Poisoning.docx

Diagnosis of Poisoning Prompt diagnosis of poisoning is necessary to determine treatment and help prevent complications. To diagnose poisoning, physicians often take a patient history (including information about exposure to toxic substance and symptoms) and perform a physical examination and laboratory tests (e.g., blood tests).

In children, parents and caregivers should provide as much information as possible about the toxic substance and the child's exposure to it (e.g., how long was the child exposed, how much did he or she ingest, how long after exposure did symptoms develop, what symptoms occurred).

Laboratory tests may be used to detect blood or urine levels of the poisonous substance and to determine how well the child's body is handling (e.g., metabolizing, excreting) the substance.

Treatment for Poisoning Treatment for poisoning depends on the type of exposure (e.g., ingestion, inhalation), the specific toxin (poisonous substance), and the severity of the person's condition.

If the person has no symptoms but has taken a potentially dangerous poison, you should also call a poison control center or go to the nearest emergency department for an evaluation.

Poisoning Causes Poisons include highly toxic chemicals not meant for human ingestion or contact, such as cyanide, paint thinners, or household cleaning products. Many poisons, however, are substances meant for humans to eat, including foods and medicines Foods  Some mushrooms are poisonous  Drinking water contaminated by agricultural or industrial chemicals  Food that has not been properly prepared or handled Drugs 

Drugs that are helpful in therapeutic doses may be deadly when taken in excess

Poisoning Symptoms

Some poisons enlarge the pupils, while others shrink them. Some result in excessive drooling, while others dry the mouth and skin. Some speed the heart, while others slow the heart. Some increase the breathing rate, while others slow it. Some cause pain, while others are painless. Some cause hyperactivity, while others cause drowsiness. Confusion is often seen with these symptoms.

Poisoning Diagnosis A combination of history, physical examination, and laboratory studies will help reveal the cause of most poisonings. Frequently, treatment must begin before all information is available.

History: As a family member or friend of a poisoned person, you can greatly assist the doctor and provide valuable clues by telling the doctor about these details:     

Everything the person ate or drank recently Names of all prescription and over-the-counter medications the person is taking Exposure to chemicals at home or at work Whether others in the family or at work have been similarly ill or exposed Whether the person has any psychiatric history to suggest an intentional ingestion (suicide attempt)

A toxicology screen or "tox" screen looks for common drugs of abuse. Most toxicology screens will detect: Testing: Many poisons can be detected in the blood or urine. However, a physician cannot order "every test in the book" when the diagnosis is unclear. The tests ordered will be based on information revealed in the history and physical exam.

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acetaminophen, aspirin, marijuana, opioids (heroin, codeine), benzodiazepines (diazepam [Valium], chlordiazepoxide [Librium]), amphetamines (uppers), cocaine, and alcohol.

A specific blood test will give serum levels of some drugs, including phenytoin (Dilantin), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo24, Theolair, Uniphyl, Slo-Phyllin), digoxin (Lanoxin), lithium (Lithobid), and acetaminophen. Some drugs affect the electrical activity of the heart. An electrocardiogram (ECG) may reveal toxicity. Sometimes a person is unconscious for no obvious reason. A CT scan of the brain will help

Poisoning Medical Treatment

Elimination: Get rid of the unabsorbed poison before it can do any harm.

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If the person is unconscious, the doctor will put a flexible, soft, plastic tube into the windpipe to protect the person from suffocating in his or her own vomit and to provide artificial breathing (intubation). Once the poison has moved past the stomach, other methods are needed. Activated charcoal acts as a "super" absorber of many poisons. Once the poison is stuck to the charcoal in the intestine, the poison cannot get absorbed into the bloodstream. Activated charcoal has no taste, but the gritty texture sometimes causes the person to vomit. To be effective, activated charcoal needs to be given as soon as possible after the poisoning. It does not work with alcohol, caustics, lithium (Lithobid), or petroleum products. Whole bowel irrigation requires drinking a large quantity of a fluid called Golytely. This flushes the entire gastrointestinal tract before the poison gets absorbed.