From the Guidelines
In Costa Rica, the management of toxicology emergencies prioritizes prompt decontamination, supportive care, and specific antidotes when available, following standard protocols with regional considerations, as outlined in the 2023 American Heart Association guidelines 1.
General Approach to Toxicology Emergencies
The approach to managing toxicology emergencies in Costa Rica involves:
- Contacting the National Poison Control Center (Centro Nacional de Control de Intoxicaciones) at 2223-1028 for immediate guidance
- Administering activated charcoal (1g/kg orally) within one hour of ingestion for most toxins, except for caustics, hydrocarbons, and metals
- Providing supportive care, including airway management, hemodynamic support, and correction of critical vital sign and metabolic derangements
Regional Considerations
Costa Rica has unique regional considerations, including:
- Snake envenomations, which are common and require polyvalent antivenom (suero antiofídico polivalente) administration at 5-10 vials IV for severe cases, with close monitoring for anaphylaxis 1
- Scorpion stings, which may require specific antivenom and supportive care
- Marine envenomations from jellyfish or stingrays, which are treated with hot water immersion (45°C) and pain management
Antidote Administration
The administration of antidotes is crucial in toxicology emergencies, with specific dosing guidelines outlined in the 2023 American Heart Association guidelines 1, including:
- Atropine for β-blockers and organophosphates
- Calcium chloride and calcium gluconate for calcium channel blockers
- Digoxin immune Fab for digoxin and yellow oleander poisoning
- Glucagon for β-blockers and calcium channel blockers
Healthcare System
Costa Rica's healthcare system provides universal coverage, with toxicology services available at public hospitals, including specialized care at Hospital San Juan de Dios and Hospital Nacional de Niños in San José. Clinicians should be aware of common local toxic exposures, including pesticides used in agriculture, marine toxins along coastlines, and venomous animals in tropical regions. Prompt decontamination, supportive care, and specific antidotes when available remain the cornerstone of toxicology management 1.
From the Research
Toxicology Emergency Medicine in Costa Rica
- There are no specific studies provided that directly address toxicology emergency medicine in Costa Rica.
- However, general principles of toxicology emergency medicine can be applied, as outlined in the provided studies 2, 3, 4, 5, 6.
General Principles of Toxicology Emergency Medicine
- The initial management of patients with suspected acute poisoning involves implementing life-support techniques, such as resuscitation for cardiorespiratory arrest, respiratory support, and glucose injection if the patient is unconscious 2.
- Prompt, initial measures may also include anticonvulsant injection for status epilepticus, sedatives for extreme agitation, atropine for severe bradycardia, and naloxone in case of respiratory depression due to opioids 2.
- The severity of poisoning is assessed by gathering all information about the patient, the drug(s) ingested, the circumstances of ingestion, and any other substances ingested at the same time 2.
- Supportive care, with particular attention to airway management, oxygenation, and circulation, is the mainstay of treatment for poisoned patients 4.
Treatment Strategies
- Activated charcoal can reduce the gastrointestinal absorption of some drugs and should be given as soon as possible, preferably within 2 hours after ingestion 2.
- Gastric lavage carries a risk of serious adverse effects and is only justified in rare cases where the patient's life is at risk following ingestion of a drug that is not adsorbed by activated charcoal 2.
- Specific antidotes or effective therapies exist for certain drugs or poisons, such as acetaminophen, salicylates, methanol, ethylene glycol, and digitalis, and should be aggressively sought and treated after initial stabilization has been accomplished 4.