PoisoningT65.9
Synonym(s)
DefinitionThis section has been translated automatically.
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.
TherapyThis section has been translated automatically.
TablesThis section has been translated automatically.
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). |
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). |
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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. |
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Acceleration of elimination |
Infuse 12 liters of electrolyte solution and excrete within 24 hrs. Risk of renal insufficiency, check renal parameters! |
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Hyperventilation |
Insufflation ofCO2 (in case of poisoning with hydrocarbons) |
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Interruption of enterohepatic circulation |
Instillation of activated charcoal or cholestyramine in the duodenum (3 times 4 g/24 hrs.) |
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Hemoperfusion |
Extracorporeal toxin elimination |
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Hemodialysis |
Elimination of renal toxins only |
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Other procedures |
Plasma separation, ultrafiltration, peritoneal dialysis, blood exchange transfusion |
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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) |
Cobalt compounds for CN binding (Co-EDTA, hydroxocobalamin, sodium thiosulfate) | |
Organophosphates |
Atropine |
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! |
LiteratureThis section has been translated automatically.
- 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