Poisoning & Its Primary Management

Chhabi Acharya B. PharmacyHOPE Intl College

Content

• Poisoning- Definition & Description- Causes- Classification- Symptoms- Diagnosis

• Primary Management• References

World’s most poisonous plant

Discovered more than 5000 feet above sea level on Mount Victoria in the Philippines, the giant, carnivorous pitcher plant secretes a nectar-like substance to draw in innocent prey into a pool of enzymes and acid.

World

’s

poisonous

plant

Nepenthes attenboroughii

Poisoning

Definition & Description

• Poisoning occurs when any substance interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed. The branch of medicine that deals with the detection and treatment of poisons is known as toxicology.

• Poisonings are a common occurrence. In 80% of the cases of poisoning, the victim is a child under the age of five.

• Curiosity, inability to read warning labels, a desire to imitate adults, and inadequate supervision lead to childhood poisonings.

• The elderly are the second most likely group to be poisoned. Mental confusion, poor eyesight, and the use of multiple drugs are the leading reasons why this group has a high rate of accidental poisoning.

• A substantial number of poisonings also occur as suicide attempts or drug overdoses.

• Poisons are common in the home and workplace, yet there are basically two major types.

• One group consists of products that were never meant to be ingested or inhaled, such as shampoo, paint thinner, pesticides, houseplant leaves, and carbon monoxide.

• The other group contains products that can be ingested in small quantities, but which are harmful if taken in large amounts, such as pharmaceuticals, medicinal herbs, or alcohol.

• Other types of poisons include the bacterial toxins that cause food poisoning, such as Escherichia coli; heavy metals, such as the lead found in the paint on older houses; and the venom found in the bites and stings of some animals and insects.

Causes

• The effects of poisons are as varied as the poisons themselves; however, the exact mechanisms of only a few are understood.

• Some poisons interfere with the metabolism.

• Others destroy the liver or kidneys, such as heavy metals and some pain relief medications, including acetaminophen and nonsteroidal anti-inflammatory drugs (Ibuprofen).

• A poison may severely depress the central nervous system, leading to coma and eventual respiratory and circulatory failure.

• Some poisons directly affect the respiratory and circulatory system. Carbon monoxide causes death by binding with hemoglobin that would normally transport oxygen throughout the body.

• Cyanide interferes with respiration at the cellular level.

• The type of poison, the amount and time of exposure, and the age, size, and health of the victim are all factors which determine the severity of symptoms and the chances for recovery.

Classification

• Mainly categorized in five broad classes : 1) Plant poisoning 2) Food & household chemicals 3) Pharmaceuticals 4) Venom poisoning 5) Other

1) Plant poisoning

The leaves are more toxic than the seed.

Most parts of the tree are toxic, except the bright red aril surrounding the seed.

The major toxin within the yew is the alkaloid taxine.

Taxus baccata

• One hundred milligrams (mg) of moist, crushed apricot seeds can produce 217 mg of cyanide. (Beers, Mark H., MD, and Robert Berkow, MD., editors. "Poisoning." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.)

2) Food & Household chemicals

Food• Food poisoning is a common, yet distressing

and sometimes life-threatening problem in the world.

• Depending on the type of infection, people can even die as a result of food poisoning.

• More than 250 different diseases can cause food poisoning. Some of the most common diseases are infections caused by bacteria, such as Campylobacter, Salmonella & E. coli.

Household Product:• Many products used daily in the home are

poisonous if swallowed. These products often contain strong acids or strong bases (alkalis).

• Toxic household cleaning products include dishwashing liquids, floor waxes and furniture polishes, laundry detergents, spot cleaners, and fabric softeners, toilet bowl cleaners.

• Personal care products found in the home can also be poisonous. These include:

Deodorant

Hairspray

Hair straighteners

Nail polish and polish remover

Perfume & Shampoo

3) Pharmaceutical

• Both over-the-counter and prescription medicines can help the body heal if taken as directed.

• However, when taken in large quantities, or with other drugs where there may be an adverse interaction, they can act as poisons.

• Drug overdoses, both accidental and intentional, are the leading cause of poisoning in adults.

• Medicinal herbs should be treated like pharmaceuticals and taken only in designated quantities under the supervision of a knowledgeable person.

• Herbs that have healing qualities when taken in small doses can be toxic in larger doses, or may interact with prescription medications in unpredictable ways.

• More than 4000 mg of acetaminophen a day causes poisoning.

• Taking more than 150mg/kg of aspirin can have serious and even deadly results if untreated

• Barbituate overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication. This is life threatening.

• Large overdose of morphine can cause breathing to stop and death if the person does not get medical attention or an antidote right away.

4) Venom Poisoning

• Venom is the general term referring to any variety of toxins used by certain types of animals that inject it into their victims by the means of a bite, sting or other sharp body feature.

• Different venomous animal and insects may inject venom in human during their attack. Such venom as toxic chemical agent shows the poisonous effect.

5) Other causes of poisonings

• People can be poisoned by fumes they inhale. Carbon monoxide is the most common form of inhaled poison.

• Other toxic substances that can be inhaled include farm and garden insecticides and herbicides, gasoline fumes, insect repellent, paint thinner fumes and many other chemical agent.

Symptoms

• Aspirin poisoning symptoms: Upset stomach and stomach pain, Nausea & Vomiting. Chronic overdose may include Tiredness, Slight fever, Confusion ,Collapse, Rapid heart beat.

• Barbiturate intoxication and overdose include: Altered level of consciousness, Difficulty in thinking, sleepiness or coma, Faulty judgment, In coordination, Shallow breathing, Slowness of speech

• Morphine poisoning symptoms: Gastrointestinal system constipation, Nausea, Vomiting, Low blood pressure, Weak pulse, Difficulty breathing.

Diagnosis

• Initially, poisoning is suspected if the victim shows changes in behavior and signs or symptoms previously described. Hallucination or other psychiatric symptoms may indicate poisoning by a hallucinogenic plant.

• Evidence of an empty container or information from the victim are helpful in determining exactly what substance has caused the poisoning.

• The vomit may be tested to determine the exact composition of the poison.

Primary Management of Poisoning

Primary Management

• Seek immediate medical help.• Try and identify the poison if possible .• Check for signs like burns around mouth,

breathing difficulty or vomiting.• Induce vomiting if poison swallowed.

• In case of convulsions, protect the person from self injury.

• If the vomit falls on the skin, wash it thoroughly • Position the victim on the left till medical help

arrives.

1) For inhalation poisoning • Seek immediate emergency help.• Get help before you attempt to rescue others.• Hold a wet cloth to cover your nose and mouth • Open all the doors and windows.

 • Take deep breaths before you begin the rescue.• Avoid lighting a match. • Check the patient's breathing.• Do a CPR, if necessary. • If the patient vomits, take steps to prevent.

Charcoal/ Ipecac• Primary detoxication by ipecac-induced emesis or

gastric lavage (cleansing or rinsing) is incomplete.• In mild to moderate poisoning administration of

activated charcoal alone without gastric emptying is often more effective, because it binds toxins promptly.

• In-vitro and in-vivo studies of many substances have shown good adsorption to activated charcoal (e.g. digitalis, beta-blocking agents, phenobarbitone, carbamazepine, theophylline).

2) Venom Poisoning: • Lie down immediately after the bite.• Call an ambulance.• Don’t move, particularly the bitten part.

• In the first second after the bite it is possible to press out the poison. Do it if possible.

• Clean the wound with antiseptic solution and bandage the wound (not tightly).

• Drink a lot of fluid, it will dilute the poison.• If possible catch the snake or at least remember

the look of animal or insect.

Research based…

• Syrup of ipecac should no longer be used routinely as a poison treatment intervention in the home.

• Current research does not support the routine administration of activated charcoal in the home as efficacy and safety have not been demonstrated.

References

1) FARLEX, http://medical-dictionary.thefreedictionary.com/Poisoning

2) St John Ambulance, http://www.sja.org.uk/sja/first-aid-advice/poisoning/drug-poisoning.aspx

3) Pediatrics, http://pediatrics.aappublications.org/content/112/5/1182.full

4) US National Library Of Medicine, http://www.ncbi.nlm.nih.gov/pubmed/8145456

5) MD INDIA,http://www.medindia.net/patients/Firstaid_Poisoning.htm