Principles of management of poisoning

Written by Dr.Md.Redwanul Huq (Masum)
Tuesday, 22 January 2013 08:26

History taking:

a) Questioning about-

i) The time of exposure to and ingestion of poison
ii) Amount and type of poison
iii) Source of poison
iv) In case of drug poisoning-the nature of the drug must be identified from description of the tablet and remaining of the tablets in the blister

b) History of past illness-

i) Jaundice
ii) Bronchial asthma
iii) CVS problem
iv) Epilepsy
v) Head injury
vi) Psychiatric illness
vii) Drug misuse

c) Family history –

Relation with family members

d) Social history.

Clinical examination:

1. General examination:

a) Temperature
b) Pulse
c) Respiratory rate
d) BP
e) Dehydration
f) Cyanosis
g) Needle marking

2. Systemic examination:

a) Examination of CVS: Heart rate
b) Examination of Respiratory system: To exclude crepitations and rhonchi
c) Examination of Nervous system:

  • Size of the pupil
  • Assessment of GCS (Glasgow coma scale)

d) Abdominal examination:

  • Abdominal tenderness
  • Bowel sound

e) Examination of Higher psychic function

  • Hallucination
  • Delusion
  • Illusion
  • Memory
  • Orientation about time, place, person.

Management of poisoning:

I. Immediate management

a) Airway clearance
b) Ensuring breathing
c) Maintenance of circulation

II. General measurements:

a) Prevention of absorption and also elimination of poison

i) Removal of clothing
ii) Skin wash with soap water
iii) Gastric lavage
iv) Eye irrigation
v) Activated charcoal
vi) Whole bowel irrigation
vii) Haemoperfusion
viii) Urinary alkainization
ix) Haemodialysis

b) Supportive management of poisoning

i) Aspiration of secretions
ii) O2 therapy
iii) IV infusion
iv) Artificial ventilation if needed

c) Inactivation of non-absorbed poison

i) Acid for alkali
ii) Alkali for acid

d) Inactivation of the absorbed poison

i) Chelating agents : e.g. Penicillamine, EDTA, Desferioxamine
ii) Antidotes
iii) Antagonists

e) Symptomatic treatment

i) Antipyretics
ii) Antibiotics
iii) Anticonvulsant

f) Maintenance of nutrition– oral (if possible) or parenteral

g) Follow up of the patient to prevent any complication.

Leave a Reply