General aspect of poisoning Flashcards
What is poisoning?
Exposure to poisons (Drugs, food, household products) that harm the body
What are the modes of poison exposure?
1) Ingestion
2) Inhalation (CO)
3) Topical exposure (Organophosphates)
4) Ocular exposure (drugs)
5) Envenomation (injection of snake venom into the body for ex)
6) Transplacental
What is the mortality rate of acute poisoning?
It is the most common medical emergency in young children with a mortality rate of <1% commonly you won’t find poisoning in adolescents you might suspect intended self-harm
How to prevent/minimize poison absorption?
1) Ipecac (enhances vomiting, but it’s not recommended anymore)
2) Gastric lavage (nasogastric tube that washes the medication, must be within the first hour of ingestion)
3) Activated charcoal (Helps in gut excretion, ineffective in pesticides, hydrocarbons, acid, alkali, alcohol, iron & lithium ingestion)
4) Cathartics (“accelerates defecation”, can cause electrolyte disturbance, severe dehydration, neuromuscular impairment, and coma)
5) Whole bowel irrigation used when the ingestion was >1hr ago (Golytely, “Polyethyleneglycol combined with electrolytes” PEG-ELS, given 0.5L/Hr for small children and 2L/hr for adolescents administering it for 4-6hours/until the effluent is clear, it is useful for iron, lithium, and sustained release drugs)
How do we enhance excretion?
1) Ion trapping, traps weak acids in the renal tubular fluid by alkalizing the urine (7-8 pH), it can help in Salicylate (Aspirin), phenobarbital, and tricyclic antidepressants elimination
2) Multiple-dose charcoal can cause bowel syndrome but it helps with the excretion of phenobarbital and theophylline poisoning
3) Hemodialysis: in case of alcohol intoxication, salicylate poisoning, & lithium overdose
What is the main difference between poisoning in adults and in children?
In adults, poisoning mostly occurs due to psychopharmacology drugs (sedatives, tranquilizers, and antidepressants) while in children it is mainly from households, plants, and personal care products.
What can you do if unexplained symptoms occur?
urinary drug screen
How to manage child poisoning?
1) Initial life support: Airway, Breathing, Circulation, Disability (ABCD)
2) Decontamination (skin wash with soapy water, eyer irrigate with0.9% NaCl, or decontaminating the GI tract)
3) Enhance the elimination
4) Antidotes
5) Supportive care
6) Prevention and education for children while psychiatric evaluation for adults
What are the general features in a medical history examination that suggest poisoning?
1) Acute onset
2) Age range 1-5
3) History of pica (ingestion of non-nutritional element) or exposure to a potential toxicant
4) Environmental stress (intentional poisoning)
5) involves multiple organ systems
6) Significant alteration in consciousness
7) puzzling clinical picture
8) Medications at home, used by other household members, particularly new medications
9) Visits from grandparents and other relatives.
10) Large family gatherings (e.g., holiday parties)
11) Moving to a new home
What are the strategies to decontaminate the GI?
1) Charcoal (most effective during the first hour of ingestion as it absorbs the drug into its surface, given 1g/kg)
2) Whole bowel irrigation (can also be valid after the toxin passes the bowel)
What are the toxins that are not adsorbed by activated charcoal?
1) Acids/alkalis
2) Alcohols
3) Metals and ionic compounds (iron, potassium, lithium) Hydrocarbons
When do we use the bowel irrigation method?
- Very rarely performed
- Polyethylene glycol (Golytely) –until effluent runs clear
1) Ingestion of a slow-release (potassium chloride) or extended-release substance (diltiazem/verapamil)
2) substance not bound to activated alcohol
3) Iron in high amounts (>60g/Kg of elemental iron was ingested)
- Presentation prior to symptom onset and
Ingestion is likely to result in significant toxicity despite supportive care or antidote therapy - Contradicted in patients with bowel obstruction, GI bleed, and perforation
What are some of the antidotal drugs available?
poisoning of (antidote):
1) Benzodiazepines (Flumazenil)
2) Opioids (Naloxone)
3) Paracetamol (N-acetyl cysteine)
4) Iron (Deferoxamine)
5) Cholinesterase inhibitors organophosphorus (Atropine & pralidoxime)
6) Carbon monoxide (oxygen)
7) Ethanol, Salicylates “aspirin”, oral hypoglycemics (Dextrose)
What is the antidote for Benzodiazepine poisoning?
Flumazenil
What is the antidote for Opioid poisoning?
Naloxone
