Poisoning - Altmeyers Encyclopedia - Department Dermatology

Synonym(s)

Intoxication

Definition
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Sum of the functional disorders caused by toxins absorbed in the intestine or cutaneously. The exposure and the time course of the symptoms can be acute (accidental and suicidal), subacute or chronic (drug side effects, occupational disease). The number of toxins is unlimited, e.g. combustion gases, chlorine, DDT, E 605, phospor, household cleaning agents, digitalis, antihistamines, psychotropic drugs, sleeping pills and painkillers, opiates, moth balls, nutmeg, nicotine. The symptoms vary depending on the poison and can include central nervous, intestinal, pulmonary and cardiac disorders.

Therapy
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Maintenance of vital functions, measures to prevent further absorption (detoxification), as well as to accelerate the excretion of toxins (see Table 1). Administration of specific antidotes (see Table 2). Cooperation with the internist is necessary.

Tables
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Detoxification and acceleration of toxin elimination

	Measures	Application/execution
Prevention of further absorption when taken by os	Saline emesis	In conscious patients, 1-2 glasses of saline solution (1-2 tablespoons/glass).
	Saline emesis	Alternative: apomorphine or gastric lavage.
	Apomorphine emesis	In conscious patients, 0.1-0.15 mg/kg bw s.c. Additionally 10 mg norfenefrin i.m. for circulatory stabilization.
	Ipecacuanha emesis	In conscious children younger than 6 years (no saline or apomorphine vomiting).
		Children < 1 ½ years: 10 ml syrup.
		Children < 1 1/2-4 years: 15 ml syrup
		Children > 4 years: 20 ml of syrup, followed by 200 ml of water.
	Gastric lavage	Rinse with 10-30 liters, or 30-60 liters of water if necessary, followed by 30-40 g of activated charcoal in patients who are unconscious and in the half-sided or head-down position.

Acceleration of elimination	Forced diuresis	Infuse 12 liters of electrolyte solution and excrete within 24 hrs. Risk of renal insufficiency, check renal parameters!
	Hyperventilation	Insufflation of_CO2 (in case of poisoning with hydrocarbons)
	Interruption of enterohepatic circulation	Instillation of activated charcoal or cholestyramine in the duodenum (3 times 4 g/24 hrs.)
	Hemoperfusion	Extracorporeal toxin elimination
	Hemodialysis	Elimination of renal toxins only
	Other procedures	Plasma separation, ultrafiltration, peritoneal dialysis, blood exchange transfusion

Specific antidotes or specific treatment

Toxins/cause of poisoning	Antidotes
Heavy metals (arsenic, mercury, gold, partly organic mercury)	Chelating agents (dimercaprol, D-penicillamine)
Hydrogen cyanide	Methemoglobin formers (amyl nitrite, sodium nitrite, dimethylaminophenol)
Hydrogen cyanide	Cobalt compounds for CN binding (Co-EDTA, hydroxocobalamin, sodium thiosulfate)
Organophosphates	Atropine
Organophosphates	Oximes as reactivators (toxogonin, PAM)
Morphine and derivatives	Morphine antagonists (levallorphan, naloxone)
Methemoglobin formers	Thionine, methylene blue
Dicumarol and derivatives	vitamin K
Fluorides	Calcium salts
Methanol	Ethanol
Snake and spider bites	Specific antisera
Carbon monoxide	No analeptics!, pure oxygen administration or carbogen.
Lead	D-penicillamine or _CaNa2-EDTA. Dimercaprol is contraindicated!
Thallium	Colloidal iron (III) hexacyanoferrate (II), otherwise early symptomatic. Dimercaprol contraindicated!
Beryllium	Salicylic acid and aurintricarboxylic acid as chelating agents.
Carbamic acid (carbamates)	Atropine in high doses
Solvents	Do not induce vomiting! Liquid kerosene (5 ml/kg bw), laxative administration. No castor oil - oils accelerate absorption!

Literature
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Henderson A et al (1993) Experience with 732 acute overdose patients admitted to an intensive care unit over six years. Med J Aust 158: 28-30
by Mach MA et al (2003) Current diagnosis of poisoning. German Med Weekly 128: 1121-1123
Wegner R (2002) Poisoning due to heavy metals and arsenic. Internist (Berl) 43: 818, 821-827