SEMINAR ON

POISONING
 CONTENTS
Introduction
Definition
Types of poisoning
Food poisoning
Gas poisoning
Drugs poisoning
Chemical poisoning
 Introduction
A poison is any substance that, in small
quantities is capable of causing illness or harm
after ingestion, inhalation, injection or contact
with the skin. Large quantities of most
chemical including medications act as poison.
Even common drugs such as aspirin,
acetaminophen and vitamins can be poisonous
if taken in excessive amounts.
 Goals
Removal or inactivation of the poison
before it is absorbed.
Administration of a specific antidote to
neutralize a specific poison.
Implementation of treatment that
hasten the elimination of the absorbed
poison.
 DEFINITION
A poison is any chemical that harms the
body. Poisoning can be accidental,
occupational, recreational or intentional.
Natural or manufactured toxins can be
ingested, inhaled, injected, splashed in
the eye, or absorbed through the skin. It
is the substance that can cause injury,
illness or death.
TYPES OF POISONING
Food Poisoning
Gas Poisoning
Drugs Poisoning
Chemical Poisoning
 DEFINITION
Food poisoning is defined as food borne
illness that is acquired through ingestion
of food contaminated with pathogenic
micro organisms, including various
bacteria, viruses and parasites or their
toxins are the most common cause of
food poisoning.
 CAUSES
Food poisoning more commonly occurs
after eating at picnics, school cafeterias,
large social functions, or restaurants one
or more people may become sick. Food
poisoning is caused by certain bacteria,
viruses, parasites or toxins.
TYPES OF FOOD POISONING
Non bacterial type of food
poisoning
Bacterial type of food poisoning
Non bacterial type of food poisoning:
It is caused by chemicals such as:
1. Arsenic
2. Certain plants and sea foods
3. Contamination of food by chemicals such as
Fertilizers
Pesticides
Cadmium
Mercury
Bacterial type of food poisoning:
It is caused by ingestion of food contaminated
by the living bacteria and their toxins.
The main food poisoning bacteria are:
Salmonella- found in raw meat, eggs,
poultry, animals.
Clostridium Perfringens- found in raw
meat, soil, excreta, insects.
Staphylococcus aureus- found in
skin, nose
Botulism- Sources improperly canned
or preserved food, home preserved
vegetables, preserved fruits, and fish,
canned commercial products.
 Pathophysiology
Pathogenesis of food poisoning can be
classified into two types such as non
inflammatory and inflammatory. In non
inflammatory diarrhea, the enterotoxins
act on the mucous of small intestine
without invasion. This leads to a large
volume of watery stool without any pus,
blood and abdominal pain and may result
in occassional dehydration.
 Cont..
Inflammatory diarrhea is due to cytotoxic
actions of the mucosa leading to invasion
and destruction. Here the distal and small
bowel is involved in this type all these
actions result in bloody diarrhea.
Occassionally, profound dehydration may
result. The toxin act directly on the
intestine and CNS.
Clinical manifestations
The most common symptoms of food
poisoning are nausea, vomiting,
abdominal cramps and diarrhea usually
appear from 1 to 6 hours after the food is
eaten.
Headache, fever and chills, loss of
appetite, muscle pain and weakness.
Bacterial food poisoning- It can be mild,
moderate or severe. The symptoms will be
different depending on what type of bacteria is
responsible.
Common symptoms include:
Nausea and vomiting
Diarrhea
Abdominal pain
Tiredness and fatigue
Headache
Fever
Death in extreme cases
Clostridium Perfringes: Perfringens will
primarily cause watery diarrhea. Other
symptoms may include nausea, vomiting,
abdominal pain and fever. 8-12 hours, but can
take up to 24 hours from ingestion. Duration of
symptoms is typically less than 24 hours.
Botulism- difficulty swallowing, muscle
weakness, double vision, drooping eyelids,
blurry vision, slurred speech, difficulty
breathing, difficulty moving the eyes.
Mushroom poisoning- Severe abdominal
pain, nausea, vomiting, diarrhea and
prostration occuring usually within 30 minutes
to 24 hours after eating the mushroom. It can
be fatal. Hallucinations, CNS excitation and
depression, cholinergic poisoning.
Salmonella poisoning- symptoms of
salmonella poisoning usually begin 12-72
hours after infection. Diarrhea,
abdominal cramping and fever are
common symptoms. The diarrhea is
typically loose and not bloody.
 Diagnostic Evaluation
Patients History- Detailed history of eating
foods, exposures to contaminated foods or
asking questions about friends or relatives
with similar symptoms, including how long you
have been sick.
Physical examination- physical symptoms such
as dehydration and abdominal tenderness.
Diagnosing stool sample to detect the blood in
stool, pathogen, parasites are tested
microscopically and toxins in the food.
Food samples should be saved for bacterial
culture and toxin analysis, primarily for use by
public health investigators.
Other useful laboratory studies include CBC,
electrolyte glucose.
In addition, the immunological test are carried
out to test for toxins. In some rare cases,
biopsy samples may be taken.
 Management
Treatment may vary based on the cause and
its severity for some people without treatment
it gets cured in few days or within a day and
sometime food poison may last longer.
Emergency and supportive measures:
Replace fluid and electrolyte loses with
intravenous fluid or other solutions patients
with mild illness may tolerate rehydration.
Fluids and electrolytes minerals such as
sodium, potassium and calcium that maintain
the balance of fluids in body lost to persistent
diarrhea need to be replaced.
Don’t use anti-diarrheal medications: Drugs
intended to treat diarrhea, such as loperamide
and diphenoxylate with atropine may slow
elimination of bacteria or toxins from system
and can make condition worse.
Try sucking on ice chips or taking small sips of
water patient might also try drinking clear
soda as 7up or sprite, or non caffeinated sports
drinks such as gatorade. Affected adults should
try to drink atleast 8 to 16 glasses of liquid
everyday, taking small frequent sips.
Ease back into eating- gradually begin to eat
bland, easy to digest foods, such as soda
caffeine, alcohol, nicotine and fatty or highly
seasoned foods.
Avoid certain foods and substances until
feeling better. These include dairy
products, caffeine, alcohol nicotine, and
fatty or highly seasoned foods.
 Prevention
Wash hands and surfaces often.
Thoroughly wash fruits and vegetables.
Separately keep raw and finished products.
Check best before date.
If in doubt throw it out.
Avoid reheating food.
Select fresh meat and vegetables.
Keep food covered at all times.
 Complications
Dehydration is the most common
complication.
Less common but much more serious
complications include:
Respiratory distress including the need for
support on a breathing machine(botulium)
Kidney problems(shigella, E.coli)
Bleeding disorders(E.coli and others)
Arthritis(Salmonella)
Nervous system disorder(botulism)
Death 50% of people with mushroom or
certain fish poisoning die and 10% with
botulism.
Carbon Monoxide Poisoning
Carbon monoxide is an odorless, invisible gas
emitted by internal combustion engines, gas
stoves and furnances and burning charcoal and
other combustible materials. When carbon
monoxide is inhaled it enters the blood stream
and promptly binds with hemoglobin.
Haemoglobin absorbs carbon monoxide 200
times more readily than it absorbs oxygen.
Therefore, it soon occupies many of the situ
on the hemoglobin needed to transport oxygen
to the cells. Carbon monoxide, bound
haemoglobin, called carboxyhemoglobin,
doesn’t transport oxygen. The victims ecome
hypoxemic and can die.
 Epidemiology
Caron monoxide accounts for approximately
50,000 emergency department visits every
year in the US.
3,500 die of accidental or intentional exposure
with CO each year.
Non vehicular sources of CO have increasingly
accounted for most unintentional poisoning
such as burning of wood or natural gas for
heating and cooking.
 pathophysiology
Carbon monoxide gas is readily absorbed and
is unchanged by the lungs. After absorption, it
largely (90%) binds to hemoglobin and
rarely(10%) to myoglobin and cytochrome. C
oxidase less than 1% is dissolved in plasma,
and less than 1% of CO is oxidised to carbon
monoxide. Cardiac injury has been associated
with hypoxia and neurological and perivascular
injuries were hypoxia as a result of oxidative
stress (reoxygenation) secondary to CO
exposure. Damage to central nervous system
(CNS) as result of hypoxia may lead to
cardiovascular insufficiency, and effect of high
doses of CO on smooth muscle may result in
hypotension.
 Causes/Sources
Car left running in garage or other
enclosed spaces.
Blocked chimney/ gas fires
Gas or wood fires or gasstoves and
ovens.
Kerosine or gas heaters or clothes
dryers.
 Risk
Infants-Because they take breathe more
frequently than adults.
Women who are pregnant- fetus at greatest
risk because fetal hemoglobin has a greater
affinity for oxygen and CO compared to adults
hemoglobin.
Elderly- older adults people who experience
carbon monoxide poisoning may be more
likely to develop brain damage.
Physical conditions that limit the bodys ability
to use oxygen.
Emphysema, asthma
Heart disease.
Physical conditions with decreased O2 carrying
capacity
Anemia
Iron deficiency and sickle cell.
 Clinical Manifestations
Dizziness
Headache
Disorientation
Visual disturbances
Impairment of the cerebral function
Coma
Muscle weakness
Muscle cramps
Seizures
Aggravation of pre existing diseases.
Heart and respiratory disaese.
 Diagnostic Evaluation
History- clinical suspicion is the most
important step in the diagnosis. Environmental
conditions, heating systems defects in heating
systems, defects in heating system,
maintenance of system (Extent of fire if any).
Physical examination- vital signs and
symptoms should be evaluated first.
Tachycardia, tachypnea, slight increase in
blood pressure, and hyperthermia may be
seen on skin surfaces.
Cardiac auscultation should include
exploration for dysrhythmia, and pulmonary
examination include signs of respiratory
distress and pulmonary edema.
Fundoscopic Examination
Biochemical analysis
Electrocardiogram
Computed tomography
 Management
Exposure to carbon monoxide requires
immediate treatment. Goals of management
are to reverse cerebral and myocardial hypoxia
and to hasten elimination of CO.
CPR if needed.
Promptly remove the patient from continued
exposure and immediately institute O2 therapy
with non rebreather mask.
Perform intubation for the camatose patient
or if necessary for airway protection and
provide 100% oxygen therapy.
Institute cardiac monitoring, pulse oximetry
although not useful in detecting
carboxyhemoglobin (Hbco) is still important
because a low saturation causes even greater
apprehension in this setting.
If possible obtain ambient carbon monoxide
measurements from fire department or utility
company when present.
Early blood sample may provide much more
accurate correlation between HbCO and
clinical status, however do not delay O2
administration to acquire them.
 Prevention
To avoid getting CO poisoning, you can take
following preventive measures:
Ensure theres plenty of ventilation in areas
with appliance or in a recreational vehicle that
burn gas, wood, propane or other fuel.
Buy a CO detector and place it in an area near
the source of CO.
Don’t fall asleep or sit for a long time in
an idling car that’s in an enclosed space.
Don’t sleep near a gas or kerosene space
heater.
Don’t ignore symptoms of CO poisoning.
 Complications
Cerebral edema
Cerebral infarct
Acute MI
Persistent learning deficit
Personality changes
Memory impairment
Death from progressive encephalopathy
 Drug poisoning
Poisoning by drugs or chemicals can result
from accumulation, excessive close level, drug
interactions or ingestion of inappropriate
substances.
A drug overdose is taking too much of a
substance, whether it is prescription, over the
counter, legal or illegal.
Drug overdose may be accidental or
intentional.
An overdose can lead to serious medical
complications, including death. The
severity of a drug overdose depend on
the drug. The amount taken and the
physical and medical history of the
person who overdosed.
Epidemiology
Drug overdose was the leading cause of injury
and death in 2012.
Among people of age 25 to 60 years old drug
overdose caused more deaths than motor vehicle
or car accidents.
The drug overdose death rate has more than
doubled from 1999 to 2013.
Highest death rate was among people 45-49
years of age.
 Causes
Accidental
Suicidal
Homicidal
Co morbidity
Related drug(type, time, preparation,
dosage)
Co ingestion
 Risk factors
Several factors can increase the risk of a
drug overdose, these include-
Improper storage of drugs
Not knowing or following dosage
instructions
History of misuse or addiction
History of mental disorders
 Symptoms
The symptoms of a drug overdose may
vary depending on the person, drug and
amount taken-
Nausea and vomiting
Drowsiness
Loss of consciousness
Trouble breathing
Difficulty walking
Agitation
Aggressive or violence
Enlarged pupils
Tremors
Convulsions
Hallucinations or delusions
 Diagnostic Evaluation
History-
Physical Examination
Toxicology screen or ‘tox’ screen
Specific blood test
Electrocardiogram
CT Scan
 Treatment
Activated Charcoal
Emesis
Antidote
 Prevention
Only take prescribed medications, that are
prescribed to you by a professional.
Misusing or abusing prescription or over the
counter medications is not a safe alternative to
illicit substance abuse.
Never take larger or more frequent doses of
your medications, particularly prescribed pain
medications, to try get faster and more powerful
effects.
Follow directions on the label when you
give or take medicines. Read all warning
labels. Some medications cannot be
taken safely when you take other
medicines or alcohols/drinks.
Dispose of unseal, unused, unneeded or
expired prescription drugs.
Monitor the use of medicines prescribed
for children and teenagers such as
medicines for attention deficit
hyperactivity of ADHD.
Never sell your prescribed drugs.
 Chemical/Pesticides
Organophosphorus poisoning
Organophosphate poisoning is poisoning
due to organophosphates (Ops).
Organophosphates are used as insecticides,
medications, and nerve agents. It occurs
most commonly as a suicide attempt in
farming areas of the developing world and
less commonly by accident.
 Epidemiology
OPs are one of the most common causes of
poisoning worldwide. There are nearly 3
million poisoning per year resulting in two
hundred thousand death. Around 15% of
people who are poisoned die as a result.
Intentional poisoning with organophosphate
occurred in 51.7% of the cases, with 21.7% of
cases being accidental and 26.6% of cases of
unknown circumstances.
Pathophysiology
 Clinical Manifestations
It can be divided into 3 broad categories
including:
Muscarinic effects
Nicotinic effects
CNS effects
Muscarinic effects
These can be remembered using the acronym
SLUDGE:
Salivation
Lacrimation
Urination
Diarrhea
GI upset
Emesis
 DUMBELS
Diaphoresis and diarrhea
Urination
Miosis
Bradycardia, bronchospasm
Emesis
Excess lacrimation
Salivation
Nicotinic effects
Muscle fasiculations
Cramping, weakness
Diaphragmatic failure
Autonomic nicotinic effects
Hypertension
Mydriasis
Pallor
CNS effects
Anxiety
Emotional lability
Restlessness
Confusion
Ataxia
Tremors
Seizures
Coma
 Diagnosis
Cholinesterase levels
Atropine test
 Management
The first is to ensure adequacy airway,
breathing and circulation of the patient.
Airway control and adequate oxygenation
are paramount in organophosphate
poisonings.
Intubation may be necessary in case of
respiratory distress due to laryngospasms,
bronchospasms, bronchorrhea or seizures.
Immediate aggressive use of atropine
may eliminate the need for intubation.
Succinylcholine should be avoided
because it is degraded by
acetylcholinesterase (AChE) and may
result in prolonged paralysis.
 Medication
The mainstays of medical therapy in
organophosphate (OP) poisoning include
ATROPINE, pralidoxime and diazepam.
Initial management must focus on adequate use
of atropine.
Anticholinergic agents
Act as competitive antagonists at the muscarinic
cholinergic receptors in both central and
peripheral nervous system.
 Nursing Diagnosis
For poisoning
Diarrhea related to bacterial, viral or
parasitic infection as evidenced by
abdominal pain, abdominal cramping,
frequency of stool, hyperactive bowel
sounds, loose stools frequency.
 Nursing Interventions
Ask the client about recent history of
taking/drinking contaminated water,
ingestion of unpasteurized dairy products,
eating food inadequately cooked.
Evaluate pattern of defecation to promote
immediate treatment.
Assess for abdominal pain, cramping,
frequency, urgency, loose stools
Teach the client about importance of
hand washing after each bowel
movement.
Imbalanced nutrition: less than body
requirement related to nausea, vomiting
as evidenced by anorexia, inadequate
food intake, percieved inability to ingest
food.
 Nursing Intervention
Measure the client’s weight to monitor the
response to therapy.
Monitor the client’s food intake to determine
the amount of food that is consumed.
Provide parenteral fluid as ordered to ensure
adequate fluids and electrolyte level.
 Risk for fluid volume deficit related to
diarrhea, inadequate fluid intake, vomiting.
Assess the client’s skin turgor and mucous
membranes for signs of dehydration.
Assess the volume and frequency of
vomiting.
Assess the clients pulse rate and BP.
 For carbon monoxide poisoning
Impaired Gas exchange related to carbon
monoxide poisoning
Nursing Interventions
Assess the vital signs- Respiration, pulse rate,
oxygen saturation 95% or higher.
Position patient in semi fowlers position
Administer 02 as prescribed by the physician.
 For chemical poisoning
Risk for injury related to contact with
chemical pollutant or poisonous agents.
Nursing Interventions
Acquire knowledge/information about
nature of emergency, accident or disaster
to help prepare staff for appropriate level
of response based on injuries.
Determine primary needs and specific
complaints of clients.
Obtain primary needs and specific
complaints of clients.
Obtain additional medical information
including preexisting conditions such as
allergies and current medications.
 Journal Review
Topic: Study of poisoning trends in north
India- A perspective in relation to world
statistics.
Author: Satinder P Singh, Akash D Aggarwal,
Surinder S oberoi, Krishnan K Aggarwal
Abstract:
India is an agriculture based country with
Punjab as one of the leading food grain producing
states. There is an ever increasing
Burden to feed the growing population. This has
led to over usage of pesticides which on one
hand has contributed significantly to increase
the crop yield while on the other hand has led
to sharp increase in the poisoning cases in the
region. The present study was undertaken to
study the deaths related to poisoning in Malwa
region of Punjab in 2010 with a view to assess
the patterns, trends and incidence of poisoning.
Introduction:
Poisoning is a major epidemic of non
communicable disease in the present century.
Among the unnatural deaths, deaths due to
poisoning come next only to road traffic accident
deaths. In earlier times, the poisoning deaths from
pesticides were mainly accidental but easy
availability, low cost and unrestricted sale have led
to an increase in suicidal ad homicidal cases as well
Pesticides which were invented to protect
crops from rodents, insects; ad humans from
starvation have themselves become an
important contributor to unnatural deaths. In
the developed world, poisoning due to
narcotics and drug overdosage is far more
common than due to pesticides. WHO
estimated 0.3 million people die every year
due to various poisoning agents.
Discussion:
During this study, 624 autopsies were
performed in over the year 2010, out of which
110 cases had died of poisoning, thereby
constituting 17.6% of the total medico legal
autopsies. The countries showing percentage
of poisoning autopsy cases to be around 10%
out of total autopsies performed include
Germany, Korea, Bangladesh, Turkey and China
In this study, 72.72% of the total cases were males
and 27.27% were females. There is strong
convergence of findings within India and abroad of
male preponderance. This could probably be
explained by the more frequent involvement of
males in dealing with poisonous substances
(occupational hazard) and more prone to stress and
thus more frequently affected. This study shows
incidence of poisoning deaths in rural population to
be 54.55% and in rural population to be 45.45%.
This study shows that maximum number
of poisoning deaths was due to alminium
phosphide poisoning i.e.,50.9% followed
by chloro compounds 23.64% and
organophosphorus compounds 25.45%.
Conclusion
Poisoning is a problem of the society which should
be considered seriously from all aspects. The
present study has demonstrated the fact once
again. The incidence of poisoning is rising and
further likely to rise more in the future because of
uncontrolled growth of human population and ours
being an agree based economy. Contributing to the
above problem is the easy availability of alminium
phosphate which has been found
This calls for urgent research to find out a
specific antidote and strict legislative measures
over the sale of fumigant. This is also applicable
to all other common drugs and poisons
responsible for poisoning cases. Perhaps the
most effective step would be to educate the
people on the seriousness of the problem
through health education and finding ways to
lead a healthy and stress free lifestyle.
 Conclusion
Food poisoning is life threatening for children,
adult, pregnant woman and older. These
individuals should take extra precautions by
avoiding the outside food and taking care about
food habits.
Awareness and simple safety precautions can
help keep us, and our children safe and well.
Implement prevention strategies in your
surroundings to stop poisoning.
 Bibliography
Chintamani, M Mrindini, G Harindarjeet, S Asha
(2014) Lewis Medical Surgical Nursing, Published by
Elsevier India Private Limited, Page no: 1039, 1040
Ignataricius, Workman (2012); Medical Surgical
Nursing Patient Centered Collaborative Care, 7th
edition, published by Elsevier, Page: 1270,1271
Phillips, Long Woods(1998); Shaffer’s Medicl Surgical
Nursing, 7th edition, published by BI publications Pvt.
Ltd., Page: 896,898,899
Linton (2013), Introduction to Medical Surgical
Nursing, 6th edition, Elsevier Publishers, Page:
245,244,246
A Parveen, CR Murus, CS Yadav (2005) Principles and
practice of emergency medicine, Published by BI
publications, Page no: 332,333,334,335.
D Suresh (2012), Handbook of emergency
medicine( Eight edition), Published by Elseiver, Page:
115,116,117.