General Poisoning Considerations

Question 1

What should you assess for in patients with poisonings?

Answer 1

Physical assessment should include vital signs, mental status, pupil size, skin temperature and moisture, pulse oximetry, EKG and continuous cardiac monitoring, finger stick glucose, need for intubation, stabilization of cervical spine if there is a possibility of trauma

Question 2

What are the symptoms associated with physiologic excitation and in what poisonings would you see this?

Answer 2

• This is manifested by CNS stimulation
• You will see tachycardia, tachypnea with deep respirations and increased temperature.
• Suspect the symptoms to be caused by anticholinergic, sympathomimetic or central hallucinogenic agents OR by drug withdrawal states

Question 3

What are the symptoms associated with physiologic depression and in what poisonings would you see this?

Answer 3

• Depressed mental status, blood pressure, pulse, respiratory rate and depth and body temperature
• Suspect: ethanol, other sedative hypnotic agents, opiates, cholinergic agents, toxic alcohols

Question 4

With what poisonings would you see mixed physiologic effects?

Answer 4

Polydrug overdoses or exposure to metabolic poisons included hypoglycemic agents, salicylates, antiarrhythmics, local anesthetics

Question 5

How is activated charcoal used with poisonings?

Answer 5

Given orally as a slurry, it absorbs toxins in the bowel. It can prevent absorption of an important proportion of the ingested dose of toxin. Efficacy decreases with time and current guidelines do not recommend it more than an hour post ingestion unless the toxin is sustained-release or when gastric emptying is delayed. Multiple doses of activated charcoal (50 g 6 times daily in an adult) may enhance the elimination of some substances at any time post poisoning

Question 6

How is whole bowel irrigation used in poisonings?

Answer 6

• It involves administration of large quantities of osmotically balanced polyethylene glycol and electrolyte solution given by NG tube (usually 1-2 liters) until the rectal effluent is clear.
• Contraindicated in hemodynamically unstable patients, obstruction, ileus, rectal hemorrhage.

Question 7

How is hemodialysis/hemoperfusion used in poisonings?

Answer 7

It is used to enhance the elimination of poisons. The toxins must be small enough to pass through the dialysis membrane (hemodialysis) or must bind to activated charcoal (hemoperfusion).