MANAGEMENT OF A CASE OF

ACUTE POISONING

Ifra Iqbal
2 nd Prof , MBBS
Steps For treatment of
poisoning cases

1)Removal of the patient

from the source of
exposure
2)Removal of the unabsorbed
poison
3)Elimination of the absorbed
poison
4)Use of specific antidote
5)Symptomatic Management
ROLE of antidotes in
poisoning
qAn antidote is any substance
which prevents the action
of a poison or neutralize
the poison or produce signs
and symptoms opposite to
those produced by the
poison.

 Types of antidotes
qAntidotes may be of the following types:
vMechanical/Physical Antidotes
vChemical Antidotes
vPhysiological/Pharmacological Antidotes
vChelating Agents
vSerological Antidote
vUniversal Antidote

 Mechanical antidotes
• These act by minimizing the
absorption of a poison. For example,
• Demulcents Eg., egg albumin
• Adsorbents Eg., activated animal
charcoal
• Diluents Eg., Water
• Bulky Food EG., Boiled rice
 Chemical antidote
qThese act by chemically reacting
with the poison and forming a non-
toxic complex. For example,
• Vinegar(Acetic Acid) for alkalies
• Magnesium oxide for acids
• Potassium permanganate for
oxidisable poisons like alkaloids,
barbiturates, phosphorus.
 Physiological antidote
qThese act by producing effects
opposite to those of the poison. For
example,
• Atropine for Organophosphate
Poisoning
• Naloxone for Morphine Poisoning
• Barbiturate for Strychnine
 Chelating agents
• These act by forming chelate
with metallic poisons
available in circulation and
facilitate their elimination
from body by renal excretion.
 Examples Of Chelating
agents :
• Dimercaprol (3-4mg/kg body weight) for
Arsenic, Mercury poisoning
• E.D.T.A. (1 gm twice a day by slow I.V. drip)
for Lead Poisoning
• Penicillamine(3mg/kg body wt/day) for
Copper Poisoning
• Desferrioxamine(8-12gm daily in divided
doses) for Iron Poisoning
•
Serological antidote
• These are immunological anti-sera
used to neutralize the poison
antigens.
• For example,
 Anti snake venom serum for
snake bite poisoning.
 Universal antidote
qUniversal Antidote is a combination
of physical and chemical antidotes.
When the exact nature of the poison
is not known, universal antidote is
administered to the patient.
qIt consists of:
 Activated Charcoal – 2 parts
 Magnesium oxide – 1 part
 Tannic acid – 1 part
 SYMPTOMATIC MANAGEMENT
 Nausea and Vomitting

• Chlorpromazine hydrochloride
• Either injection or orally (5
c.c.ampule/10 c.c.ampule )

 qRelieving
pain
Body pain :
 Paracetamol
 Ibuprofen
 Diclofenac sodium
Abdominal pain :

 Atropine injection
 SAFEGUARDING RESPIRATION

1)Clearing the airways + elevation of

lower limb + O2 + CO2(5%) +
Nikethamide(1-3c.c.,I/V or deep I/V or
even intra-cardiac)
2)Endotracheal Intubation
3)Tracheotomy
4)Oxygen Inhalation
5)Artificial Respiration
 Management Of Circulatory
Failure
• NA + Methyl amphetamine injection
• Elevation Of foot end of the bed
(Trendelenburg Position)
• Use Of Vasopressors like Dopamine (2-
20 µg/kg/min)
• Use Of Plasma Expanders (Plasma/ Whole
Blood/Low Molecular Weight Dextran)
 Pulmonary oedema

• 60% O2 inhalation + Atropine

sulphate + Aminophylline + Sedative
• 50 c.c. syringe ( 40 c.c. Glucose
solution + 10 c.c.
Aminophylline ),infused slowly.
• Followed by Deriphylline injection –
I/M or I/V (cubital vein )
qComa :
• Analeptics
qCerebral oedema :
• Hypertonic Urea(30%) or
 20% I/V Mannitol or
 Sorbitol
Oedema glottis :


• Epinephrine 1:1000
• Atropine(0.5-1 mg injection)
• Cortisone

Narcosis :
Morphine
Short acting barbiturate
To prevent narcosis :
Laptozol, Nikethinamide etc.
qCardiac arrest :
• Cardiac massage
• Caffeine
• Digitalis
• Nicotinamide
• Xylocaine
• Digoxin
qVAGAL INHIBITION :
 Atropine
 Hepatic coma
• Deeply sedated : 10% Glucose
solution is to be administered
bottle after bottle
• Monosodium glutamate – 500 ml
 Control of convulsions
 The patient is given Diazepam (0.2-0.4
mg/kg) slow I.V. upto a maximum of 10
mg at a time. If I.V. administration
isn’t possible, Diazepam is to be
administered per rectally.
 qAllergy
Anti-histaminics : Promethazine


Chlorpromazine
qDermatitis
Al acetate/MgSO4/Na2 CO3/KMnO4
qCough :
• Antitussives or Expectorants


qRespiratory Infections :
• Antibiotics
 qDiarrhoea
• Without antibiotics:
Pectin+Bismuth+Kaolin
• With antibiotics: All fluoroquinolones

qAbdominal distension
Nasogastric or Intestinal intubation
 Management of hypothermia

• In cases of mild hypothermia, a warm

room and a blanket are required
• In severe cases of hypothermia, the
patient is to be given a warm water
bath(42’C) or by heating the inspired
air.
• Pilocarpine/Physostigmine
MANAGEMENT OF HYPERTHERMIA
• The patient’s clothes are removed.
• The regions of the patient’s neck and
groin are to be packed with ice.
• Otherwise, the patient is immersed
upto the neck in cold water
bath(25’C).
Correction of fluid or
electrolyte imbalances
Correction of hyponatremia

• The patient is given 0.9% NaCl over

15-30 minutes at a time.
Correction of hypernatremia

• The patient is given 0.2% NaCl over

several hours
 Correction of
hypokalemia
• The patient is given 4-6 mEq of
Potassium per kg per day orally or
in an IV solution not exceeding 40-
60 mEq/L
•
Correction of hyperkalemia

• The patient is given Furosemide 1

mg/kg I.V.
• In severe cases, the patient is
administered 10% Calcium Gluconate
(5-10 ml) I.V.
 Correction of metabolic
acidosis
• Sodium bicarbonate(1-2 mEq/litre) I.V.
is given over 15-30 minutes.
CORREction of hypocalcemia

• The patient is given 10% Calcium

Gluconate(2ml/kg/day) I.V.
 Coma cocktail
qThis is a combination of three
antidotes that is often given to
poisoned patients exhibiting CNS
depression. It consists of:
• Naloxone(2mg)
• Thiamine(100mg)
• Dextrose(50 ml of 50% solution)
•Thank you !