What is the protocol after ingesting a chemical?

Protocol for Chemical Ingestion

In case of chemical ingestion, immediately contact poison control (800-222-1222) and activate emergency medical services if the patient shows any life-threatening symptoms such as sleepiness, seizures, difficulty breathing, or vomiting. 1

Initial Assessment and Actions

Step 1: Assess for Life-Threatening Symptoms

• Look for signs of:
  • Altered mental status (sleepiness, confusion)
  • Respiratory distress
  • Seizures
  • Vomiting
  • Hemodynamic instability

Step 2: Contact Resources

• Call Poison Control Center immediately (800-222-1222 in US, 112 in Europe) 1
• Provide specific information:
  • Nature and time of exposure
  • Name of chemical/product
  • Approximate amount ingested
  • Current symptoms
  • Patient age and weight

Step 3: Critical Do's and Don'ts

• DO NOT:
  • Administer anything by mouth (including water or milk) unless specifically advised by poison control 1
  • Administer activated charcoal without poison control direction 1
  • Administer syrup of ipecac (no longer recommended) 1, 2
  • Induce vomiting 3

Management Based on Chemical Type

For General Chemical Ingestions

1. Follow poison control's specific instructions for the particular chemical
2. Monitor vital signs including heart rate, blood pressure, respiratory rate, and oxygen saturation 3
3. Ensure airway patency and monitor for respiratory distress 1
4. Assess for signs of shock, including tachycardia and poor perfusion 3

For Caustic Chemicals (Acids/Alkalis)

• Do not dilute with water or milk unless specifically instructed by poison control 1
• Animal studies suggest dilution may reduce tissue injury, but human studies have not confirmed clinical benefit 1
• Potential adverse effects of water/milk administration include emesis and aspiration 1

For Dry Chemicals

• For powdered chemicals that may have contacted skin, brush off with gloved hand or cloth before irrigation 1
• Some dry chemicals (sodium hydroxide, elemental sodium, potassium) may react with water causing thermal injury 1
• Perform dry decontamination first (brushing off chemical) before using water 1

For Specific Chemicals

• Some chemicals (hydrofluoric acid, phenol) require specific decontamination agents other than water 1
• Follow chemical-specific treatment recommendations from Safety Data Sheets or poison centers 1

Special Considerations

For Hydrogen Peroxide Ingestion

• Monitor for hematemesis and respiratory distress 3
• Assess for potential gastrointestinal injury 3
• Consider laboratory tests including complete blood count and electrolytes 3

For Acetaminophen Ingestion

• N-acetylcysteine is the antidote for acetaminophen poisoning 4
• Treatment should begin immediately if ingestion occurred within 24 hours 4
• Plasma acetaminophen levels should be measured at 4 hours post-ingestion or as soon as possible thereafter 5

Ongoing Monitoring

• Observe for at least 4-6 hours for development of complications 3
• Monitor for continued symptoms or signs of significant injury 1
• Follow poison control recommendations for duration of observation and follow-up

Pitfalls to Avoid

1. Delaying contact with poison control - call immediately even if symptoms seem mild
2. Administering home remedies without professional guidance
3. Assuming dilution with water/milk is always beneficial - this can worsen some chemical exposures
4. Inducing vomiting, which may cause additional harm with certain chemicals
5. Failing to recognize that some chemicals can cause delayed toxicity

Remember that specific management will depend on the exact chemical involved, and poison control centers are equipped with databases of specific treatments for thousands of potential toxins 1.