Poisoning

Question 1

Common drugs ingested

Answer 1

Aspirin
Paracetamol
Antidepressants

Question 2

Common household agents ingested

Answer 2

Disinfectants
Bleach
Weedkiller
Parrafin or white spirit
Dishwasher tablets

Question 3

Assessment

Answer 3

Type of ingestion (drug, preparation)
Time of incident
Amount of ingestion (include all medication that was potentially in the bottle or packet when calculating)
Weight of child
Is the ingestion potentially harmful?
Beware of the possibility of mixed overdose
Beware of the possibility of inaccurate dose reporting on history taking
If mixed or undetermined ingestion Paracetamol level should be done.

Question 4

Important examination

Answer 4

Conscious level
Pupils equal and reactive
Vitals
Evidence in mouth of ingestion

Question 5

Management

Answer 5

Call poisons unit
Management

Airway
Breathing
Circulation
Disability, AVPU
Glucose
ECG
Removal of poison (if necessary)

Emesis
No role in the hospital setting
Activated Charcoal
Has a very limited role in treatment and should not be used without consultation with a toxicologist.

• > Whole Bowel Irrigation has a limited role in treatment of some slow release preparations
• > Gastric Lavage has a very limited role in treatment and should not be used without consultation.
• > Specific antidotes may be available and serum drug levels may help in treatment decisions

Advice on home safety and avoiding additional poisonings

Question 6

Contraindications to activated charcoal

Answer 6

Contraindications:
Patients with altered conscious state 
The following agents:
Ethanol/glycols
Alkalis
Boric acid
Lithium
Iron compounds
Potassium and other metallic ions
Fluoride
Cyanide
Hydrocarbons
Mineral acids

Question 7

Intentional poisoning in adolescent

Answer 7

Must be admitted until adolescent unit after discussion with mental health team

Question 8

Assessment of coma/ALOC with posioning

Answer 8

Assess direct, secondary and non-toxicological reasons for ALOC

Question 9

What can cause ALOC in poisoning

Answer 9

Direct toxic effect
Secondary effect mediated by hypoxia, hypoglycemia, hyponatremia, hypotension, seizures, edema
Non-toxicological->head injury

Question 10

Investigations in ALOC and poisoning

Answer 10

ECG
Paracetamol levels
VBG, anion gap, osmolar gap
Drug levels
Specific Mx for->ethanol, phenobarbitone/carbamazepine/valproic acid, aspirin and toxic alcohols level in unexplained metabolic acidosis
Consider flumazenil to confirm benzodiazepine overdose, but not if possibility of coingestion of pro-anticonvulsant substances

Question 11

Assessment of delirium and agitation from poisoning

Answer 11

Consider potential for harm to self/staff/community

Assess direct, secondary and non-toxicological complications

Question 12

Management of delirium from poisoning

Answer 12

ABC
Glucose
Electrolytes
General manage infection, trauma etc
Specific:
1. Calm environment->Oriented, quite, reassured
2. Physical restraint until pharmacological restraint can be achieved
3. Oral / IV diazepam or IV/IM midazolam if oral not possible
4. Antipsychotics->caution Haloperidol with anticholinergic. Olanzepine can be given orally.
5. If hyperpyrexia urgent contact with Poisons->Poisons Info contact number (131126)

Question 13

Seizures in the setting of these ingestions indicate worse prognosis

Answer 13

Salicylates
Theophyline
TCA's
Propranolol
Chloroquine
Isoniazid

Question 14

What is pyridoxine specific treatment for

Answer 14

Seizures due to isoniazid toxicity

Question 15

Management of hypotension with poisoning

Answer 15

ABC
IV access
Fluids
ECG- correct dysrrhythmias
VBG
Glucose
Seek senior help, ongoing monitoring, admit

For refractory shock->need ICU
Inotrope and vasopressor
Insulin-dextrose euglycemia for CCB overdose
ECMO for refractory severe cardiovascular compromise
Consideration of “lipid rescue” in cases of local anaesthetic toxicity (and other drugs) leading to cardiovascular collapse refractory to conventional therapy