Poisoning

Question 1

General principals of the management of poisoning

Answer 1

_Supportive care (management of S&S)_
- ABCDE

Prevent absorption
- shower, PPE, gastric emptying via ETT, activated charchoal (usually within 1-2 hours unless large dose/slow release), whole bowel irrigation

Enhanced elimination
*rarely used
- multiple doses activated charcoal have a laxative effect. haemoperfusion (external blood filtering)
- large amount of diuretics plus IVT to dilute and excrete poison

Monitoring

Antidotes

Question 2

Clinical manifestations and treatment of Anticholinergic poisons

Answer 2

* Anticholinergic - inhibits the action of acetylcholine.
Therefore inhibits the parasympathetic NS.

Clinical manifestations
- Tachycardia, hyperthermia, dialated pupils, dry mouth and skin, urinary retention, ileus, hallucinations/agitation.

Treatment

• Symptom management
• Physotigmine

Question 3

Clinical manifestations and treatment of Cholinergic poisons

Answer 3

* Organophosphate poisoning (in pesticides/insecticides)

Clinical manifestations
- Bradycardia, sweating, pin point pupils, frothing at the mouth, bradycardia

Management

• Decontamination (remove clothes, shower etc)
• Atropine (anticholinergic)
• activated charchoal if inhected within 1 hour
• Benzodiazepines for seizures/agitation

Question 4

Clinical manifestations and treatment of Sympathomimetic poisons

Answer 4

*have an activating effect on the SNS through catacholamines
*pseudoephadrine, amphetamines, cocaine

Clinical manifestations
Tachycardia, HTN, hyperthermia, agitation, tremmors, chest pain

Treatment
- Symptomatic (for HTN, seizures etc)

Question 5

Clinical manifestations and treatment of Seritonergic poisons

Answer 5

‘seretonin syndrome’

Clinical manifestations

• Neuromuscular: hyperreflexia, teeth grinding
• CNS: Confusion, agitation, coma, seizures
• Autonomic: Tachycardia, fever, sweating, HTN/hypotension

Management

• Cease seretonergic agents
• Supportive care to normalise vitals
• Sedation with benzodiazepines
• Activated charcoal
• Antidote: Seretonin antagonist (cyproheptadine) if above fails to normalise vitals and reduce agitation

Question 6

Clinical manifestations and treatment of paracetamol poisons

Answer 6

Management

Activated charchoal - within 2 hours for normal paracetamol, within 4 hours for SR paracetamol.

Serum paracetamol - 4 hours post ingestion, 4 hours later.

N-acetylcystine - 200mg/kg over 4 hours then 100mg/kg over 16 hours. Pts ingested >10g should have NAC started immediately.

Question 7

Clinical manifestations and treatment of corrosive ingestions

Answer 7

*corrosives cause injury by an acid-base reaction with tissues

Clinical manifestations

• Mouth/throat pain, nausea, vomiting, abdo pain, haematemesis, resp distress (oedema of airway), stridor, tachycardia, tachypnoea, perforation of stomach associated with signs of shock

Treatment
- Airway management

• Rinse mouth to decontaminate
• Symptomatic management
• Do not use charcoal
• Endoscopy for pt with ongoing symptoms