Poison

1. POISONING
GENERAL
APPROACH
DR. RANJITHKANNA,M.D.
SENIOR RESIDENT,
DEPT. OF GENERAL MEDICINE,
KARUR GOVT. MEDICAL COLLEGE.

2. GENERAL APPROACH TO POISONING AND
DECONTAMINATION
 Poison is any substance when introduced into the living body or brought
into contact with any part thereof will produce ill effects or death, by its local
or systemic or both.
 Acute Poisoning is a state of poisoning wherein a single large dose or
several small doses taken in a short period resulting in abrupt onset of
symptoms and signs of intoxication

3. MODE OF ENTRY
 Ingestion
 Instillation over skin, mucous membrane and eyes
 Inhalation
 Injection

7. NARCOTIC (OPIODS) TOXIDROME
 Coma
 Pinpoint Pupil
 Respiratory depression
 Hypotension
 Hypothermia
 Hyporeflexia

8. SYMPATHOMIMETIC(MATHS)
 Mydriasis
 Agitation/Arrhythmia
 Tachycardia
 Hypertension,Hyperthermia
 Seizure,Sweating

12.  Alkaline diuresis ?Mechanism: Alkalinisation of the urine increases urinary
excretion of weak acids (e.g. salicylates, phenobarbitone).
 Indications: Salicylates, chlorpropamide, phenobarbitone and possibly the
chlorphenoxy herbicides.
 Method : Each cycle consists of 500 ml of 0.9 % over 1 hour followed by 400
ml of 5% dextrose with 100 ml Soda bicarbonate over 1 hour and then
followed by 500 ml 0.9% NS with 10 mEq of kcl over 1 hour.
 If urine output less than 100ml/hr- then inj. Frusemide IV stat to he given, if
urine output not increasing give another dose inj. frusemide IV stat is give and
even after that if it is less than 100 ml/hr stop FAD and plan hemoldialysis
 If urine out put more than 100 ml/hr then continue FAD (Patient may be
catheritized for monitoring urine output )
 Look for Lungs signs to rule out Pulmonary edema during FAD cycle

14. GENERAL MANAGEMENT OF POISONING
 Initial assessment
 Supportive Care
 Prevent Absorption
 Increase Elimination
 Antidotes
 Prevent Re-exposure

15. SUPPORTIVE CARE
 Airway protection
 Oxygenation/ventilation Hemodynamic support
 Treatment of seizures
 Correction of temperature abnormalities
 Correction of metabolic derangements
 Treatment of arrhythmias

16. TO PREVENT AND TREAT SECONDARY
COMPLICATIONS
 Aspiration, pneumonia
 Bedsores
 Cerebral and pulmonary edema
 Rhabdomyolysis, renal failure
 Thromboembolic disease, coagulopathy
 Sepsis & generalized organ dysfunction due to hypoxia or shock.

17. INITIAL EVALUATION
 SUPPORTIVE CARE:
 A-B-C
 Treatment of Arrhythmia, Seizures
 In poor GCS, Obtunded pts  Secure Airway.

18. PREVENT ABSORPTION
 GI Decontamination
- Gastric lavage
- Activated Charcoal
- Whole bowel irrigation
- Endoscopic removal
 Decontaminate Eyes & Skin

19. Gastric lavage
 Gastric lavage – 200mL – 2L
 Left lateral position
 Activated charcoal 10:1 (poison)
100:1
1gm/Kg
 Acid / Alkali / Heavy metals / Corrosives
 Check for Bowel sounds
 Contraindication: Ileus / Drowsy pt. / Intestinal obstruction
 Complications: Aspiration Pneumonitis / Constipation

21. Whole Bowel Irrigation
 PEG – Poly Ethylene Glycol
 2L/hr. in Adults
 0.5L/hr. in Children
 Large amount of Tablets – Lithium/Iron/Enteric
coated tablets
 Sitting position

22. Endoscopic Removal
 Drug filled pack / Condom

23. Poison Elimination
 Multiple dose of Activated Charcoal
 Gut dialysis
 1g/Kg  Loading dose
 0.5g/Kg  Every 2 hours
 Urine pH  Forced Alkaline Diuresis
 Ind: Hair dye, Herbicide, Salicylates, CuSO4.
 500mL NS – 1 hour
 400mL DNS + 100mL NaHCO3  500mL NS + 1 amp Kcl + 40mg
Lasix
 < 100mL urine  20 mg Inj. Lasix I.V.

24. FAD
INDICATIONS CONTRAINDICATIONS
Copper sulphate Congestive cardiac failure
Phenobarbitone Renal failure
Salicylates Cerebral edema
Methotrexate
Sulfonamides
Herbicides
Hair dye

25. Poison Elimination
 Hemodialysis:
 Useful in eliminating:
 Salicylates
 Phenobarbitone
 Methanol
 Ethanol
 Isopropanol
 Ethylene glycol
 Lithium

26. Poison Elimination
 Hemodialysis:
 Contraindications:
 If the toxic substance
1.Has an antidote available
2.Cardiogenic shock
3.Coagulopathy

27.  Seizures  Diazepam 0.2 mg/Kg I.V.
Midazolam
Phenobarbitone 10 mg/Kg
Phentobarbitone 5 mg/Kg
Phenytoin Contraindicated

28. USES OF ANTIDOTE
SPECIFIC POISON ANTIDOTE
Methemoglobinemia Methylene blue
Paracetamol N-acetylcysteine
Opioids Naloxone
Carbon monoxide, cyanide, hydrogen
sulphide, other hypoxia-producing
agents
Oxygen
Anticholinergics (severe) Physostigmine
Organophosphates Pralidoxime
Isoniazid, ethylene glycol Pyridoxine
Toxins producing prolongation of QRS
complexes
Sodium bicarbonate

29. USES OF ANTIDOTE
SPECIFIC POISON ANTIDOTE
Cyanide Amyl nitrite, sod. nitrite, sodium
thiosulphate
Snake bites Anti-snake venom
Carbamates Atropine
Beta-blockers, calcium channel blockers,
fluorides
Calcium gluconate
Iron Deferoxamine
Hypoglycemia Dextrose
Methanol, ethylene glycol Ethanol
Benzodiazepines Flumazenil
Toxins producing prolongation of QT
interval
Magnesium sulphate

31. THANK YOU