๐Ÿงด TREATMENT OF POISONING – A COMPREHENSIVE OVERVIEW

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By Dr. Sk Sabir Rahaman, MBBS, MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD 

๐Ÿงช Definition & Scope

  • Toxicology: Branch of pharmacology dealing with harmful effects of chemicals on living organisms.

  • Poisoning: Harmful effects caused by ingestion, inhalation, dermal exposure, or injection of toxic substances (drugs, pesticides, household chemicals, industrial agents, venoms).

  • Medico-legal importance:

    • All poisoning cases are medical emergencies.

    • Must be reported to police/authorities (especially suicidal, homicidal, or accidental cases) under Indian law.

๐Ÿ›‘ General Principles of Management (ABCDE of Toxicological Emergencies)

A – Airway

  • Ensure patency (tongue fall, aspiration common in comatose patients).

  • Place in left lateral position to reduce aspiration.

  • Intubate with cuffed endotracheal tube if airway compromised.

  • Regular suction of secretions.

B – Breathing

  • Monitor with pulse oximetry and ABG.

  • Give humidified oxygen for hypoxia.

  • Mechanical ventilation if respiratory depression (e.g., opioids, barbiturates).

C – Circulation

  • Check pulse, BP, perfusion.

  • Secure i.v. line.

  • Correct shock with fluids (normal saline) ± vasopressors (dopamine, noradrenaline).

  • Treat arrhythmias with appropriate antidote or antiarrhythmics (careful in TCA poisoning where lignocaine preferred).

D – Disability (Neurologic Status)

  • Assess Glasgow Coma Scale (GCS).

  • Seizures → i.v. benzodiazepines (diazepam, lorazepam).

  • Check blood glucose; correct hypoglycemia with 50% dextrose.

  • Thiamine 100 mg i.v. in alcoholics before glucose to prevent Wernicke’s encephalopathy.

E – Exposure & Decontamination

  • Prevent further absorption:

    • Inhalation → remove from source, give fresh air.

    • Dermal/Ocular → remove clothes, wash with water/soap, irrigate eyes with saline.

    • Ingestion:

      • Gastric lavage: within 1–2 hrs, only if life-threatening, patient conscious/intubated.

      • Contraindications: corrosives (acids/alkalis), hydrocarbons (kerosene), strychnine (seizure-inducing).

๐ŸŒ‘ Activated Charcoal – Universal Antidote

  • Dose: 1 g/kg (max 50 g) orally or via NG tube.

  • Adsorbs many toxins → prevents systemic absorption.

  • Useful in: antidepressants, barbiturates, salicylates, digoxin, theophylline.

  • Not effective for: iron, lithium, alcohols, acids/alkalis.

๐Ÿ’‰ Specific Antidotes

PoisonAntidoteMechanism
Organophosphates, CarbamatesAtropine + PralidoximeMuscarinic blockade; cholinesterase reactivation
BenzodiazepinesFlumazenilGABA-A receptor antagonist
Opioids (morphine, heroin)Naloxoneฮผ-opioid receptor antagonist
AcetaminophenN-acetylcysteine (NAC)Restores glutathione, detoxifies NAPQI
Methanol, Ethylene glycolFomepizole / EthanolCompete for alcohol dehydrogenase
CyanideHydroxocobalamin, Sodium thiosulfateBinds cyanide / converts to thiocyanate
IronDeferoxamineChelates free iron → ferrioxamine
WarfarinVitamin K1 (phytonadione)Restores clotting factors
HeparinProtamine sulfateBinds & neutralizes heparin
Heavy metals (lead, arsenic, mercury)BAL (dimercaprol), EDTA, SuccimerChelation & excretion

๐Ÿงน Methods to Enhance Elimination

A. Urinary Alkalinization

  • Sodium bicarbonate infusion → ↑ renal excretion of weak acids.

  • Indications: salicylates, phenobarbital.

B. Hemodialysis / Hemoperfusion

  • Indications: lithium, methanol, ethylene glycol, salicylates, theophylline.

  • Best for small MW, low protein binding, low Vd drugs.

C. Whole Bowel Irrigation

  • Polyethylene glycol-electrolyte solution.

  • Indications: iron, lithium, sustained-release tablets, drug packers ("body packers").

๐Ÿฅ Symptomatic and Supportive Therapy

  • Seizures → Diazepam/lorazepam.

  • Hypoglycemia → Dextrose.

  • Hypokalemia → KCl replacement.

  • Hyperkalemia → Calcium gluconate + sodium bicarbonate.

  • Metabolic acidosis → Sodium bicarbonate i.v.

๐Ÿ“ž Poison Information Centers (India)

  • WHO-supported centers for real-time poison data:

    • AIIMS, New Delhi

    • NHLMMC, Ahmedabad

    • Regional centers: Chennai, Kochi, etc.

  • Databases: INTOX, POISONDEX.

๐ŸŽฏ Clinical Relevance for Students

  • Most poisons lack antidotes → supportive therapy is lifesaving.

  • ABC resuscitation is always the first priority.

  • Charcoal, lavage, dialysis depend on timing and poison characteristics.

  • Medico-legal awareness is vital — poisoning cases often involve suicide/homicide and must be reported.

  • Classic exam cases:

    • Paracetamol → NAC

    • Opioid → Naloxone

    • Organophosphate → Atropine + Oxime

    • Lead → EDTA/Succimer

✅ KEY TAKEAWAY:
The cornerstone of poisoning management is early stabilization + decontamination + supportive care. Antidotes exist for only a few poisons, but timely intervention saves lives. 



๐Ÿ“˜ Prepared by Dr. Sk Sabir Rahaman
๐Ÿ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert

๐ŸŒ Visit My Website for  Articles & other Free PDFs and Resources

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