A Quick Recap of Principles of Management of Poisoning

1. A R G H A P R AT I M R OY
R O L L 1 0
General Principles of
Management of Poisoning
PHARMACOLOGY
SEMINAR

2. Introduction & Objectives
 Poisoning: In a Broad Sense poisoning implies harmful
effects of a chemical on a biological system. It may result
from large doses of drugs because ‘it is the dose which
distinguishes a drug from poison’
Objectives
1. To know about the general detoxification and supportive
measures.
2. To Know about the antidotes of different drug poisoning.

3. Management
Management
of
Poisoning
ABC
Enhance
Elimination
Antidote
Decontamination
& Prevention of
Absorption

4. ABC

5. Decontamination
A. Decontamination of the skin
Cleansing with soap + water: used after dermal exposure
to organophosphates
Cleansing with acetic acid (vinegar): for Nicotine
B. Decontamination of the stomach
Emesis
Gastric lavage
Activated Charcoal
Endoscopic surgical removal
C. Decontamination of the intestines by whole
bowel irrigation (WBI)

6. Decontamination: Termination of Exposure
Emesis
 Seldom use, have risk
 AcEmesisute ingestion of potentially toxic substance (< Ihr) Pre-hospital
setting with long transport time to medical care
Oro Gastric Lavage (GL)
Within 60mins of ingestion (Except Anti Cholinergic <12hrs ; Salicylate
<24hrs
Contraindications:
Caustic/ Corrosive ingestion ,Large foreign bodies, Airway not
protected, Suspected UGI injury or Hypoxia

7. Decontamination: Prevention of Absorption
Activated Charcoal
Dose • Single Dose: lg/kg
• Multiple Dose: 0.5g/kg Q2-6H
Indication Digoxin, Amitriptyline, Phenobarbitone, Dozepin,
Theophylline, Salicylates,Phenobarbital, Dapsone, phyentoin
Carbamazepine; Aspirin
Contraindication • Paralytic Ileus or intestinal obstruction
• GI perforation
•>2hrs of Poison Ingestion
Large Surface Area, High Binding property, Interrupts Enterohepatic & Enteroentric
Circulation
Charcoal doesn't
absorb
Strong Acids and alkalies, metallic salts, iodine, cyanide,
caustics, alcohol, hydrocarbons and other organic solvents

8. Whole Bowel Irrigation
 Mechanically flushing the ingested poison out of the GIT
before it can be absorbed into the body
Iso-osmolar solution of polyethylene glycol
Rate: 1-2L per hour (minimally)
P.O. or R/ T, Entire procedure
usually takes 4 to 6 hours, Till rectal effluent clear
Indication Contraindications
Drugs Not well-absorbed by activated
Charcoal
Compromised airway
Sustained release Enteric coasted
preparation
GI Perforation
Rising drug level despite GL/AC Paralytic Ileus

9. Enhancement of Toxicant Elimination
A. Intracorporal techniques
 Forced diuresis and alkalization (barbiturates,aspirin etc)
 Repeated administration of a charcoal
B. Extracorporeal techniques
 Hemodialysis (Lithium)
 Hemoperfusion (carbamazepine, theophylline,
 digitoxin, phenobarbital, valproic acid
 PIasmapheresis (Verapamil, Thyroxine)

10. Antidotes

11. Relevant Questions shall be highly appreciated in question hour, Please Type-in your
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