Poisoning

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Last modified 02/03/2015

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18 Poisoning

Care of the unconscious patient

Other problems

Reduction of poison absorption

Increasing poison elimination

Once a poison has been absorbed, unless there is an antidote, it is reasonable to use treatments that might speed its elimination from the body.

Specific poisons

Specific management for each poison is set out below alphabetically. Antidotes are available for only a small number of poisons (Table 18.1) and dosage recommendations are given under each poison.

Table 18.1 Antidotes of value in poisoning

Poison Antidote
Anticoagulants (oral) Vitamin K1
Arsenic DMSA*
Dimercaprol (BAL)
Benzodiazepines Flumazenil
β-adrenoceptor-blocking drugs Atropine
Glucagon
Carbon monoxide Oxygen
Copper DMPS
Cyanide Oxygen
Dicobalt edetate
Hydroxocobalamin
Sodium nitrite
Sodium thiosulphate
Diethylene glycol Fomepizole, ethanol
Digoxin Digoxin-specific antibody fragments
Ethylene glycol Fomepizole, ethanol
Iron salts Desferrioxamine (deferoxamine)
Lead (inorganic) Sodium calcium edetate
DMSA*
Methaemoglobinaemia Methylthioninium chloride (methylene blue)
Methanol Fomepizole, ethanol
Mercury (inorganic) DMPS
Nerve agents Atropine
Pralidoxime, obidoxime
Opioids Naloxone
Organophosphorus insecticides Atropine
Pralidoxime, obidoxime
Paracetamol Acetylcysteine
Thallium Berlin (Prussian) blue

* Dimercaptosuccinic acid (succimer).

2,3-dimercaptopropanesulfonate (unithiol).

Acetone

This is inhaled or ingested and absorbed through the lungs, gut or skin. It is exhaled unchanged or metabolized to glucose and subsequently liberated as carbon dioxide. A common source of acetone is nail varnish remover, which can be swallowed accidentally by children.

Amfetamines

The N-methylated derivative, metamfetamine, is now used widely; the crystalline form of this salt is known as ‘crystal meth’ or ‘ice’. Ecstasy (MDMA) is discussed on page 675.

Anticonvulsants

See carbamazepine (p. 671), gabapentin (p. 677), lamotrigine (p. 679), phenytoin (p. 688) and sodium valproate (p. 691).

Antidepressants

See selective serotonin reuptake inhibitors (p. 690), mirtazapine (p. 681), monoamine oxidase inhibitors (p. 682), tricyclic antidepressants (p. 692) and venlafaxine (p. 693).

Beta-adrenoceptor-blocking drugs

Calcium channel blockers

There are three classes of calcium channel blocker: phenylalkylamines, e.g. verapamil; benzothiazepines, e.g. diltiazem; and dihydropyridines, e.g. amlodipine, felodipine, nifedipine.

Dihydropyridines are predominantly peripheral vasodilators with little direct cardiac effect, while verapamil, and diltiazem to a lesser extent, have significant cardiac effects (both myocardial depression and impaired cardiac conduction), in addition to peripheral vasodilatation.

Calcium channel blockers are often prepared as sustained-release preparations, which both delays and prolongs toxicity in overdose.

Treatment

Carbon monoxide