.Introduction to poisoning .Types of poisoning .Cases of poisoning .Treatment and management of poisoning

2. Assignment:
• Hospital
Pharmacy
Submittedto:
• Mam
Dr.
Rabea
Khan
SubmittedBy:
• 12
• 60
• 74
• 83
• 91

3. Poisoning Management
• Introduction to poisoning
• Causes and Cases of poisoning
• Types of poisoning
• Treatment considerations
• Prevention

4. • “Poison is a substance ( solid/ liquid or gaseous ),
which if introduced in the living body, or brought into
contact with any part there of, will produce ill health
or death, by its constitutional or local effects or both.”
• “Any substance that can harm the body by altering
cell structure or functions.”
What is a Poison ?

5. What is Poisoning..?
• “The development of dose related adverse effects
following exposure to chemicals, drugs or other
xenobiotics.”
• Poisoning occurs when any substance interferes with
normal body functions after it is swallowed, inhaled,
injected, or absorbed.
• The branch of medicine that deals with the detection
and treatment of poisons is known as toxicology.

6. Poisoning Management
• It includes procedures designed
to prevent the absorption,
minimize the toxicity, and hasten
the elimination of the suspected
toxin.
• The prompt employment of
appropriate emergency
management procedures often
can prevent unnecessary
morbidity and mortality.
• It includes all those attempts that
are made to accurately
a) identify the toxin,
b) estimate the quantity involved,
c) determine the time that has
passed since the exposure and
finally
d) controlling or minimizing the
effects of poison.

7. Nature of Poisoning
Homicidal – killing of a human being
by another human being by
administering poisonous substance
deliberately.
Suicidal – when a person administer
poison himself to end his/ her life.
Accidental – E.g. Household poisons-
nail polish remover , acetone .
Occupational – in professional
workers. E.g. insecticides, noxious
fumes.
Nature of
Poisoning
Homicidal
Suicidal
Accidental
Occupational

8. Routes of Poisoning

9. Routes of Poisoning
Inhalational
 Poisons that are breathed in:
 Gases: ammonia, chlorine
 Vapors: carbon monoxide
 Sprays: insecticides
 Volatile liquid chemicals: change
easily from liquid to gas
Ingestion
 Poisons that are swallowed:
 Household and industrial
chemicals
 Medications
 Improperly prepared food
 Plant materials
 Petroleum products

10. Routes of Poisoning
Injection
o Intra venous –
Benzodiazepines,
barbiturates, tricyclic
antidepressants etc.
o Intramuscular –
Benzodiazepines, opioids etc.
o Subcutaneous – Botulinum
toxin
o Intra- dermal – Local
anesthetics,
organophosphates
Absorption
Poisons taken in through
unbroken skin:
o Corrosives or irritants
o Through bloodstream
o Insecticides and chemicals

11. Checking the Scene
Often, the scene itself is the best clue that a poisoning may have occurred.
Factors to notice include—
o Unusual odors.
o Flames or smoke.
o An open medicine cabinet.
o Open or spilled containers.
o Overturned or damaged plants.
o Drug paraphernalia or empty containers.
Check for severity of scene that depends upon:
o The type and amount of poison.
o How and where the poison entered the body.
o The time elapsed since the poisoning.
o The victim’s size, weight, medical condition and age.

12. Scene Assessment
What substance was involved and how
much?
• Get exact spelling.
• Bring container to hospital with patient.
• If unknown—estimate the maximum
possible amount.
When did the exposure occur?
• ED personnel need to know as closely as
possible the time of ingestion.
Period of exposure
• First time use or chronic user
• If unknown—estimate the shortest and
longest possible time.

13. Scene Assessment
What interventions have been done?
– Traditional home remedies may be harmful.
Patient’s weight?
– Critical in determining appropriate
treatment
What effect is patient experiencing?
– Nausea and vomiting are the two most
common signs and symptoms.

14. Signals of poisoning
• Nature of Signals
 Sudden appearance of symptoms after food or drink in an otherwise healthy
person
 Symptoms – uniform in character, rapidity
 Sudden onset delirium, paralysis, cyanosis, collapse etc.
• Neurological Status
- conscious, - confused, - comatose
• Convulsions
 Ethylene glycol, Lithium, SSRI

15. Signals of poisoning
• Pupillary Examination
 Normal – Celphos (Al phosphide) poisoning
 Miosis – Opioids, OP poisoning
 Mydriasis – TCA, Theophylline, Datura, Methanol
• Hyperthermia
 Amphetamines, Alcohol withdrawal, MAO inhibitors, Anticholinergic agents,
Salicylates
• Hypothermia
 Barbiturates, Benzodiazepines, Ethanol, Opiates, Cyclic antidepressants

16. Signals of poisoning
• Skin Color & Lesions
Colour Toxin/ Poison
Pink Cyanide
Yellow (Jaundice) Phosphorous, hepatotoxins ( Acetaminophen)
Red Rifampicin
Blue (Cyanosis) Aniline, Nitrites,
• Diaphoresis
 Salicylate, OP poisoning
 Sympathomimetic, serotonin syndrome
 Phencyclidine, alcohol or sedative withdrawal

17. Fundamentals of poisoning management
1. Initial resuscitation and stabilization
2. Removal of toxin from the body
3. Prevention of further poison
absorption
4. Enhancement of poison elimination
5. Administration of antidote
6. Supportive treatment
7. Prevention of re - exposure

18. Management
1. Initial resuscitation & stabilization:
 First priorities are ABC’s
 I/V access – I/V fluids
 Endo tracheal intubation - to prevent aspiration
Unconscious patients
Respiratory depression/ failure
 Convulsions- give anticonvulsants
2.Removal of Toxin :
 Copious flushing with water or saline of the body including skin folds, hair
 Inhalational exposure
 Fresh air or oxygen inhalation

19. 1).Gastric Lavage:
 Done with water ,1:5000 potassium permanganate , 4% Tannic acid, saturated lime
water or starch solution with orogastric or Ewald’s tube.
 Performed until clear fluid is obtained or a maximum of 3 L .
 Lavage decreases ingestant absorption by an average of :-
 52 % - if performed within 5 min. of ingestion
 26 % - if performed at 30 min.
 16 % - if performed at 60 min.
Contraindications:
o Corrosive poisoning
o Recent esophageal / gastric surgery
o Unconscious patient
3.Prevention of poison absorption
Ewald’s tube

20. 3.Prevention of poison absorption
2). Ipecac Syrup induced emesis
Administered orally
Dose :-
 30 ml – adults
 15 ml – children
 10 ml – small infants
Contraindications:
 Corrosives
 CNS depression or seizures
 Rapidly acting CNS poisons ( cyanide, strychnine, camphor )

21. 3.Prevention of poison absorption
3). Activated Charcoal:
o Charcoal adsorbs ingested poisons within gut lumen allowing charcoal- toxin complex to be
evacuated with stool or removed by induced emesis / lavage
o Dose – 1 g/kg body wt.
o Given orally as a suspension ( in water ) or through NG tube
Contraindications:
o Mineral acids, alkalis, cyanide, fluoride ,iron

22. 3.Prevention of poison absorption
4).Whole bowel irrigation
 Administration of bowel cleansing solution containing electrolytes &
polyethylene glycol
 Orally or through gastric tube
 Rate – 2 L/hr. ( 0.5 L /hr. in children)
 End point- rectal fluid is clear
 Position – sitting
Contraindications :
a. Bowel obstruction
b. Ileus
c. Unprotected airway

23.  Infusion of large amount of NS+NAHCO3
 Used to eliminate acidic drug that mainly excreted by the kidney eg salicylates
 Serious fluid and electrolytes disturbance may occur
 Need expert monitoring
4.Enhancement of Elimination of Poison
Forced alkaline diuresis
Acidification of urine:
o Enhance elimination of weak bases such as Phencyclidine & Amphetamine

24. 4.Enhancement of Elimination of Poison
Extracorporeal Removal:
Dialysis
Acetone, Barbiturates, Bromide, Ethanol, Ethylene glycol, Salicylates, Lithium
Less effective when toxin has large volume of distribution (>1 L/kg), has large molecular
weight, or highly protein bound.
Peritoneal Dialysis
 Alcohols , long acting salicylates, Lithium
Chelation:
 Heavy metal poisoning
 Complex of agent & metal is water soluble & excreted by kidneys
 Eg. BAL, EDTA,
 BAL – Arsenic, Lead, Copper, Mercury
 EDTA- Cobalt, Iron, Cadmium

25. Administration of Antidote:
• Not all poisons have antidotes
• Typical Examples are mentioned only

26. Prevention:
 By following these guidelines you will be able to prevent most poisoning emergencies:
 Keep the household products and medications out of the reach of children.
 Use childproof safety caps on containers of medications and other potentially
dangerous substances.
 Keep products in their original containers.
 Use poison symbols to identify dangerous substances.
 Dispose of outdated medications and household products.
 Use chemicals only in well-ventilated areas.
 Wear proper clothing.

27. Some poisoning cases:
Food Poisoning:
A young boy visited Pharmacy department. Unfortunately he drank a glass of water from water cooler and
on his way back to home , ate a more than enough amount of eatables from canteen. After some time, he
developed following signs and symptoms:
Nausea, vomiting, abdominal cramps, chills, diarrhea, and fever
Home Remedies:
 Take enough amount of fluids
 Drink oral rehydration mixtures to replace fluids and minerals lost through vomiting and diarrhea
 Get plenty of rest
In case of severity;
 Call 1122
 In the hospital, the treatment is designed to rehydrate the pt. This is usually done with intravenous (IV)
fluids. The doctor may prescribe antibiotics if your food poisoning is bacterial.
Prevention:
-Wash your hands, utensils and food surfaces often -Keep raw foods separate from ready-to-eat foods.
-Cook foods to a safe temperature -Never visit department again.

28. Inhaled Poisoning:
A laboratory worker while on his work inhaled Chlorine gas . He claimed of :
Eye tearing, nose and throat irritation , Sneezing, Excess salivation, Vomiting.
TREATMENT:
Nebulized lidocaine analgesia & cough.
Nebulized sodium bicarbonate
Saline irrigation for skin or eye exposures
Perform on-going assessment.
Consult medical control.
Transport.
Do focused history and physical exam (SAMPLE & vital signs).
Expose chest for auscultation.
Establish airway and provide high-concentration oxygen
Remove from source of poison.

29. Poisoning understudy:
Facebook Poisoning: