Treatment of poisoning

1. TREATMENT OF POISONING

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. – Maintain body temperature
– Maintain blood sugar level by dextrose
infusion, especially in patients with altered
sensorium
– If unconscious, nurse semiprone

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. • 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. • Hastening and elimination of poison
– Inducing diuresis (furosemide/ mannitol)
– Altering urinary pH (Alkalinization of urine for
acidic drugs)
– Hemodialysis and hemoperfusion

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. • 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. 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. 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. 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