Poisoning can occur through ingestion, inhalation, injection, or skin absorption of toxic substances. Poisonings are classified as intentional, unintentional, or undetermined. Common causes of poisoning include pharmaceuticals, household products, pesticides, and plants/mushrooms. Initial medical care focuses on life support and stabilizing the patient. Preventing further absorption and administering antidotes specific to the toxin are also important treatment steps. Proper storage and disposal of toxic substances can help prevent accidental poisoning.

1. POISONING
Myrna D.C. San Pedro, MD, FPPS

2. Poison
• Any substance that is harmful to
the body
• When ingested, inhaled, injected,
or absorbed through the skin
• Does not include adverse
reactions to medications taken
correctly

3. Classification
• Intentional poisoning: A person
taking or giving a substance with the
intention of causing harm, e.g.
Suicide and Assault
• Unintentional poisoning: If the person
taking or giving a substance did not
mean to cause harm, e.g. For
recreational such as in an “Overdose”
or Accidentally taken by a toddler
• “Undetermined”: When the distinction
between intentional and unintentional
is unclear

4. U.S. Occurrence

5. Pesticide Poisoning in the
Philippines

6. <10%

7. 71.3%
Insecticides
10.2%
Herbicides
10.9%
Not Known

8. 79.5%

9. *Top Poisons
(Those 19 Years and Below)
1. Methamphetamine
2. Multiple drugs
3. Mixed pesticide
4. Ethanol
5. Isoniazid
6. Marijuana
7. Salicylic Acid (Salicylates)
8. Malathion (Organophosphates)
9. Paracetamol (Acetaminophen)
10.Caustic Substances

12. Data Needed
• Phone Number
• Address
• Evaluation of Severity
• Weight and Age
• Route of Exposure
• Time of Exposure
• Past Medical History
• Type of Exposure
• Amount of Exposure
• Informant’s Relationship to Victim

13. Types of Exposure
• Acute: Exposure < 24 hours
 Single: a single or continuous exposure
(e.g. carbon monoxide)
 Repeated: multiple interrupted exposures
where there may be accumulation (e.g.
aspirin overdose)
• Chronic: > 24 hours or long-term exposure,
for weeks or months (e.g. lead poisoning)
• Acute “on chronic”: Acute exposure against a
background of chronic exposure to the same
agent (e.g. organophosphorus pesticide
exposure on a chronically exposed child)
• “Hit and run”: Acute exposure leading to
delayed effects once the toxicant is gone
(e.g. thalidomide exposure during gestation
leading to phocomelia)

14. Acute Poisoning
• Pharmaceuticals: sedatives, analgesics,
contraceptives, cardiovascular drugs
• Household products: bleaches,
detergents, solvents, kerosene
• Cosmetics: perfumes, shampoo, nail
products
• Substances of abuse: alcohol, tobacco,
illicit drugs
• Pesticides: insecticides, rodenticides,
herbicides
• Plants and mushrooms: berries, seeds,
leaves
• Seafood Poisoning: paralytic shellfish
poisoning, fish poisoning
• Venomous bites and stings: snake,
scorpions, bees, jellyfishes, spiders

15. Chronic Poisoning
• Metals
Lead
Mercury
• Pesticides in food or fields
Organophosphates
Carbamates
Warfarins
Organochlorines: Persistent
Organic Pollutants (POPs), has
potential developmental
neurobehavioral and endocrine
effects, e. g. DDT

16. Prevention
1. Primary: to prevent occurrence
a) Discard old prescriptions
b) Have only few tablets per bottle at a
time
c) Use child-proof packaging
d) Keep medicines in high locked cabinets
e) Keep potentially dangerous substances
properly labeled and stored in places not
easily accessible to toddlers
2. Secondary: to lessen injury after exposure
a) Create poison control centers

17. Is your home poison proof?
Remove the risk. Put poisons away. Straight away.

18. • Discard old
prescriptions •Keep potentially dangerous
• Have only few substances properly labeled
tablets per
bottle at a time

19. •Keep medicines in high •Use child-proof packaging
locked cabinets

20. •Keep potentially dangerous substances
properly labeled and stored in places not
easily accessible to toddlers

21. Exposure to Lead in Children

24. Initial Medical Care
• Initial attention should be on life
support, primarily on
cardiorespiratory care
• Shock, arrhythmias and convulsions
must be dealt with urgently and as
in the case of any critically ill
• When the patient’s condition is
stable, the specific treatment or
antidote can be given

25. Preventing Absorption
• Emesis: Syrup of Ipecac, 15-30 ml followed by water
results in vomiting in > 95% less than 5 yr
 Contraindications:
1) When there is significant risk of aspiration
2) A comatose or convulsing patient
3) Ingestion of strong acids or bases
 About 8-30% recovery of ingested substance
• Lavage: Warm saline or warm tap water
 Complication is esophageal perforation
 Used to remove fragments of tablets & capsules
• Charcoal: Activated charcoal most effective and safest
to prevent absorption given as water slurry, 15-30 gm
in a child and 30-100 gm in adolescent; repeat 20 gm q
2 hr until charcoal in stool
• Cathartic: Sorbitol max 1 gm/kg, MgSO4 max 250
mg/kg, sodium citrate max 250 mg/kg, or phosphosoda
max 250 mg/kg
 Used to hasten emptying of GIT

26. Requiring Simultaneous Antagonist
and Life Support
• Carbon Monoxide
 Oxygen 100% ASAP to reduce
concentration of CO in the blood
 Those with high toxin levels may need
hyperbaric oxygen therapy
• Opiates
 Naloxone minimum of 0.4 mg to any
patient irregardless of age or weight
 If unresponsive, up to 2.0 mg given IV
rapidly to larger children and adolescents
and may be repeated as needed
 Newborns to 6-month-old infants should
be given a dose of 10-100 g/kg

27. • Cyanide
 Oxygen immediately then antidote
 Antidote kit:
1) Amyl nitrite inhalers broken under nose
for 30 sec/min while sodium nitrite
solution being readied
2) Sodium nitrite 3% solution 0.33 ml/kg
(10 mg/kg) to maximum 10 ml/patient
with normal hemoglobin
3) Sodium thiosulfate 25% solution given
next at 1.65 ml/kg to maximum of whole
ampule
 Hydroxocobalamine-thiosulfate mixture in
doses of 4-10 g, an alternative
 These antidotes produce methemoglobin
that help remove cyanide by competition
for the cytochrome

28. • Substances Causing Methemoglobinemia
(Aniline Dyes, Nitrobenzene, Azo
Compounds & Nitrites)
Unresponsive to oxygen
If there is at least 20%
methemoglobinemia, patient’s drop of
blood will be relatively brown when
dried on filter paper
Methylene blue at 0.1-0.2 ml/kg (1-2
mg/kg)/dose of 1% solution is
therapeutic
Exchange transfusion may be needed
if two doses failed

29. • Cholinergic Agents (Organophosphates &
Carbamates)
 Manifestations are salivation, lacrimation,
urination, defecation and fasciculations
 Atropine 0.05 mg/kg to maximum initial
dose of 2-5 mg to be given while patient
decontaminated with soap and water
 If unresponsive, repeated doses of
atropine may be necessary
 Pralidoxime, a cholinesterase
regenerator, may be given when
cholinesterase level falls to 25% of
normal or lower, at a dose of 25-50
mg/kg over 30 min IV every 8-12 hr in
young children to maximum of 1 g/dose
in older children

30. Everything is poison,
there is poison
in everything.
Only the dose makes a
thing not a poison.
--Paracelsus, Father of Toxicology