General Measures in the Management of Poisoning

Endotracheal intubation

_______ should be done by trained or experienced personnel if there is respiratory insufficiency, loss of consciousness, impaired or absent gag reflex and status epilepticus

less than 80 mmHg

If pO2 is ________ give oxygen via nasal cannula, face mask or mechanical ventilator.

1. Alcohol

2. Carbon Monoxide

3. Opiates

4. Organophosphates

5. Quinine

Common toxicants that can cause hypoxia

Oxygen

______ is contraindicated in watusi poisoning and paraquat poisoning

NSS and crystalloid solution

Recommended IV Fluid for hypotensive patients

D5NSS and D5LR

Recommended IV fluid for adult maintenance

D5 0.3 NaCl

Recommended IV fluid for pediatric maintenance

• Direct convulsant effect of the poison

• Cerebral hypoxia from respiratory or cardiovascular

depressive effect

• Hypoglycemia

• Severe muscle spasm

• Withdrawal reactions (ethanol,diazepam)

• Decreased seizure threshold in an epileptic patient

Convulsions in poisoned patients may be due to

Aminophylline

Lithium

MAOI

Amphetamines

Mefenamic acid

Carbon monoxide

Organophosphates

Cocaine

Salicylates

Cyanide

Strychnine

Ethylene glycol

Theophylline

Hypoglycemic agents

TCA

Withdrawal of

INH

Lead

Narcotics, diazepam or ethanol

Toxicants commonly associated with Convulsions

•Alkalinizing agents

(NaHCO3)

• Bronchodilators (Theophylline, Salbutamol)

• Corticosteroids

• Diuretics (Furosemide)

Causes of Hypokalemia

• ACE inhibitors

• Beta blockers

• Cardiac glycosides

• Carbon monoxide

• Cyanide

• Oral potassium

• Potassium Sparing Diuretics

Causes of Hyperkalemia

Potassium chloride (KCl) solution up to 40mEq/hr not to exceed 60mEq/hr

Treatment of Hypokalemia

• Glucose-insulin infusion

• Sodium bicarbonate

• 10% Calcium gluconate (alternative to NaHCO3)

• Dialysis

Treatment of Hyperkalemia

• diuretics

• xanthines

• aminoglycosides

• cardiac glycosides

• chronic alcohol abuse

Causes Hypomagnesemia

Magensium sulfate

Treatment of Hypomagnesemia

Hypocalcemia

• watusi poisoning

• jatropha seed ingestion

• complications of bites and stings of sea urchins and spiders

Causes Hypocalcemia

• Calcium salt - for parenteral, calcium chloride is preferred because it has more predictable retention in the body than calcium gluconate

Treatment of Hypocalcemia

• with a rectal temperature

<30°C due to

• Alcohol

• Barbiturates

• Carbon monoxide

• General anesthetics

• Opioids

• Phenothiazines

• Sedative-hypnotics

• TCA

Causes Hypothermia

• with a rectal temperature >40°C

due to

• Amphetamines

• Anticholinergics

• Antihistamines

• Cocaine

• INH

• Phenothiazines

• Phenytoin

• Quinidine

• Salicylates

• Sulfonamides

• Xanthines

• Aminophylline

• Theophylline

Causes Hyperthermia

• alcohol intoxication

• salicylate toxicity

• due to prolonged utilization

and depletion of hepatic

glycogen stores

Causes Hypoglycemia

Glucose infusion

Treatment of Hypoglycemia

Blood and urine

Specimen collection is done through the means of

• Cyanide

• Alcohol

• Lithium

• Iron

• Petroleum distillates

Substances not effectively adsorbed by activated charcoal

• External Decontamination

• Empty the stomach

• Administer Single-dose Activated Charcoal

• Administer Cathartic

• Use demulcents/neutralizing

agents

• Whole bowel irrigation

Methods in Elimination of Poison

Raw egg white and sodium bicarbonate

demulcents/ neutralizing agents

Milk and acetic acid/ tannic acid

not recommended as neutralizing agents

Whole bowel irrigation

Not recommended for routine use

• Multiple-dose activated charcoal

• Forced diuresis

• Alkalinization therapy

• Acidification therapy

• Dialysis and hemoperfusion

Methods in Enhancing Elimination of Poison

Sodium bicarbonate

Alkalinization therapy

Ascorbic acid

Acidification therapy

• Barbiturates

• Disopyramide

• Glutethimide

• Meprobamate

• Salicylates= 2-3x more efficient than dialysis

• Theophylline

Indications for hemoperfusion

Antidote

a therapeutic agent that counteracts the toxic actions of the drug/toxin.

use of thiosulfate in cyanide toixcity

example of accelerated detoxification

Ethanol; phenytoin

______used to inhibit conversion of methanol and ethyl glycol to their

more toxic metabolites. This is also true with the use of ________ in

malathion poisoning wherein it prevents the conversion of malathion to its

more toxic metabolite, malaoxon.

Naloxone; atropine

______ exerts its action by blockade of receptor sites in the central

nervous system, except those in the spinal column. Likewise,______ blocks

the action of acetylcholine at the muscarinic receptor sites.

oxygen; pyridoxine

Administration of ____can bypass the effects of cyanide because

it may have a synergistic antidotal action when used with sodium

thiosulfate and sodium nitrite as shown in animal studies. This

mechanism also explains the use of ______ in INH toxicity.

Digoxin-specific antibodies (Fab fragments); antivenin

_____ reverse the binding of digitalis compounds to cardiac receptors. In snakebites, especially cobra bites, administration of _____ neutralizes the venom