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Poisoning

4. General management principles

 

The specific management of all poisons is beyond the scope of this module. However, two central management points are worth highlighting.

 

In certain circumstances decontamination may be appropriate. This refers to reducing the absorption, or increasing the elimination, of a poison.

Activated charcoal

Activated charcoal has a very large surface area and many drugs will ‘stick’ (adsorb) to the charcoal and not be adsorbed into the body. A list of drugs NOT bound by activated charcoal is provided in table 7. Activated charcoal is indicated if the poison is adsorbed to charcoal and time since ingestion is 1 – 2 hours (or longer if the drug delays gastric emptying or is a slow release preparation). Occasionally repeat doses are given if the drug has significant entero-hepatic circulation (for example, carbamazepine overdose).

 

Cyanide

Ethanol

Ethylene glycol

Heavy metals

Iron

Lithium

Methanol

Table 7. Poisons that do NOT bind activated charcoal

Gastric lavage

Gastric lavage is rarely indicated but may be used in life-threatening overdoses within 1 hour of ingestion. Whole bowel irrigation with polyethylene glycol is used when multiple packets of drugs such as cocaine or heroin have been ingested to avoid arrest (‘body stuffers’) or for smuggling across borders (‘body packers’).

 

As described earlier, patients with poisoning are often admitted to an ICU for organ support. However, certain poisons have antidotes. Some of the common ones are listed in Table 8.

 

Poison

Antidote(s)

Benzodiazepine

Flumazenil (with caution)

Beta Blockers

Glucagon

Calcium Channel Blockers

Calcium, Glucagon, Insulin/Dextrose

Cholinergic toxidrome

Atropine, Pralidoxime

Carbon Monoxide

Oxygen, Hyperbaric Oxygen

Cyanide

Dicobalt edetate, Sodium nitrite, Sodium thiosulphate

Digoxin

Digoxin Fab antibodies

Iron

Desferrioxamine

Lead

Sodium calcium edetate, DMSA

Opiates

Naloxone

Paracetamol

Acetylcysteine

Toxic alcohols

Fomepizole

Tricyclics

Sodium bicarbonate

Table 8. Common antidotes available for poisons

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