Acute Poisoning - General Principles

Hx
Can be very unreliable
What, when, how much was taken?
?empty bottles
?witness reports
?emesis

Ex
DR ABCDEs as usual
Pay special attention to:

- Odours
- Mucous membranes
- Eyes

Ix
Temperature
Blood glucose
Toxicology - blood & urine
ALWAYS - paracetamol and salicylate levels

Other tests...
U&Es, LFTs, Clotting, Bicarbonate, ABGs
Osmolality, Osmolar gap, Anion gap
ECG, CXR, AXR
etc

Pills seen on AXR

ATE CHIPS

Arsenic
Theophylline
Enteric Coated Pills

Chloral Hydrate
Heavy Metals
Iron

Phenothiazines
Salicylates

Mx

Principles

- Supportive
- Correct abnormal electrolytes and obs (hypoxia, hypotension, dehydration, hypo/hyperthermia, acidosis)

1) Reduce absorption
2) Increase elimination
3) Give antidotes
- Monitor - TPR, BP, ECG, Oxygenation, GCS

Elimination

Emesis
- Activated Charcoal
(good for organic compounds, not lithium/iron/alcohol, 1G/kg or x10 ingested dose, C-I corrosive ingestion)
- Gastric Lavage
- Whole Bowel Irrigation
(Klean Prep, polyethylene glycol, up to 12hrs p-ingestion, poss use in lithium/arsenic/iron/lead oxide/body packers)

Enhanced Emesis
- Forced Diuresis
- Chelation
- HBO
- Haemodialysis
- Haemoperfusion

Predisposing factors to toxicity
- Old age
- Cardiac disease - myocarditis, active ischaemia
- Metabolic abnormalities - hypokalaemia, hypomagnesaemia