Hailey Tran
Poisoning is when a toxic substance harms the body and can occur through ingestion, inhalation, or contact with the skin or eyes. Poisoning can be treated in a variety of ways, depending on the type of poison and the patient's health. Observation and supportive care are the mainstays of therapy, and hospitalization is generally indicated for serious poisoning. Treatment may involve monitoring vital signs, cardiac telemetry, oxygen saturation, and multisystem monitoring with blood studies. In some cases, chelation therapy may be used to remove metals from the body. If you suspect poisoning, it is important to seek medical attention immediately and contact poison control for guidance.
| Characteristics | Values |
|---|---|
| When to go to the hospital | If you or someone you know has swallowed or breathed in a poison and is experiencing nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin colour |
| What to bring to the hospital | All the medicine bottles, containers (household cleaners, paint cans, vitamin bottles), or samples of the substance (such as a plant leaf) |
| Diagnosis | A combination of history, physical examination, and laboratory studies will help reveal the cause of poisoning. Many poisons can be detected in the blood or urine. |
| Treatment | Observation and supportive care are the mainstays of therapy. Indiscriminate use of gastric lavage, antidotes, and drugs should be avoided. Monitoring of vital signs, cardiac telemetry, and oxygen saturation is mandatory. Hospitalization in an intensive care unit is generally indicated for serious poisoning. |
| Poison control | Call 1-800-222-1222 in the U.S. for guidance. Poison control is free, expert, and confidential. |
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What You'll Learn
Identifying the poison
Poisoning is caused by a toxic substance that makes you sick or harms your body. Poisons can come from plants, animals, household cleaners, chemicals, medications, carbon monoxide, and more. The identification of the substance causing the poisoning is critical to the patient's prognosis and treatment.
If you suspect that you or someone you know has been poisoned, you should call an ambulance or poison control immediately, even if there are no symptoms. Poison Control can be reached 24/7 online or by phone at 1-800-222-1222 in the U.S. It is important to act quickly, as poisons can act fast and cause serious harm or even death. When calling for help, it is important to provide as much information as possible about the potential poison, including any medicine bottles, containers, or samples of the substance.
When a patient presents to the hospital with suspected poisoning, a combination of history, physical examination, and laboratory studies will help identify the cause. Many poisons can be detected in the blood or urine, but the tests ordered will depend on the information gathered during the initial assessment. In some cases, a more comprehensive toxicological analysis or STA may be performed to identify the causative agent.
If you find a loose pill or are unsure about the contents of a container, many medications can be identified from the letters and numbers imprinted on the pill. Additionally, some poisons may be identified by their distinctive appearance, such as the nickel-sized 3-volt lithium coin cells that are hazardous to children if swallowed.
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Observation and supportive care
Poisoning is when a toxic substance (poison) makes you sick or harms your body. Poisons can come from plants, animals, household cleaners and chemicals, medications, carbon monoxide, and more. The treatment of poisoning depends on the type of poison and other factors like age and health.
In the case of critical care patients, observation and monitoring are crucial. These patients may require frequent observations and specialized life support measures. For instance, poisoned patients in the ICU are at risk for venous thromboembolic disease if their condition requires an extended period of bed rest. Therefore, observation and supportive care involve monitoring for potential complications and providing prophylaxis when necessary.
Additionally, nutritional support is an important aspect of supportive care. The goal is to meet the patient's nutritional needs without overfeeding, as excess carbohydrates can lead to increased carbon dioxide production. Enteral feedings are preferred as they help maintain the integrity of the gut's mucosal barrier.
The identification of the poison is essential to guide treatment. A combination of history, physical examination, and laboratory studies helps reveal the cause of most poisonings. Once the poison is identified, specific antidotes or treatments can be administered. For example, acetylcysteine is an effective antidote for preventing liver failure due to paracetamol overdose, which is a common means of self-poisoning.
In summary, observation and supportive care in the treatment of poisoning involve monitoring the patient's vital signs, providing respiratory and circulatory support, ensuring nutritional needs, and preventing further absorption of the poison. This care is provided while specific treatments or antidotes are administered to counteract the effects of the identified poison.
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Preventing absorption
In a hospital setting, activated charcoal is commonly used to prevent the absorption of poison. Activated charcoal is a black powder processed for medical use. It binds to the poison in the digestive tract, preventing its absorption into the bloodstream. It is typically administered orally if the patient is alert and cooperative. However, it is not recommended to introduce activated charcoal through a tube placed in the nose or mouth for uncooperative or lethargic individuals. Activated charcoal is given every 4 to 6 hours to help cleanse the body of poison. It is important to note that activated charcoal does not work on all poisons, such as alcohol, iron, or many household chemicals.
Stomach pumping is another method to prevent poison absorption, but it should only be performed by healthcare professionals. Inducing vomiting is rarely advised and should only be done under the guidance of poison control or a qualified healthcare provider.
To prevent accidental poisoning, it is crucial to keep medications and toxic substances in their original child-proof containers. These containers should be stored in locked cabinets out of the reach of children. Additionally, toxic substances should not be placed in drink bottles or cups, even temporarily. Always read labels before taking or using any medications or household products. Properly dispose of expired or unused medications through hospital, pharmacy, or government disposal programs.
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Chelation therapy
Poisoning is when a toxic substance (poison) makes you sick or harms your body. Poisoning affects each person differently. It depends on the type of poison and other factors like age and health. Some common forms of poisoning, like food poisoning or poison ivy exposure, are mild and can be treated at home. More serious situations may require hospitalization.
In recent years, some people have claimed that chelation therapy can also treat other conditions, including heart disease, autism, Alzheimer's disease, and diabetes. However, there is little to no credible scientific research that supports the use of chelation therapy for these conditions. The American College of Cardiology and the Mayo Clinic do not endorse chelation therapy for heart disease, and the American Academy of Pediatrics (AAP) does not recommend it for autism. Over-the-counter chelation products are not approved for sale in the United States, and chelation therapy should only be performed by qualified health professionals.
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Psychiatric evaluation
The psychiatric evaluation in poisoning cases aims to address both medical and psychosocial needs. It involves a comprehensive history-taking process, including information on the patient's psychiatric history, current medications, allergies, and any recent emotionally traumatic events. This information can provide valuable insights into the patient's mental state and potential reasons for intentional ingestion or overdose.
During the psychiatric evaluation, clinicians also assess the patient's level of consciousness, ventilation, and circulation. This includes measuring vital signs such as pulse, blood pressure, and temperature to evaluate cardiovascular function. Additionally, tools like the Glasgow Coma Scale (GCS) are used to assess the degree of consciousness impairment, which can help determine the need for further interventions, such as respiratory assessment and intubation.
In cases of suspected intentional ingestion or overdose, a psychiatric evaluation can help determine the patient's intent and underlying psychiatric condition. This information is crucial for providing appropriate psychiatric care and ensuring patient safety. It also guides the development of a tailored treatment plan that addresses the patient's specific needs and prevents further harm.
The psychiatric evaluation is often conducted in collaboration with other medical specialties, such as toxicology and social work teams. This multidisciplinary approach ensures that patients receive comprehensive care that addresses both the medical and psychosocial aspects of poisoning. Additionally, outpatient and long-term follow-up may be necessary to provide ongoing psychiatric support and monitor the patient's mental health and recovery progress.
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Frequently asked questions
If you suspect someone has been poisoned, you should call the poison control center at 1-800-222-1222 or call 911 if the individual collapses, has a seizure, has trouble breathing, or can’t be awakened. If you are in a hospital, take all the medicine bottles, containers (household cleaners, paint cans, vitamin bottles), or samples of the substance (such as a plant leaf) with you to the hospital's emergency department.
Poisoning symptoms vary widely and can include nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin color.
Observation and supportive care are the mainstays of therapy for poisoned patients. Indiscriminate use of gastric lavage, antidotes, and drugs should be avoided. Monitoring of vital signs, cardiac telemetry, and oxygen saturation is mandatory. Hospitalization in an intensive care unit is generally indicated for serious poisonings.
