Poisoning

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Poisoning and its management

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Poisoning

  1. 1. Poisoning
  2. 2. • Toxicology is the science that deals with the study of poisons, their source, properties, actions, detection and treatment of poisoning.
  3. 3. General principles of treatment • Stop the source of poison • Limit the absorption of poison • Supportive therapy – ABC and coma cock tail – Naloxone 2 mg – Thiaine 100 mg – Dextrose 50% 50 mL • Specific therapy with antidotes • Other measures
  4. 4. Other measures are – Forced alkaline diuresis : Frusemide, Sodium bicarbonate and IV fluids – Forced acid diuresis : Frusemide, Ascorbic acid and IV fluids – Hemodialysis
  5. 5. General management • • • • Gut decontamination Management of respiratory failure Management of circulatory failure Management of fluid and electrolyte imbalance • Metabolic acidosis • Convulsions • Antidotes
  6. 6. Gut decontamination • Emesis : Ipecac syrup 20-30 ml or Strong salt solution or freshly prepared mustard powder solution • Do not induce emesis : Corrosive agent or petroleum product or unconscious patient • Stomach wash • Activated charcoal / Medicoal • Purgatives: MgSO4 20-30 g or Sod. Sulphate 20-30 g
  7. 7. Management of respiratory failure • Oxygen • Mechanical ventilation • Sitting position
  8. 8. Management of circulatory failure • Plasma expanders : Dextran or whole blood • Vasopressors : Dopamine 2-10 mcgr/kg or phenylephrine 5-20 mcgr/kg or methoxamine or mephenteramine
  9. 9. Management of fluid and electrolyte imbalance • • • • Hyponatremia : Normal saline Hypernatremia : Frusemide Hypokalemia : KCl 4-6 mEq/L Hyperkalemia : Frusemide or thiazide or 10% calcium gluconate • Hypocalcemia : 10% calcium gluconate
  10. 10. Metabolic acidosis • Sodium bicarbonate 1-2 mEq/L IV for 30 minutes
  11. 11. Convulsions • Diazepam 10 mg slow IV • Phenytoin 10 mg/kg IV • Phenobarbitone 10 mg/kg
  12. 12. Antidotes • Physical antidote : Activated charcoal adsorbs alkaloids • Chemical antidote : acetic acid reacts with alkalis, chelating agents bind heavy metals like lead, arsenic, copper, mercury, etc. • Pharmacological antidotes
  13. 13. Pharmacological antidotes Toxic agent Antidote Paracetamol N-Acetyl cysteine Morphine and other opioids Naloxone Heparin Protamine sulphate Cyanide Sodium nitrate + Sodium thiosulphate Organophosphates Atropine, Pralidoxime Atropine Physostigmine Copper D-Penicillamine Iron Desferrioxamine Arsenic Dimercaprol Lead Calcium disodium edetate Insulin Glucose Methanol Ethanol Carbon monoxide Oxygen Warfarin Vit K1 oxide
  14. 14. Thank you

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