory nightshade (several varieties) oleander potato rhododendron rhubarb sweet pea tomato wisteria yew Symptoms of plant poisoning range from irritation of the skin or mucous membranes of the mouth and throat to nausea, vomiting, convulsions, irregular heartbeat, and even death. It is often difficult to tell if a person has eaten a poisonous plant because there are no telltale empty containers and no unusual lesions or odors around the mouth.

Household chemicals
Many products used daily in the home are poisonous if swallowed. These products often contain strong acids or strong bases (alkalis). Toxic household cleaning products include: ammonia

bleach dishwashing liquids drain openers floor waxes and furniture polishes laundry detergents, spot cleaners, and fabric softeners mildew removers oven cleaners toilet bowl cleaners Personal care products found in the home can also be poisonous. These include: deodorant hair spray hair straighteners nail polish and polish remover perfume shampoo Signs that a person has swallowed one of these substances include evidence of an empty container nearby, nausea or vomiting, and burnson the lips and skin around the mouth if the substance is a strong acid or alkali. The chemicals in some of these products may leave a distinctive odor on the breath.

Pharmaceuticals
Both over-the-counter and prescription medicines can help the body heal if taken as directed. When taken in large quantities, or with other drugs where there may be an adverse interaction, they can subsequently act as poisons. Drug overdoses, both accidental and intentional, are the leading cause of poisoning in adults. Medicinal herbs should be treated like pharmaceuticals and taken only in designated quantities under the supervision of a knowledgeable person. Herbs that have healing qualities when taken in small doses can be toxic in larger doses.

Diagnosis
Initially, poisoning is suspected if the victim shows changes in behavior and the signs or symptoms previously described. Evidence of an empty container or information from the victim are helpful in determining exactly what substance has caused the poisoning. Some acids and alkalis leave burns on the mouth. Petroleum products, such as lighter fluid or kerosene, leave a distinctive odor on the breath. Vomitus may be tested to determine the exact composition of the poison. Once hospitalized,blood and urine tests may be done on the patient to determine his metabolic condition.

Treatment
Treatment for poisoning depends on the poison swallowed or inhaled. Contacting a poison control center or hospital emergency room is the first step in getting proper treatment. The

poison control center's telephone number is often listed with emergency numbers on the inside cover of the telephone book, or can be reached by dialing 911 or the operator. The poison control center will ask for specific information about the victim and the poison, then give appropriate first aid instructions. If the patient is to be taken to a hospital, a sample of vomitus and the poison container should be taken along, if they are available. Most cases of plant poisoning are treated by inducing vomiting, if the person is fully conscious. Vomiting can be induced by taking syrup ofipecac, an over-thecounter product available at any pharmacy. For acid, alkali, or petroleum product poisonings, the patient should not be made to vomit. Acids and alkalis can burn the esophagus if they are vomited, and petroleum products can be inhaled into the lungs during vomiting, resulting in aspiration pneumonia. Once under medical care, doctors have the option of treating the patient with a specific remedy to counteract the poison (antidote) or with activated charcoal to absorb the substance inside the patient'sdigestive system. In some instances, pumping the stomach may be required. Medical personnel will also provide supportive care as needed, such as intravenous fluids or mechanical ventilation.

Prognosis
The outcome of poisoning varies from complete recovery to death, and depends on the type and amount of the poison, the health of the victim, and the speed with which medical care is obtained.

KEY TERMS
Acid chemical substance that contains the element hydrogen and has a pH above seven, which is considered neutral. Acids are generally described as sour or biting in character. Alkali chemical substance that has the ability to neutralize acid. It has a pH below seven, which is considered neutral, and is generally described as caustic in nature. Aspiration pneumonialuid entering the lungs through choking or vomiting, and leading to infection of the lung. Gastric lavagensertion of a tube into the stomach for the purpose of washing out and removing toxic material. Ipecac medication made from the dried root of a plant native to Brazil, often used to induce vomiting.

Health care team roles
In most cases, a poisoning victim will initially be discovered by a family member or friend. Once the health care staff has been engaged at the request of those involved, it can include:

Staff at local poison control centers. These are people specially trained regarding the properties and treatment of poisons. Staff may include physicians and nurses who are especially skilled at obtaining necessary information regarding the poison and providing the needed facts in regard to treatment.

Emergency medical technicians (EMTs), are specially trained in providing
emergency care to people outside of hospitals. Often under the supervision of an emergency room physician, EMTs are frequently the first to provide medical intervention. They work from ambulances, providing the initial care often in the home, or place where the poisoning took place. If the poisoning victim is transported to a hospital emergency room, a licensed physician trained in emergency medicine will either begin or take further measures to negate the effect of the poison.

Both registered nurses (RNs), and licensed practical nurses (LPNs) work in hospital
emergency rooms, and are often located in poison control centers. In emergency rooms, both RNs and LPNs will be responsible for monitoring vital signs, obtaining specimens of vomitus, administering such medications as activated charcoal or ipecac, or providing assistance in carrying out such procedures as gastric lavage (pumping the stomach). Providing reassurance to frightened patients and families, and offering information regarding poisons, especially to the families of children that have been poisoned, are both critical elements of care. Clinical laboratory scientists have specialized training and must pass a state examination. They draw blood samples or test urine to do toxic screens for various drugs, or other tests that determine what toxic substance has been ingested.

Radiologic technologists have specialized training and must pass a state examination.
They may be called upon to take a chest x rayto ensure that the person has not aspirated (had foreign material such as vomit enter the lungs), causing aspiration pneumonia.

Prevention
Most accidental poisonings are preventable. The number of deaths of children from poisoning in the United States has declined from about 450 per year in the 1960s to about 50 each year in the 1990s. This decline has occurred primarily due to better packaging of toxic materials, and to better public education. Actions to prevent poisonings include: removing plants that are poisonous keeping medicines and household chemicals locked and in a place inaccessible to children keeping medications in child-resistant containers never referring to medicine as "candy"

keeping cleaners and other poisons in their original containers disposing of outdated prescription medicines

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