This document discusses evaluation and treatment approaches for various medical conditions and complications that may arise from poisonings, including hypothermia, hyperthermia, acid-base disorders, convulsions, agitation, and electrolyte imbalances. It provides details on evaluating vital signs and laboratory tests, the various methods for decontamination of the skin, eyes, and gastrointestinal tract, as well as recommendations for treatment of specific conditions like hypothermia, hyperthermia, acidosis, seizures, and delirium.

1. EVALUATION
Dr.Sunanda Nandikol
Assistant Professor
Clinical Pharmacy Practice Department
BLDEA’s SSM College of Pharmacy & Research Centre,Vijayapur

2. Evaluation:
• In all poison cases where there appears to be NO immediate
crisis, a detailed and thorough clinical examination should be
made with special reference to the detection and treatment of
any of the following abnormalities:
• Hypothermia
• Hyperthermia
• Acid-Base disorder
• Convulsions
• Agitation
• Electrolyte Imbalance

3. HYPOTHERMIA:
• Hypothermia, is a potentially dangerous drop in body
temperature.
• Some common drugs which produce hypothermia are
Alcohols, Anti-depressants, Barbiturates, Benzodiazepines, Carbon
monoxides, opiates, Phenothiazine’s.
• Treatment:
• Rewarming
• For Mild cases, a warm water bath is sufficient until the core
temperature rises to 92F, the patient should be placed in a bed
with warm blankets.
• Heating the inspired air is recommended by some as very
effective in raising the core temperature.

4. Hyperthermia:
• Oral temperature above 102 F is referred as Hyperthermia. If it exceeds 106
F, there is imminent danger of encephalopathy.
• Drugs producing Hyperthermia are
Amphetamine, Anti-depressants, Cocaine, Salicylates, Thyroid Hormones,
Anticholinergics, Anti-histamines, Ephedrine.
• TREATMENT:
-Remove all clothes, and pack the neck and groin with ice.
-Immersion of cold water bath is very effective but dangerous in the elderly
and in heart diseased patients.
-Stop cooling measures when core temperature falls below 102F and nurse
the patients in bed in a cool room.
-Administration of dantrolene may be beneficial in some cases.
-Do not use anti-pyretic’s drugs like Paracetamol, they are in-effective in such
cases.

5. ACID-BASE DISORDER:
• Serum electrolytes to evaluate for metabolic acidosis should be obtained.
• The diagnosis of these acid-base disorders is based on arterial blood gas,
PH,PaCo2, bicarbonates, and serum electrolytes disturbance.
• In case of metabolic acidosis, it is necessary to calculate the anion gap.
• Whereas Anion gap is calculated by (Na+ +K+)-(HCO3-+Cl-)
• Normal range is 12 to 16mmol/L
• If the anion gap is greater than 20mmol/L, a metabolic acidosis is present
regardless of the PH or serum Bicarbonate concentration.
• The common cause for the various acid-base disorders are: Anxiety,
Hypoxia, Lung diseases, CNS diseases.
• Treatment: The drug of choice is Sodium Bicarbonate. It is widely
considered to be the best antidotes for acidosis of almost any aetiology.

6. CONVULSIONS:
• There are several drugs and poisons which causes convulsions.
Eg: Amphetamine, anticholinergics, antidepressants, caffeine, cocaine,
Heavy metals, INH.etc..
Treatment:
• Administer Oxygen by nasal cannula or mask
• Position patient’s head for optimal airway patency
• Establish IV line
• Begin drug therapy with Benzodiazepines (Lorazepam,
Diazepam, Phenytoin)
• If status still persists, administration of Phenobarbitones
• Monitor ECG, Hydration, and Electrolyte balance.

7. AGITATION: (Anxiety/ Nervous Excitement)
• Several drugs and Poisons are associated with increased aggression
which may sometimes progress to Psychosis and violent behaviour.
• DELIRIUM is the term which is often used to denote such acute
psychotic episodes and is characterization by disorientation,
irrational fears, Hyper-excitability.
• DEMENTIA refers to a more gradual decline in mental processes
mainly resulting in confusion and memory loss.
• Dementia due to drugs is usually reversible.
Treatment:
• DELIRIUM is managed by Chlorpromazine, Diazepam, and
Haloperidol. Caution is however necessary because of sedatives

8. ELECTROLYTE IMBALANCE:
• HYPERKALAMIA: (High potassium level)
• causes includes Digitalis, beta 2 antagonist, Potassium sparing
diuretics, NSAIDS, Fluorides, Heparin, etc.
• Clinical symptoms includes Abdominal pain, diarrhoea, Myalgia,
weakness,
• TREATMENT: Glucose, Insulin infusion, sodium bicarbonate, calcium
gluconate.
• HYPOKALAEMIA: (low Potassium level)
• causes includes Beta 2 antagonist, agonist, theophylline, insulin,
chloroquine, caffeine, dextrose, loop diuretics, thiazides.
• Clinical symptoms: muscle weakness, paralytic ileus, ECG abnormal
• TREATMENT: oral or IV potassium

9. • Hypernatremia: (high Sodium levels)
• causes: colchicine, lithium propoxyphene, rifampicin, phenytoin, alcohol,
mannitol, sorbitol,, sodium salts, excessive water loss, IV saline solution, salt
emetics.
Treatment: water restriction with or without loop diuretics
Hyponatraemia: ( less sodium level)
• Causes : carbamazepine, chloropropamide, NASIDs, Amitriptiline, Biguanides,
Sulfonylureas, captopril, and other ACE inhibitors, Lithium
Treatment: Hypertonic saline
Hypocalcaemia: (less calcium level)
• Causes: Hydrogen flurides, oxalates,aminogylcosides, ethanol,
phenobarbitones, phenytoin, theophylline, etc
Treatment: Calcium gluconate IV,
• Drug induced Hypercalcaemia is Rare/uncommon.

10. Decontamination
• Decontamination procedures should be undertaken
simultaneously with initial stabilization, diagnostic
assessment, and laboratory evaluation. Decontamination
involves removing toxins from
• Skin
• Eyes
• Gastrointestinal tract.

11. • SKIN
• Contaminated clothing should be completely removed and
double-bagged to prevent illness in health care providers
and for possible laboratory analysis. Wash contaminated
skin with Non-Germicidal Soap and Water.
• special cases like Phenolic Burns should be treated with
Polyethylene.
• Phosphorus burns should be treated with copper sulfate
solution.
• For Hydrofluoric acid burns, use of intradermal or intra-
arterial calcium gluconate decreases tissue necrosis.

12. EYE:
• Wash with Normal saline or water for 15-20min
• don’t use alkaline or acidic solutions
• as a first aid measure victim should wash affected area in
running water, while holding the eye lids open.

13. GUTS:
• Various methods of poison removal from the GI tract are
• Emesis
• Gastric Lavage
• Catharsis
• Activated Charcoal
• Whole bowel irrigation

14. EMESIS:
• The only recommended method of inducing a poisoned patient
to VOMIT is administration of syrup Ipecac
• Syrup: Root of small shrub(Cephaelis ipecacuanha)
• Active principles: cephaeline, emetine, traces of psychtrine
• MOA: Local activation of peripheral sensory receptors in the GI
tract. And Central stimulation of the chemoreceptors trigger
zone with subsequent activation of the central vomiting centre.
• Other emetics are apomorphine, Warm water, Mustard water,
copper sulfate, zinc sulfate, stimulation of posterior pharynx
with a finger or a blunt object may induce vomiting by provoking
the gag reflux.

15. • End