Poisoning

Question 1

Types of Poisoning Exposures

Answer 1

Unintentional

• Typical childhood poisoning
• Envenomations
• Food poisonings
• Occupational exposures

Intentional

• Substance abuse
• Suicide attempt

Therapeutic Misadventures

• Dosing errors: common 10 fold dosing error in pediatrics
• Double dosing in the elderly

Question 2

Chronicity

Answer 2

• Acute: single exposure to a substance (usually high dose)
• Chronic: multiple exposures occurring over a prolonged period of time (usually low dose exp. occurring over wk-mo)
• Acute-on-Chronic: large exposure in a patient who has been exposed to that substance chronically

Question 3

Prevention of Poisonings

Answer 3

Active Measures

• Proper storage and disposal
• No mixing of chemicals
• Appropriate use of chemicals: follow directions
• Anticipation of childhood ability

Passive Measures

• Safety closures
• Unit of use packaging

Question 4

Poison Prevention Packaging Act of 1970

Answer 4

• Administered by the US Consumer Product Safety Commission
• Requires child-resistant closures on specifically designated products
• Establishes the standards and monitors testing of closures

*Packages are child-resistant, not “child proof”

Question 5

Poison Control Centers

Answer 5

• First established in 1953 in Chicago to support pediatricians confronted with poisoned patients
• Developed into a service for the public and health professionals
• Gathers a history of the exposure from the caller
• Assesses the potential threat to the victim’s life or health
• Suggests appropriate first aid procedures
• Calms and reassures caller
• Refers patient for appropriate additional care
• Consults with physician providing care

Question 6

Efforts to Reduce Absorption of Ingested Toxins

Answer 6

Induction of emesis

• Ipecac syrup
• Others: salt water, metals

Adsorption in stomach
- Activated charcoal

Question 7

Contraindications to the use of Emesis

Answer 7

• Substance that may cause drowsiness or convulsions (e.g. sedatives, antihistamines, isoniazid, antidepressants, etc.)
• Corrosive materials: acids or alkalis
• Low viscosity petroleum distillates

Question 8

Activated Charcoal (ratio, dose, moa)

Answer 8

• Has extremely large surface area with charged “binding sites”
• Chemicals are adsorbed onto the charcoal
• Binding is not strong and desorption may occur, therefore high charcoal to chemical ratio is desired

Most effective charcoal to chemical ratio is >10:1
- Dose; 50-100 grams in adults; 1 gram/kg in
children
- Not effective for low molecular weight, highly ionic materials (iron,lithium,cyanide)

• No strong evidence for use
• No AE when given orally
• Hard to give to children