millions of poisoning cases are seen every year with several hundred dying but several more are unreported. A poison may be defined as any substances which if administered or comes in contact with living being produces ill-health.

1. TREATMENT OF POISONING →
Toxicity is the science that deals with the study of poison,their source
,properties,actions , detection and treatment of poisoning.
A poison may be defined ass any substance which if administered or comes
in contact with a living being produces ill-health ,disease or death.
Sources→
Venom,toxins and poisons may be originating from animals,microorganism,plants or
chemicals.

2. POISONING MAY BE →
•Acute – a single large dose or multiple small doses repeated at short
intervals result in acute poisoning . Onset of signs and symptoms are abrupt.
•Chronic – small doses repeated over a long period result in chronic
poisoning . Signs and symptoms appear gradually.

3.  STEPS IN THE TREATMENT OF POISONING : -
1. Stop the source of poison:- the patient should be shifted away from the
source of poison.
2. Limit the absorption of poison:-this depends on the route of entry .
3. Supportive therapy:-emergency stabilization of the cardiovascular and
respiratory system is needed ABC –(airway , breathing,circulation) of
poisoning.
4. Specific therapy :- specific antidots,antivenoms and antitoxins should be
used whenever available for example, ethanol in methanol poisoning ,nitrites
in cyanide.
5. Other measures:- liked forced diuresis , peritoneal dialysis hemodn
cyanide etc, ialysis,hemoperfusion , exchange transfusion etc.

4.  GENERAL MANAGEMENT :-
1. Gut decontamination :- vomiting may be induced or stomach
wash (gastric lavage ) may be given to clear the stomach of the unabsorbed
poison.
2. Management of respiratory failure :- it is necessary to
maintain a clear airway.
 Patient should be placed in semiprone position .
 Secretions should be aspirated regularly and tongue should be drawn forward .
 Oxygen may be given if there is hypoxia.

5. SOME SPECIFIC ANTIDOTES FOR DRUGS :-
 AGENT CAUSING TOXICITY
• Paracetamol
• Morphine
• Heparine
• Cyanide
• Theophylline,caffeine
• Atropine
• Coper
• Iron
• Arsenic
• Lead
• Insulin
• Digitalis
• CO
 ANTIDOTE
• N-acetyl cysteine
• Naloxone
• Protamine sulphate
• Sodium nitrate + sodium thiosulphate
• Esmolol
• Physostigmine
• D-penicillamine
• Desferrioxamine
• Dimercaprol
• Calcium disodium edetate
• Glucose
• Digoxin specific antibody fragments
• Oxygen

6.  TREATMENT OF SOME COMMON
POISONING CASES :-
 Paracetamol poisoning :-
 About 10-15g in aWhen large are taken, acute paracetamol poisoning results .
 dults can cause serious toxicity .
 Paracetamol is hepatotoxic and cause severe hepatic damage .
 Menifestations :-
 Jaundices,liver tenderness , acute renal failure .
 Mechanism involved :-
 The toxic metabolite binds to hepatic proteins resulting in hepatic necrosis .
 Chronic alchoholics and infants are more prone to hepatotoxicity.

7.  TREATMENT
 Stomach wash is given .
 Antidote is N-acetylcycteine more effective when given early .
 Atropine poisoning :-
 Atropine and scopolamine or hyoscine are belladonna alkaloids .
 Poisoning with these alkaloids is mostly accidental from therapeutic overdose,excess absorption from belladonna plaster or
when children eat fruits of datura or belladonna by mistake.
 Signs and symptoms :-
 Dry skin
 Fever
 Dry mouth
 Dysphagia
 Excitement
 Restlessness
 Hallucinations
 Hypotension and
 Coma

8.  TREATMENT
:-
 Saline purgatives to prevent absorption of the poison
 Gastric lavage with tannic acid – if the poisoning is by oral route
 Tepid sponging to reduce temperature
 Catheterization of the bladder
 Insulin :-
 Overdose of insulin is mostly accidental .
 Hypoglucemia is the most common complication of excess insulin.
 Signs and symptoms :-
 Sweating
 Palpitation
 Tremors
 Weakness
 Confusion
 Convulsions and
 Coma

9.  TREATMEN
TOral glucose or fruit juice like orange juice or in severe case ,IV glucose promptly
reverse the symptoms .50ml of 50% glucose is given intravenously followed by dextrose
infusion depending on the requirements.
Iron :-
 Acute iron poisoning is common in infants and children in whom about 10 tablets (1-2g) can be
lethal.
Signs and symptoms :-
Abdominal pain
Vomiting
Bloody diarrhea
Shock
Cyanosis and

10.  TREATMENT :-
Gastric lavage is given with 2% sodium bicarbonate solution
Desferrioxamine is the antidote 5 to 10g is instilled into the stomach at the
end of the stomach wash , to prevent iron absorption . It is injected
intramuscularly 2g every 12hours or IV 10 -15 mg/kg/hr.
Correction of acidosis and shock .
Hemodialysis or exchange transfusion helps in severe cases.