Poisonings and Overdoses Notes

Poisonings and Overdoses Notes

Learning Objectives

  • At the end of this presentation, students will be able to:
  1. Recognize signs and symptoms of poisoning.
  2. Recommend initial measures related to acute poisonings.
  3. Identify exclusion criteria for self-treatment of poisonings/overdose.
  • Required Reading: Handbook of Nonprescription Drugs – Chapter 21

Background

  • Unintentional Poisoning:
  • Leading cause of toxic poisoning in children.
  • Primary cause of hospitalization.
  • 81.4% of fatalities involve medications and illicit drugs.
  • 70% of poison exposures managed at home.
  • Common Sources of Poisoning:
  • Analgesics, cough and cold preparations (most common).
  • Cosmetics.
  • Pesticides.
  • Food products (poisoning).
  • Alcohols.
  • Chemicals.

Data: US Poison Control Centers (2019)

  • Human Poison Exposures: 2,148,141
  • Animal Poison Exposures: 68,711
  • Confirmed Non-Exposures: 5,165
  • Information Calls:
  • Drug ID: 70,179
  • Other: 280,984
  • Total Calls: 2,573,180

Clinical Presentation

  • Affected Organ Systems:
  • Cardiovascular, pulmonary, hematology, metabolic.
  • Toxicity Similarity:
  • Toxicity after overdose may mimic drug’s ADR (e.g., diphenhydramine).
  • Can be asymptomatic initially or may have delayed symptoms (e.g., methanol exposure).

Treatment Goals

  • Goals:
  • Minimize duration or limit extent of exposure.
  • Stem progression of toxicity.
  • Self-Treatment Criteria:
  • Unintentional poison exposure.
  • Expected to cause no or minimal toxicity.
  • Absence of serious or life-threatening symptoms.
  • Consult with poison control center or emergency system as needed.

Poison Control Center

  • Web Poision Control:
  • Cost-effective online/smartphone resource.
  • Free application launched in December 2014.
  • Services Offered:
  • 24-hour poison information, clinical toxicology consultation, and education.
  • Staffed by pharmacists, nurses, physicians with clinical toxicology training.

General Approach to Poisoning

  • Inhalation:
  • Remove patient from toxic fumes.
  • Skin Exposure:
  • Wash with soap and water (twice).
  • Eye Exposure:
  • Immediate irrigation for 10-15 minutes.
  • Ingestion Management:
  • Ipecac syrup (for inducing vomiting, rarely used today).
  • Administer activated charcoal, if appropriate.
  • Emergency Situations:
  • Call 911 for unresponsiveness or life-threatening symptoms.

Activated Charcoal

  • Function:
  • Adsorbent for many drugs and chemicals; binds to substances to prevent absorption from GI tract.
  • Not absorbed itself.
  • Usual Dose:
  • 1g/kg, most effective if ingested within 1 hour.
  • Available as a charcoal slurry.
  • Contraindications:
  • Not effective for:
    • Highly ionized substances (potassium, lithium).
    • Alcohol or glycols.
    • Heavy metals (iron, lead, arsenic).

Exclusions to Self-Treatment

  • Conditions or situations that exclude self-treatment include:
  • CNS depression or convulsions.
  • Poor or absent gag reflex.
  • Unknown substances involved.
  • Pregnancy.
  • Recent abdominal/thoracic surgery.
  • Bleeding or being debilitated/elderly.<6 months of age.
  • Suspected suicide, homicide, child or elder abuse.
  • Substance abuse issues.

Poison Prevention

  • Strategies:
  • Store medicines and household products in original containers.
  • Lock medicines/household products out of reach of children.
  • Use child-resistant packaging and ensure caps are tight after use.
  • Always read the label before taking or administering medications.
  • Use household products according to label directions to prevent poisoning.

Thank You!

  • Concluding remarks from the presentation by Allison Chacon-O’Shea, PharmD, APh from USC Mann School of Pharmacy and Pharmaceutical Sciences.