What is the management approach for food poisoning?

From the Guidelines

The management of food poisoning should primarily focus on supporting vital functions and electrolyte management, as recommended by the most recent guideline. This approach is supported by the latest evidence from the ESPEN micronutrient guideline published in 2022 1, which emphasizes the importance of supporting vital functions and managing electrolytes in cases of acute poisoning, with a strong consensus of 97%.

Key Management Strategies

• Preventing dehydration through fluid replacement is crucial, and oral rehydration solutions like Pedialyte or a homemade mixture can be used.
• Rest is essential, and a gradual return to eating is recommended, starting with bland foods.
• Medications are generally not needed, but over-the-counter remedies like loperamide (Imodium) can help control diarrhea in adults, and bismuth subsalicylate (Pepto-Bismol) may reduce nausea.
• Medical attention is necessary for severe symptoms, including persistent vomiting, bloody stools, high fever, signs of dehydration, or symptoms lasting more than 3 days.

Prevention Measures

• General guidelines for food safety, as outlined in the American Cancer Society guide 1, include washing hands thoroughly, keeping food preparation areas clean, handling raw meats with care, cooking to proper temperatures, and storing foods promptly at low temperatures.
• Avoiding foods that may have bacterial contamination, such as salad bars, sushi, and raw or undercooked meat, fish, shellfish, poultry, and eggs, is also recommended.

Antibiotic Use

• Antibiotics are rarely prescribed except for specific bacterial infections, as most food poisoning is self-limiting and resolves within 48 hours.
• The decision to use antibiotics should be based on the severity of the infection and the presence of specific bacterial pathogens, such as severe Campylobacter, Shigella, or certain E. coli infections.

From the Research

Management Approach for Food Poisoning

The management approach for food poisoning typically involves rehydration and electrolyte replacement.

• Oral rehydration solutions (ORS) are widely used for rehydration in diarrheal illness and are preferred over intravenous fluids except for patients with severe dehydration 2, 3, 4.
• The preferred ORS is one similar to the glucose-containing reduced osmolarity World Health Organization ORS 2.
• In areas where conventional fluids are unavailable, coconut water can be used as a rehydration fluid, although it may require the addition of table salt to compensate for sodium and chloride deficiency 5.
• For patients with intractable nausea associated with food poisoning, ondansetron may be used as an alternative to present antiemetic therapy 6.

Rehydration Methods

• Oral rehydration is the preferred method of rehydration, except in cases of severe dehydration where intravenous rehydration may be necessary 3.
• Intravenous rehydration can be used to rehydrate severely ill patients in a shorter time (2 to 3 hours) and allows for early refeeding 3.
• Maintenance solutions contain 40 to 60 mEq per liter of sodium and are used for prevention of dehydration or after rehydration, while rehydration solutions contain 60 to 90 mEq per liter of sodium and are effective for the oral repletion of fluid and electrolyte deficits 4.

Additional Considerations

• Other liquids, such as sport drinks, juice, soft drinks, and chicken broth, are not recommended for rehydration, although they can be considered for patients with no or mild dehydration 2.
• Vitamin and mineral supplements are not recommended routinely for patients with food poisoning unless known deficiencies exist 2.