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MANAGEMENT OF A CASE OF ACUTE POISONING

Ifra Iqbal 2 nd Prof , MBBS

Steps For treatment of poisoning cases
1)Removal of the patient from the source of exposure 2)Removal of the unabsorbed poison 3)Elimination of the absorbed poison 4)Use of specific antidote 5)Symptomatic Management

ROLE of antidotes in poisoning

qAn antidote is any substance which prevents the action of a poison or neutralize the poison or produce signs and symptoms opposite to those produced by the poison.

Types of antidotes qAntidotes may be of the following types: vMechanical/Physical Antidotes vChemical Antidotes vPhysiological/Pharmacological Antidotes vChelating Agents vSerological Antidote vUniversal Antidote  .

egg albumin • Adsorbents Eg.Mechanical antidotes • These act by minimizing the absorption of a poison.... Boiled rice . • Demulcents Eg. activated animal charcoal • Diluents Eg. Water • Bulky Food EG. For example..

• Vinegar(Acetic Acid) for alkalies • Magnesium oxide for acids • Potassium permanganate for oxidisable poisons like alkaloids.Chemical antidote qThese act by chemically reacting with the poison and forming a nontoxic complex. For example. phosphorus. . barbiturates.

Physiological antidote qThese act by producing effects opposite to those of the poison. • Atropine for Organophosphate Poisoning • Naloxone for Morphine Poisoning • Barbiturate for Strychnine . For example.

Chelating agents • These act by forming chelate with metallic poisons available in circulation and facilitate their elimination from body by renal excretion. .

drip) for Lead Poisoning • Penicillamine(3mg/kg body wt/day) for Copper Poisoning • Desferrioxamine(8-12gm daily in divided doses) for Iron Poisoning • .V.Examples Of Chelating agents : • Dimercaprol (3-4mg/kg body weight) for Arsenic.D. Mercury poisoning • E.A. (1 gm twice a day by slow I.T.

 Anti snake venom serum for snake bite poisoning.Serological antidote • These are immunological anti-sera used to neutralize the poison antigens. . • For example.

Universal antidote qUniversal Antidote is a combination of physical and chemical antidotes. qIt consists of:  Activated Charcoal – 2 parts  Magnesium oxide – 1 part  Tannic acid – 1 part . When the exact nature of the poison is not known. universal antidote is administered to the patient.

 SYMPTOMATIC MANAGEMENT .

ampule )  .c.c.ampule/10 c.Nausea and Vomitting • Chlorpromazine hydrochloride • Either injection or orally (5 c.

qRelieving pain Body pain :  Paracetamol  Ibuprofen  Diclofenac sodium Abdominal pain :  Atropine injection  .

.c.I/V or deep I/V or even intra-cardiac) 2)Endotracheal Intubation 3)Tracheotomy 4)Oxygen Inhalation 5)Artificial Respiration .SAFEGUARDING RESPIRATION 1)Clearing the airways + elevation of lower limb + O2 + CO2(5%) + Nikethamide(1-3c.

Management Of Circulatory Failure • NA + Methyl amphetamine injection • Elevation Of foot end of the bed (Trendelenburg Position) • Use Of Vasopressors like Dopamine (220 µg/kg/min) • Use Of Plasma Expanders (Plasma/ Whole Blood/Low Molecular Weight Dextran) .

c. • Followed by Deriphylline injection – I/M or I/V (cubital vein ) .infused slowly.Pulmonary oedema • 60% O2 inhalation + Atropine sulphate + Aminophylline + Sedative • 50 c. syringe ( 40 c. Glucose solution + 10 c.c. Aminophylline ).c.

qComa : • Analeptics qCerebral oedema : • Hypertonic Urea(30%) or  20% I/V Mannitol or  Sorbitol .

5-1 mg injection) • Cortisone Narcosis : Morphine Short acting barbiturate To prevent narcosis : Laptozol. . Nikethinamide etc. Oedema glottis : • Epinephrine 1:1000 • Atropine(0.

qCardiac arrest : • • • • • •  Cardiac massage Caffeine Digitalis Nicotinamide Xylocaine Digoxin Atropine qVAGAL INHIBITION : .

Hepatic coma • Deeply sedated : 10% Glucose solution is to be administered bottle after bottle • Monosodium glutamate – 500 ml .

Diazepam is to be administered per rectally.V.Control of convulsions  The patient is given Diazepam (0.V. upto a maximum of 10 mg at a time.2-0. .4 mg/kg) slow I. If I. administration isn’t possible.

qAllergy   Anti-histaminics : Promethazine qDermatitis Al acetate/MgSO4/Na2 CO3/KMnO4 Chlorpromazine .

qCough : • Antitussives or Expectorants  qRespiratory Infections : • Antibiotics .

qDiarrhoea • Without antibiotics: Pectin+Bismuth+Kaolin • With antibiotics: All fluoroquinolones qAbdominal distension Nasogastric or Intestinal intubation .

Management of hypothermia • In cases of mild hypothermia. the patient is to be given a warm water bath(42’C) or by heating the inspired air. a warm room and a blanket are required • In severe cases of hypothermia. • Pilocarpine/Physostigmine .

• Otherwise. .MANAGEMENT OF HYPERTHERMIA • The patient’s clothes are removed. the patient is immersed upto the neck in cold water bath(25’C). • The regions of the patient’s neck and groin are to be packed with ice.

Correction of fluid or electrolyte imbalances .

9% NaCl over 15-30 minutes at a time.Correction of hyponatremia • The patient is given 0. .

2% NaCl over several hours .Correction of hypernatremia • The patient is given 0.

Correction of hypokalemia • The patient is given 4-6 mEq of Potassium per kg per day orally or in an IV solution not exceeding 4060 mEq/L • .

the patient is administered 10% Calcium Gluconate (5-10 ml) I.V. • In severe cases.V. .Correction of hyperkalemia • The patient is given Furosemide 1 mg/kg I.

.V.Correction of metabolic acidosis • Sodium bicarbonate(1-2 mEq/litre) I. is given over 15-30 minutes.

V. .CORREction of hypocalcemia • The patient is given 10% Calcium Gluconate(2ml/kg/day) I.

It consists of: • Naloxone(2mg) • Thiamine(100mg) • Dextrose(50 ml of 50% solution) .Coma cocktail qThis is a combination of three antidotes that is often given to poisoned patients exhibiting CNS depression.

•Thank you ! .