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Poisoning

• Barbara S. Hays

• Winter, 2006
Food poisoning
• Contaminated food

• Illness caused by
toxins produced by
bacteria
– Botulism
– Staphylococcus
aureus
– Salmonella
– MRSA
Botulism
(claustridium botulilnum)

• Improperly
canned/cured food,
especially meat
and beans
Botulism
• Assessment (presents in about 24-36
hrs)
– Headache
– Diplopia
– Muscle incoordination, trouble
breathing, talking, swallowing
– Airway/gas exchange
– Fatigue
– n/v
Botulism
• Intervention (quite effective)
– Airway/ventilation
– Be ready to do CPR
– Induce vomiting if
• Ingestion is recent
• No seizures
• No loss of consciousness

– antitoxin
Staphylococcus aureus
• Respiratory
tract/skin of food
handlers

• Unrefrigerated
cream- filled foods

• Fish/meat
Staph poisoning
• Assessment
– n/v/d, abdominal cramps
– Weakness

• Interventions (supportive)
– Rest
– Anti-emetics, anti-diarrheals
– Fluids (possible IV therapy)
Salmonella poisoning

• Inadequately
cooked meat,
poultry, eggs
Salmonella poisoning
• Assessment
– n/v/d, abdominal pain
– Weakness
– Fever/chills

• Interventions (supportive)
– Rest
– Fluids (possible IV therapy)
– Anti-emetics, anti-diarrheals
Tylenol poisoning
• Degree of damage
depends on
available
gluthathione in
liver to detoxify
metabolites of
tylenol
• Causes liver
damage
– Cell damage
– Liver dysfunction
– Liver failure
Tylenol poisoning
• Initial phase (>150mg/kg; 12 – 24 hours)
– n/v
– Pallor
– Malaise

• Latent phase (about 4 days)


– Feel relatively well
– May recover

• Third phase (4 days to a week)


– Hepatic failure
– Coma
– death
Tylenol poisoning
• Medical management
– Induce emesis (no charcoal if giving
antidote)
– gastric lavage

– Mucomyst (N-acetylcysteine) [“Easy” p


292]
• Alters metabolism
• Decreases liver damage
• Bad taste, smell: bronchospasm
Aspirin poisoning
• Most frequently
accidentally
ingested by
toddlers/children

• 1.5 to 5 grains per


pound = requires
treatment
Aspirin OD
• Respiratory stimulation first
– Respiratory alkalosis (blow off CO2)

• Metabolic acidosis second


– Kreb’s cycle
– Lactate builds up
– Anorexia/vomiting
– Diaphoresis

• Hypoglycemia
• Loss of fluids/electrolytes: dehydration
• GI irritation
• Bleeding
Aspirin OD
• Treatment
– Emesis induction (if not
comatose/convulsing)
– Cathartics to speed through GI tract
– Maybe dialysis
– Fluids
– Assised ventilation PRN
– Seizure precautions/Rx
Aspirin OD

• Prognosis
– With prompt treatment: Good

– If seizures: poor
Emetics (“Easy” p 349 –
351)
• Syrup of Ipecac: stimulates vomiting
center in brain

• Administer with 200 – 300cc warm


water
• Induces vomiting in about 20
minutes

• Give before activated charcoal (yet


Heavy metal poisoning
• Lead (most
common)

• Iron

• Mercury

• Arsenic
Children at risk because

• [tend to eat strange things]


• Sensitivity to toxic effects
• Immature body systems
• May be deficient, so body takes in
more quickly
Non-dietary sources of lead
• Lead-based paint
– Chipping off old paint
– In soil as dust after removal of above
– Old toys

• Lead shot, fishing weights

• Underglazed pottery (especially red)


Non-dietary sources of lead
• Colored ink in
newspapers/magazines
– Yellow, red

• Inhaled
– Automotive fumes
– Burning batteries

• Lead crystal decanters


Poisoning: Lead deposits in
• CNS, peripheral nervous system
– Cerebral edema: irritable
• Delay/regression in development

– Convulsions, paralysis, blindness

– Coma, death
Poisoning: Lead deposits in
• Bone marrow

• Kidneys: injury to tubules


– Aminoaciduria
– Proteinuria
– Glucouria
– phosphaturia
Heavy metal poisoning
Treatment (“chelation
therapy”)
• Metallic ion bound to chelating
molecule, excreted
– Calcium Disodium Edetate (CAEDTA)
– British Anti-Lewisite Calcium (BAL)

• Fluids
• Assessment
• Support/education to parents
CaEDTA

• Helps excrete in urine 20 – 50 times


normal rate

• Also helps excrete calcium…

• Give DEEP IM or IV
BAL

• Removes lead from CNS

• Six doses/day for 7 days


Poison ingestion in general

• Find out what was taken


• Call Poison Control Center

• Maybe or maybe not induce vomiting


– (bleach ingestion: milk better than
water)