Poisoning

1
Poisoning

• Barbara S. Hays
• Winter, 2006

2
Food poisoning

• Contaminated food
• Illness caused by toxins produced by bacteria
• Botulism
• Staphylococcus aureus
• Salmonella
• MRSA

3
Botulism(claustridium botulilnum)

• Improperly canned/cured food, especially meat and
  beans

4
Botulism

• Assessment (presents in about 24-36 hrs)
• Headache
• Diplopia
• Muscle incoordination, trouble breathing,
  talking, swallowing
• Airway/gas exchange
• Fatigue
• n/v

5
Botulism

• Intervention (quite effective)
• Airway/ventilation
• Be ready to do CPR
• Induce vomiting if
• Ingestion is recent
• No seizures
• No loss of consciousness
• antitoxin

6
Staphylococcus aureus

• Respiratory tract/skin of food handlers
• Unrefrigerated cream- filled foods
• Fish/meat

7
Staph poisoning

• Assessment
• n/v/d, abdominal cramps
• Weakness
• Interventions (supportive)
• Rest
• Anti-emetics, anti-diarrheals
• Fluids (possible IV therapy)

8
Salmonella poisoning

• Inadequately cooked meat, poultry, eggs

9
Salmonella poisoning

• Assessment
• n/v/d, abdominal pain
• Weakness
• Fever/chills
• Interventions (supportive)
• Rest
• Fluids (possible IV therapy)
• Anti-emetics, anti-diarrheals

10
Tylenol poisoning

• Degree of damage depends on available
  gluthathione in liver to detoxify metabolites of
  tylenol
• Causes liver damage
• Cell damage
• Liver dysfunction
• Liver failure

11
Tylenol poisoning

• Initial phase (gt150mg/kg 12 24 hours)
• n/v
• Pallor
• Malaise
• Latent phase (about 4 days)
• Feel relatively well
• May recover
• Third phase (4 days to a week)
• Hepatic failure
• Coma
• death

12
Tylenol poisoning

• Medical management
• Induce emesis (no charcoal if giving antidote)
• gastric lavage
• Mucomyst (N-acetylcysteine) Easy p 292
• Alters metabolism
• Decreases liver damage
• Bad taste, smell bronchospasm

13
Aspirin poisoning

• Most frequently accidentally ingested by
  toddlers/children
• 1.5 to 5 grains per pound requires treatment

14
Aspirin OD

• Respiratory stimulation first
• Respiratory alkalosis (blow off CO2)
• Metabolic acidosis second
• Krebs cycle
• Lactate builds up
• Anorexia/vomiting
• Diaphoresis
• Hypoglycemia
• Loss of fluids/electrolytes dehydration
• GI irritation
• Bleeding

15
Aspirin OD

• Treatment
• Emesis induction (if not comatose/convulsing)
• Cathartics to speed through GI tract
• Maybe dialysis
• Fluids
• Assised ventilation PRN
• Seizure precautions/Rx

16
Aspirin OD

• Prognosis
• With prompt treatment Good
• If seizures poor

17
Emetics (Easy p 349 351)

• Syrup of Ipecac stimulates vomiting center in
  brain
• Administer with 200 300cc warm water
• Induces vomiting in about 20 minutes
• Give before activated charcoal (yet this delays
  the use of charcoal)

18
Heavy metal poisoning

• Lead (most common)
• Iron
• Mercury
• Arsenic

19
Children at risk because

• tend to eat strange things
• Sensitivity to toxic effects
• Immature body systems
• May be deficient, so body takes in more quickly

20
Non-dietary sources of lead

• Lead-based paint
• Chipping off old paint
• In soil as dust after removal of above
• Old toys
• Lead shot, fishing weights
• Underglazed pottery (especially red)

21
Non-dietary sources of lead

• Colored ink in newspapers/magazines
• Yellow, red
• Inhaled
• Automotive fumes
• Burning batteries
• Lead crystal decanters

22
Poisoning Lead deposits in

• CNS, peripheral nervous system
• Cerebral edema irritable
• Delay/regression in development
• Convulsions, paralysis, blindness
• Coma, death

23
Poisoning Lead deposits in

• Bone marrow
• Kidneys injury to tubules
• Aminoaciduria
• Proteinuria
• Glucouria
• phosphaturia

24
Heavy metal poisoningTreatment (chelation
therapy)

• Metallic ion bound to chelating molecule,
  excreted
• Calcium Disodium Edetate (CAEDTA)
• British Anti-Lewisite Calcium (BAL)
• Fluids
• Assessment
• Support/education to parents

25
CaEDTA

• Helps excrete in urine 20 50 times normal rate
• Also helps excrete calcium
• Give DEEP IM or IV

26
BAL

• Removes lead from CNS
• Six doses/day for 7 days

27
Poison ingestion in general

• Find out what was taken
• Call Poison Control Center
• Maybe or maybe not induce vomiting
• (bleach ingestion milk better than water)