Treatment of poisoning

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Treatment of poisoning

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Treatment of poisoning

  1. 1. TREATMENT OF POISONING
  2. 2. How do you manage a case of poisoning A. General measures • Resuscitation and maintenance of vital functions – Ensure patent airway, adequate ventilation, artificial respiration and 100% Oxygen as needed – Maintain BP, heart rate by fluid and crystalloid infusion, pressor agents and cardiac stimulants as needed
  3. 3. – Maintain body temperature – Maintain blood sugar level by dextrose infusion, especially in patients with altered sensorium – If unconscious, nurse semiprone
  4. 4. • Termination of exposure (decontamination) – Moving patients to fresh air (for inhaled poison) – Washing skin, eyes for poisons entering from mucus membranes and skin – Induction of emesis with syrup for ingested poisons
  5. 5. • Prevention of absorption of ingested poisons – Suspension of 20-40 g (1g/Kg) of activated charcoal should be administered in 200 mL of water – Consider, if specific antidote is present
  6. 6. • Hastening and elimination of poison – Inducing diuresis (furosemide/ mannitol) – Altering urinary pH (Alkalinization of urine for acidic drugs) – Hemodialysis and hemoperfusion
  7. 7. B. Follow up • Further inpatient care – Refer to psychiatrist to check for any psychiatric disorder and council those patients – Asymptomatic patients with signs of toxicity or altered sensorium can be discharged after 6 hours of observation – Admit symptomatic patients to ICU for monitoring of temperature, pulse, respiration, BP, Oxygen saturation and urine output
  8. 8. • Medication – antidotes can be given • Monitoring of complications of toxins • Patient education about toxins, drugs, pesticides/poisons/symptoms and self care at home in emergencies in future • Investigations to be done like blood glucose, RFT, CBC, EEG, urine/ serum toxicology, INR etc • Prevention – to prevent accidental childhood ingestion of toxin, drugs, pesticides
  9. 9. Name the antidotes for the following poisons Poisoning Antidotes Paracetamol N acetyl cysteine Benzodiazepines Flumazenil Morphine Naloxone Beta blockers Glucagon Cyanides Amyl nitrite, sodium nitrite, sodium thiosulfate Digoxin Digibind (anti digoxin antibody) Iron Desferroxamine mesylate Warfarin Vitamin K OP compounds Atropine
  10. 10. Mention the drugs responsible for following symptoms of toxicity Symptoms Drug poisoning Respiratory depression Diazepam, opiod Irregular pulse Salbutamol, quinine, anti muscarinic, tricyclin antidepressants Hypothermia Alcohol, barbiturates, BZD, phenothiazines Hyperthermia Anti muscarinics, anti depressants (MAO inhibitors), cocaine, amphetamine, opiods, alcohol, BZD Coma Hypoglycemic agents, aminophylline Constricted pupils Opiods, antipsychotics ( haloperidol, quetiapine, olanzapine), organophosphates Dilated pupils Anti cholinergic drugs (atropine, hyoscine, scopolamine, LSD)
  11. 11. Seizures Hypoglycemic agents, aminophylline Metabolic acidosis – increased anion gap Salicylates, ethanol, mathanol, formaldehyde, sulphates, metformin, INH Metabolic acidosis – normal anion gap Ammonium chloride, acetazolamide, bile acid sequestration, isopropyl alcohol

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