Poisoning – General Notes

Notes
  1. General principle of poisoning management
  • Ensure adequate cardiopulmonary functions
  • Treat the symptoms e.g. seizures, shock, and pain.
  • Protein-based poisons such as sting of poisonous animals can be treated by tying the affected part with a pressure bandage and applying hot water at about 50°C. Hot water breaks down the poison.
  • Absorption of the substance that were recently ingested may be decreased through gastric decontamination using activated charcoal, gastric lavage, whole bowel irrigation, or nasogastric aspiration.
  • Routine use of emetics such as syrup of Ipecacuanha and laxatives is no longer advised.
  • Activated charcoal is the preffered treatment to prevent absorption of the poisons. It is not effective against metals [such as sodium, potassium, and lithium], alcohols, strong acids and alkalis.
  • Fuller’s Earth [adsorbent claylike substance consisting of hydrated aluminum silicates and magnesium oxide] is sometimes used instead of activated charcoal. It is used in paraquat poisoning.
  • Iso-osmotic laxatives such as large amounts of a polyethylene glycol [PEG] solution clean the bowel by causing diarrhoea. This is osmotically balanced solution that is not absorbed into the body. This laxative is used to remove ingested sustained release drugs and toxins that are not absorbed by activated charcoal such as lithium and iron
  • Gastric lavage [stomach pump] has not been found to provide much benefit. It is may be useful when carried out within 1 hour of ingestion.
  • Nasogastric aspiration procedure is mostly used for liquid ingestions when activated charcoal is ineffective such as ethylene glycol poisoning.
  • Two types of cathartics were in the past used in poisoning; saline cathartics [sodium sulfate, magnesium citrate, magnesium sulfate] and saccharide cathartics [sorbitol]. The use of these cathartics in poisoning is not currently recommended.
  • Antidotes for common poisoning and their presence or absence in the Essential Drug List [EDL]

 

   - √:    Not     - X: In Kenya Market -X*

 

Poison

Antidote

  

§    

Adenosine

Theophylline

X*

§    

Anticholinergics

Pyridostigmin;

X

Neostigmin

X*

§    

Arsenic

Dimercaprol [BAL]

§    

Benzodiazepines

Flumezanil

X*

§    

Beta andrenergic agonists

Beta-blockers

§    

Beta-blockers

Calcium Gluconate

and / or Glucagon

X

§    

Botulism

Botulinum anti-toxin

X*

§    

Cocaine

Pentolamine

X

§    

Calcium channel Blockers

Calcium Gluconate

§    

Carbon monoxide

Oxygen (normal or hyperbaric)

§    

Coumarins

Vitamin K

§    

Cyanide

 

Amyl nitrite

X

Sodium nitrite and

X

Sodium thiosulfate

X

§    

Cycloserine

Pyridoxine

§    

Ethylene glycol

Ethanol and thiamine

Fomepizole

X

§    

Digoxin

Digoxin-specific antibodies

X

§    

Epinephrine

Pentolamine

X

§    

 

 

 

§    

Ergot alkaloids

Pentolamine

X

§    

Ethylene glycol

Ethanol

§    

Fluorides

Calcium gluconate

§    

Heparin

Protamine

§    

Folic acid antagonists##

Leucovorin calcium

X*

§    

Hydrofluoric acid

Calcium gluconate

§    

Iron [and other heavy metals]

Desferrioxamine

Deferiprone

X

§    

Isoniazid

Pyridoxine[1]

§    

Insulin

Glucose

Glucagon

X

§    

Kerosene

Charcoal

§    

Lead

Dimercaprol [BAL]

combined  Sodium Edetate (EDTA)

Succimer [Dimercapto succinic acid, DMSA]

§    

Magnesium

Calcium gluconate

§    

Methanol

Ethanol and folinic acid

Fomepizole

X

§    

Mercury

Penicillamine

Charcoal

§    

Methemoglobin

Methylene blue

§    

Methotrexate

Folinic acid

§    

Monoamine Oxidase inhibitors (MAOIs)

Pentolamine

X

§    

Opioids

Naloxone

§    

Oral sulfonylurea

Octreotide

X*

§    

Organophosphates

Atropine and

 Pralidoxime (2-PAM)

§    

Oxalates

Calcium gluconate

§    

Paracetamol

N-acetylcysteine (NAC)

§    

Snake bite (venomou)

Multivalent antivenom

§    

Sodium channel  blockers or membrane stabilizer#

Sodium bicarbonate

§    

Thallium

Prussian blue

X

§    

Tricyclic antidepresants

Sodium bicarbonate

§    

Warfarin

Vitamin K and blood transfusion

# Sodium channel  blockers or membrane stabilizer include carbamazepine, lamotrigine, gabapentin, topiramate, anesthetics, quinidine among others.

## Folic acid antagonists are sulphonamides and related compounds

 

  1. Accidental poisoning occurs mainly in children and elderly while suicidal poisoning occurs mainly in other ages.
  • A retrospective study by Bundotich and Gichuhi (2012) established the following facts about the acute poisoning at Rift Valley Provincial General Hospital:

*The prevalence of the acute poisoning among patients at the hospital was 0.07%

*52.08% of the poisoning cases were associated with pesticides and rodenticides such as organophosphates and zinc phosphide. Other causes of poisoning included  food poisoning (9.38%), petroleum distillates - mainly kerosene (9.38%), animal poison -such as snake bites (8.33%), pharmaceuticals (5.21%), noxious gases (4.17%), poisonous plants (2.08%); corrosive agents (2.08%) and others (7%).

*48.96% of cases of poisoning were intentional.

  • Nyamu et al (2012) established the following facts about the acute poisoning cases at Kenyatta National Hospital, Nairobi:

*The profile of poisoning: pesticides (43%), household agents (24%); prescription drugs (14%) and unknown substances (7%).

*The profile of poisoning from household agents: kerosene (66%, mainly in children); acids and alkali (10.1); carbon monoxide (3.7%) and others (17.4%).

 

[1] This is vitamin B6 that acts as a coenzyme in a number of reactions such as synthesis of GABA, homocysteine metabolism and haemoglobin synthesis. Dose usually 25-200mg daily

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