Approaches to Managing Poisoning and Overdose
1. Initial Stabilization
1.1 ABC Protocol
- Airway: Maintain a clear airway; use intubation if needed.
- Breathing: Provide oxygen or mechanical ventilation.
- Circulation: Monitor BP, pulse; provide IV fluids and vasopressors if needed.
1.2 Vital Monitoring
- ECG, temperature, blood glucose, and neurological status.
2. Clinical Evaluation and Poison Identification
2.1 Patient History
- Substance taken, dose, route, time of ingestion, intentional/accidental.
2.2 Physical Examination
- Consciousness level, pupils, skin color, temperature, respiration patterns.
2.3 Laboratory Investigations
- Blood tests, urine toxicology, serum drug levels.
3. Prevention of Further Absorption
3.1 Gastric Lavage
- Performed within 1–2 hours; contraindicated in corrosives and petroleum ingestion.
3.2 Activated Charcoal
- Universal adsorbent; can be single or multiple doses.
3.3 Induced Emesis
- Rarely used; contraindicated in unconscious or convulsion cases.
3.4 Whole Bowel Irrigation
- Polyethylene glycol solution; used for SR formulations or body packers.
4. Enhancement of Toxin Elimination
4.1 Forced Diuresis
- Salicylates and barbiturates; urine alkalinization.
4.2 Hemodialysis
- Useful for methanol, ethylene glycol, lithium, salicylate.
4.3 Hemoperfusion
- Effective for theophylline, carbamazepine, phenobarbital.
5. Use of Antidotes
5.1 Specific Antidotes
| Poison | Antidote |
|---|---|
| Opioids | Naloxone |
| Paracetamol | N-acetylcysteine |
| Benzodiazepines | Flumazenil |
| Organophosphates | Atropine + Pralidoxime |
| Cyanide | Sodium nitrite + Sodium thiosulfate |
| Iron | Deferoxamine |
| Heparin | Protamine sulfate |
6. Supportive and Symptomatic Treatment
6.1 Symptom Control
- Anticonvulsants for seizures, antiarrhythmics, fluid & electrolyte balance.
6.2 Psychological Support
- Counseling in cases of intentional overdose.
7. Prevention and Patient Education
7.1 Safe Storage
- Keep drugs and chemicals away from children.
7.2 Awareness & Counseling
- Prevent recurrence.