Poisoning

Poisoning • Barbara S. Hays • Winter, 2006

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

Botulism (claustridium botulilnum) • Improperly canned/cured food, especially meat and beans

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

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

– antitoxin

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

Staph poisoning • Assessment – n/v/d, abdominal cramps – Weakness

• Interventions (supportive) – Rest – Anti-emetics, anti-diarrheals – Fluids (possible IV therapy)

Salmonella poisoning • Inadequately cooked meat, poultry, eggs

Salmonella poisoning • Assessment – n/v/d, abdominal pain – Weakness – Fever/chills

• Interventions (supportive) – Rest – Fluids (possible IV therapy) – Anti-emetics, anti-diarrheals

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

Tylenol poisoning • Initial phase (>150mg/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

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

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

Aspirin OD • Respiratory stimulation first

– Respiratory alkalosis (blow off CO2)

• Metabolic acidosis second – – – –

• • • •

Kreb’s cycle Lactate builds up Anorexia/vomiting Diaphoresis

Hypoglycemia Loss of fluids/electrolytes: dehydration GI irritation Bleeding

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

Aspirin OD • Prognosis – With prompt treatment: Good – If seizures: poor

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

Heavy metal poisoning • Lead (most common) • Iron • Mercury • Arsenic

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

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)

Non-dietary sources of lead • Colored ink in newspapers/magazines – Yellow, red

• Inhaled – Automotive fumes – Burning batteries

• Lead crystal decanters

Poisoning: Lead deposits in • CNS, peripheral nervous system – Cerebral edema: irritable • Delay/regression in development

– Convulsions, paralysis, blindness – Coma, death

Poisoning: Lead deposits in • Bone marrow • Kidneys: injury to tubules – – – –

Aminoaciduria Proteinuria Glucouria phosphaturia

Heavy metal poisoning Treatment (“chelation therapy”)

• Metallic ion bound to chelating molecule, excreted

– Calcium Disodium Edetate (CAEDTA) – British Anti-Lewisite Calcium (BAL)

• Fluids • Assessment • Support/education to parents

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

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

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)