Managing Of Poisoning

Poisoning preventation strategies:

Keep all household poisons separate from food
Keep all products in their original container
Read all labels carefully before using
Never give or take medication in the dark
Dispose of all products in a safe or proper manner
Dispose of all old medicine
Never refer to medicines as vitamin or candy
Teach children never to take medication unless given by an adult they know or
trust
Drugs supplied in child proof packaging are preferable
Store all drugs or toxic agents out of sight & out of reach, use cabinet lock
Keep syrup of Ipeca
Not to be administered except at the direction of a physician or the local poison
center
Keep the telephone number for the local poison control center at each telephone

Measures of treatment:
1- Induction of vomiting:
a- Ipeca syrup is the best emetic
Age

Dose

6 9 months

5 ml

9 12 months

10 ml

1 12 years

15 ml

More than 12 years

30 ml

The dose maybe repeated once if the child doesnt vomit within 15 20 minutes
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Appearance color & odor as clues to identify poisons

Odor:
Fruity odor Acetone, alcohol, ammonia, glue, bitter almond (cyanide), phenol
Garlic odour ( Arsenic, Malathion, Parathion, Phosphrous , yellow, selenium,
zinc phosphide)
Rotten egg odour H2S, shoe polish (nitro benzene)

b- Apomorphine:
Used as an emetic but it is rarely used because
depress respiratory center
causes lethargy & hypotension
Contraindication of vomiting:
Obtunded patients or those taking poisons causing obtundation (risk of aspiration)
Poisoning with caustic agent
Vomiting exposes the esophagus to the caustic agent a second time
Poisoning with hydrocarbons e.g. petroleum products as kerosene (risk of
aspiration & pneumonitis)
Convulsions
Vomiting induces convulsions:
Induction of vomiting not recommended in children 6 months will cause
convulsion.
Emetics not recommended treating poisoning:
1- Sodium chloride & water (may cause fatal hypertension)
2- Finger down the throat (incomplete & unsuccessful and may be dangerous)
3- Copper & Zn sulfate ( not reliable & obstruction may cause poisoning)

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2- Gastric lavage (stomach washout):

Preferable for cooperative adolescents & adults already in medical facility
Used if the patient presents one hour after ingestion
After 1 hour the amount removed is insignificant
Contraindication:
Ingestion of hydrocarbon (petrol, kerosene) ( risk of aspiration & pneumonitis)
Ingestion of corrosives ( risk of gut perforation)
Airways cannot be protected e.g. comatose patient (risk of aspiration)
Uncontrolled convulsions (danger of aspiration)
Cardiac dysrhythmias must be controlled before initiating vomiting because
insertion of the tube may create a vagal response leading to life threatening
dysrhythmias or cardiac arrest.
Lavage solution for specific intoxification:

Solution

Poison

Ammonium A.C

Formaldehyde

Ca gluconate

Oxalic acid, fluoride

Normal saline

Silver nitrate

K permanganate

Alkaloids, mushrooms

NaHco3

Ferrous sulfate

Tannic acid

Alkaloids

Starch solution

Iodine

3- Activated Charcoal:
Has large surface area of adsorption & adsorb a large number of poisons
Agents not adsorb:
Iron, lithium, potassium, alcohol, cyanide, hydrocarbons, solvents, acids,
alkaloids, fluoride

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Contraindication:
Not given 1 hour after ingestion
If the poison is not adsorb
Airway cannot be protected e.g. comatose patient
Oral antidote is given
The antidote maybe adsorb
Complication of charcoal:
Diarrhea or constipation
Possibility of intestinal obstruction
Aspiration pneumonitis
Dose:
50 g (10 table spoonful) in a glass of water orally or via gastric tube
Not given with Ipeca
The active ingredients maybe adsorbed to charcoal

4- Purgation ( catharsis):
Saline cathartics & sorbitol are used
Oil cathartics are not usedwhy?? because oil may make the poison more
lipophilic & enhance its absorption within the body
Sorbitol not given in children 1 year & caution in patient 3 years
Possible severe electrolyte disturbance
Contraindication:
Absence of bowel sounds ( adynamic ileus )
Intestinal obstruction
Pre-existing electrolyte disturbance
GIT bleeding, perforation, peritonitis

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 Poisoning with corrosive

Severe diarrhea
Generally irritant cathartics not used
MgSo4 not used in renal impairment
Na2So4 not used in patients requiring Na restriction e.g. congestive heart
failure

5- Chemical inactivation:
Administration of a chemical to make the poison less toxic or to prevent its
absorption
Examples:
Formaldehyde + NH3 Hexamethylene tetramine
Na Formaldehyde Sulfoxate + Mercuric CL Metallic Mercury (Less soluble)
Ferrous iron + NaHCo3 Ferrour carbonate (poorly adsorbed)

6- Enhanced elimination:
a- Biotransformation:
After absorption of the poison this procedure is used to enhance elimination
E.g. detoxification of CN by thiosulfate
CN + Thiosulfate

Rhodonase

Thiocyanate
(less toxic)

Use of Ethanol to treat methanol poisoning:

Methanol

Formaldehyde

Formic acid
(Toxic)

Alc.dehydrogenase

Ethanol
MAK

Alc.dehydrogenase

Acetic acid
(nontoxic)

Acetaldehyde
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b- Urinary excretion:
Forced diuresis by using Furosemide or osmotic diuretics e.g. Mannitol

c- Acid forced diuresis:

Diuretics + acidifying agents (Ammonium CL or Ascorbic acid)
To enhance excretion of basic poisons e.g. Amphetamine

d- Alkaline forced diuretics:

Diuretics + Alkaline agent ( NaHCo3) to enhance excretion of acidic poisons
e.g. Salicylates & barbiturates

7- Extracorporial removal:
Intoxification of patients with life threatening symptoms and not responsive to
conventional treatment developing renal failure, severe acid-base disturbance &
fluid, electrolyte disturbance
A- Peritoneal dialysis:
Valuable for removal of poisons only in preschool children
Disadvantage:
Insufficient
Complicated with infection, intra-abdominal trauma

B- Hemodialysis:
5 10 times more effective than peritoneal dialysis
Disadvantage:
Medical complication
Extracorporial clotting, infection, blood loss, hematomas, shock
Needs complex apparatus & skilled persons

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C- Charcoal or Resin hemoperfusion:

Perfusion of blood through activated charcoal or an activated an exchange
Resin

Antidotes:
Poison

Antidote

Dicobalt anticoagulants

Vit. K

Beta blocker

Adrenaline, isoprenaline

Cynaide

O2, dicobalt edetate, Na thiosulfate

Ethyleneglycol

Ethanol

Lead

Dimercaptosuccinic acid, di Na, Ca

edetate

Iron

Deferrioxamine

Opioids

Naloxone

Organophosphrous insecticide, nerve

Atropine, pralidoxine

gas
Paracetamol

N-Acetyl cysteine, Methionine

Co

O2

Nitrite

Methylene blue

Notes about the final exam:

First of all isa el exam fee7 ketaba keter ya3ny eassay keter we al as2la hatb2a
isa cases momkn 2 aw 3 7atekteb eh el toxicany we mode of action bet3ao.
Tany haga hyb2a fe7 give reason we fe7 kaman give examples, we tab3n
example 3andna keter ya3ny masln give example for poison with garlic odor ?
El gadwel ely fel lecture de7 kol7a tba3n 7efz.law fe ay so2al conecerning el
wa2 contact me we I love to her ur opinions Big thanksGood Luck

DANKE
MAK

Lecture 18

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