Treatment of specific poisons
Cholinergic signs: DUMBELS: D
Also, fasciculations, muscle weakness and paralysis
- Get rid of poison
- Eyes (irrigation)
- Skin (remove clothing) and bathe
- Specific treatment
- Atropine 20 micrograms/kg IV or IM every 15 min until secretions have stopped and the chest is dry
- Monitor regularly (respiratory rate, coma score, heart rate, secretions) e.g. every 15 minutes initially, then every 30 minutes
- Assisted ventilation if necessary
Usually taken for diarrhoea and vomiting.
May lead to acidosis, respiratory distress, paralytic ileus.
- Rehydration i.e. give IV fluids and glucose
- Pass an NGT and leave on free drainage
Petroleum compounds (Paraffin)
Frequently presents with features of respiratory distress.
May cause pneumonitis, pneumomediastinum, pneumothorax and subcutaneous
- Do not induce vomiting
- Give oxygen if necessary
- Chest x-ray if symptomatic
- Antibiotic therapy may be needed for secondary chest infections
Carbon monoxide poisoning
Toxic effects are due to hypoxia.
Oxygen saturations can be misleading.
Usually only small quantities are ingested
- Mainly supportive and activate charcoal if available
- Liberal fluids and milk
- Do not induce vomiting
- Check for fang marks, note if scarifications present or not
- Look for evidence of use of a tourniquet
- Ask about time of bite
- Check bitten limb for swelling, pulses, colour and viability
- Check for systemic evidence of envenoming - fever, altered coma score, shock, anaemia
- Mark with a pen, the level of swelling on a limb so that further swelling can be assessed
- FBC and diff, blood culture and blood clotting time (see how long it takes for blood to clot in a plain tube)
- Group and cross match and hold blood unless anaemic
- Place an IV infusion of normal saline
- Check that tetanus toxid immunisation is up to date; if not give it. Immunisation protocol
If local swelling is marked or there is evidence of systemic envenoming:
- Inform senior. Anti snake venom will be required
- Give 40mls in 200mls of normal saline IV over 1hr but have adenaline standing by: anaphylactic reactions are not uncommon.
- If circulation is threatened inform the surgical team on call as compartment syndrome may need fasciotomy.
- Treat pain appropriately - morphine may be needed
- Gastrointestinal (GI) phase: 30 minutes to 6 hours after ingestion
- Latent, or relative stability, phase: 6 to 24 hours after ingestion
- Shock and metabolic acidosis: 6 to 72 hours after ingestion
- Hepatotoxicity/hepatic necrosis: 12 to 96 hours after ingestion
- Bowel obstruction: 2 to 8 weeks after ingestion
- Supportive therapy to maintain adequate blood pressure and electrolyte balance is
- I.V. fluid resuscitation
- May need potassium and glucose supplementation
- Consider desferrioxamine 15mg/kg/hr I.V. if available
- If oliguria or anuria develop, take sample for U&E, monitor BP, catheterise
andconsider peritoneal dialysis
Presents with tachypnoea, metabolic acidosis, and to a lesser extent, tachycardia.
Early symptoms include tinnitus, vertigo, nausea, vomiting, and diarrhoea.
More severe intoxication can cause fever, altered mental status, coma, non-cardiogenic
pulmonary oedema, and death.
- Administer multiple doses of activated charcoal (first dose: 1 g/kg orally up to 50 g)
- Administer supplemental glucose in patients with altered mental status, even if serum glucose concentration is normal: IV dextrose 50 g as 100 mL of 50 percent dextrose
- Send U&E and RBS
- Correct electrolyte abnormalities
- Consider peritoneal dialysis