Emergency treatment of poisoning

Emergency treatment of poisoning

Prevention of absorption

Given by mouth, activated charcoal can bind many poisons in the gastro­intestinal system, thereby reducing their absorption. The sooner it is given the more effective it is, but it may still be effective up to 1 hour after ingestion of the poison—longer in the case of modified-release preparations or of drugs with antimuscarinic (anticholinergic) properties. It is relatively safe and is particularly useful for the prevention of absorption of poisons that are toxic in small amounts, e.g. antidepressants.

CHARCOAL, ACTIVATED:

Indications: adsorption of poisons in the gastro-intestinal system.

Contraindications: drowsy or comatose patient (risk of aspiration); reduced gastro-intestinal motility (risk of obstruction); not for poisoning with petroleum distillates, corrosive substances, alcohols, clofenotane (dicophane, DDT), Malathion, and metal salts including iron and lithium salts.

Dose and Administration: Reduction of absorption, adult and child over 12 years, 50 g; child under 12 years, 1 g/kg (max. 50 g).

IPICAC:

Indications: To induce vomiting after ingesting something poisonous.

Contraindications: Do not administer ipecac when a patient has a decreased level of consciousness or has ingested either a corrosive substance or hydrocarbon with a high aspiration potential.

Dose and Administration: Ipecac syrup, which contains total alkaloids123 to 157 mg per 100 mL, has been used to induce vomiting. The usual dose range for the syrup is 10 to 30 mL, yielding a dose of alkaloids of 12 to 48 mg. Do not confuse the syrup with the fluid extract of ipecac, which is 14 times stronger. Cumulative toxicity requires administration of emetine for amebic dysentery in low doses for a short time with intervals of several weeks before further treatment.

Specific drugs

ACETYLCYSTEINE:

Indications: Indicated For the treatment of paracetamol overdosage.

Contraindications: Hypersensitivity to any ingredient in the preparation.

Dose and Administration: By intravenous infusion, adult and child, initially 150 mg/kg (max. 16.5 g) over 15 minutes, then 50 mg/kg (max. 5.5 g) over 4 hours then 100 mg/kg (max. 11 g) over 16 hours.

NALOXONE HYDROCHLORIDE:

Indications: Opioid-induced toxicity especially respiratory depression. Post­operative opioid depression. Neonatal respiratory depression secondary to the administration of opioids to the mother.

Contraindications: Known sensitivity to naloxone hydrochloride. Safety in pregnancy has not been established.

Dose and Administration: Doses used in acute opioid overdosage may not be appropriate for the management of opioid-induced respiratory depression and sedation in those receiving palliative care and in chronic opioid use. Opioid toxicity in Adults: 0,4 to 2 mg intravenously repeated if necessary at two to three

minute                              intervals                              as                              needed.
If no response has been observed after a total dose of 10 mg, then the diagnosis of overdosage with agents other than opioids should be considered. Children – Opioid toxicity: 0,01 mg/kg body mass intravenously followed, if necessary, by a larger dose of 0,1 mg/kg body mass.

DESFERRIOXAMINE MESILATE:

Indications: Treatment for chronic iron overload, e.g. transfusional haemosiderosis in patients receiving regular transfusions (e.g. thalassaemia major). primary and secondary haemochromatosis in patients in whom concomitant disorders (e.g. severe anaemia, hypoproteinaemia, renal or cardiac failure) preclude phlebotomy. Treatment for acute iron poisoning. For the diagnosis of iron storage disease and certain anaemias. Aluminium overload – In patients on maintenance dialysis for end stage renal failure where preventative measures (e.g. reverse osmosis) have failed and with proven aluminium-related bone disease and/or anaemia, dialysis encephalopathy; and for diagnosis of aluminium overload.

Contraindications: Hypersensitivity to desferrioxamine mesilate unless the patients can be desensitised.

Dose and Administration: By continuous intravenous infusion, adult and child up to 15 mg/kg/hour, reduced after 4–6 hours; max. 80 mg/kg in 24 hours.

PENICILLAMINE:

Indications: lead poisoning.

Contraindications: Hypersensitivity to penicillamine or any of the ingredients. Agranulocytosis or severe thrombocytopenia due to penicillamine. Lupus erythematosus. Moderate or severe renal impairment.

Dose and Administration: 1–2 g daily in 3 divided doses before food until urinary lead is stabilised at less than 500 micrograms/day; child 20 mg/kg daily in 3 divided doses before food.

FLUMAZENIL:

Indicated for the complete or partial reversal of the central sedative effects of benzodiazepines. It may therefore be used in anaesthesia and intensive care in the following situations: Termination of general anaesthesia induced and/or maintained with benzodiazepines. Reversal of benzodiazepine sedation in short diagnostic and therapeutic procedures. For the specific reversal of the central effects of benzodiazepines, to allow return to spontaneous respiration and consciousness, in patients in intensive care see under (15.1.7).

PROTAMINE SULPHATE:

Indications: Neutralisation of the anticoagulant effect of heparin therapy and the treatment of heparin overdose.

Contraindications: Previous life threatening reaction to protamine.

Dose and Administration: Adults: Protamine Sulphate Injection should be administered by slow intravenous injection (max rate 5 mg/min) over a period of 10 minutes. The dose is dependent on the amount of heparin to be neutralised. One mg of Protamine Sulphate will usually neutralise at least 100 IU of mucous heparin or 80 IU of lung heparin if given within 15 minutes of heparin administration. If more than 15 minutes has elapsed since heparin administration then less Protamine is required due to the rapid excretion of heparin. Not more than 50 milligrams of Protamine Sulphate should be administered in a ten minute period. To antagonise heparin infusion: 25-50mg after stopping infusion. To antagonise heparin subcutaneous injection: 1-1.5 mg/ 100 IU heparin. 25-50 mg can be given by slow IV injection and the remainder by slow IV infusion over 8- 16 hours (or the expected duration of absorption of heparin), or 2 hourly divided doses.

METHYLENE BLUE (Methylthioninium chloride):

Indications: Methemoglobinemia. large doses of methylene blue are sometimes used as an antidote to potassium cyanide poisoning.

Contraindications: Deficiency of Glucose-6-Phosphate Dehydrogenase, Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies, Severe Renal Disease.

Dose and Administration: Adult Min/Max Dose: 1.0mg/kg/4.0mg/kg Pediatric Min/Max Dose: 1.0mg/kg/4.0mg/kg.

DIGOXIN-SPECIFIC ANTIBODY:

Indications: indicated for the treatment of known or strongly suspected digoxin or digitoxin toxicity, where measures beyond the withdrawal of the digitalis glycoside and correction of any serum electrolyte abnormality are felt to be necessary.

Contraindications: Allergy to ovine protein.

Dose and Administration: Acute ingestion of unknown amount of glycoside: Adults and children over 20 kg: If a patient presents with potentially life-threatening digitalis toxicity after acute ingestion of an unknown amount of digoxin or digitoxin, and neither a serum digoxin concentration nor an estimate of the ingested amount of glycoside is available, 20 vials of Digibind can be administered. This amount will be adequate to treat most life-threatening ingestions in adults and large children. Infants and children 20 kg: In infants and small children 20 kg) with potentially life- threatening digitalis toxicity after acute ingestion of an unknown amount of digoxin or digitoxin, when neither a serum concentration nor an estimate of the ingested amount is available, clinical judgement must be exercised to estimate an appropriate number of vials of Digibind to administer.