What is the treatment for food poisoning?

Treatment for Food Poisoning

The initial and most important treatment for food poisoning is aggressive rehydration, with oral rehydration solution (ORS) for mild to moderate cases and intravenous fluids for severe dehydration or those unable to tolerate oral intake. 1

Initial Assessment

• Assess for signs of dehydration:

  • Dry mucous membranes
  • Decreased skin turgor
  • Sunken eyes
  • Lethargy or altered mental status
  • Tachycardia
  • Hypotension (in severe cases)

• Gather key information:

  • Duration of illness
  • Quantity, frequency, and consistency of stool
  • Presence of blood in stool
  • Frequency of vomiting
  • Presence of fever
  • Time elapsed since consuming suspected food
  • Other individuals affected by the same food

Red Flags Requiring Immediate Medical Attention

• Severe dehydration
• Persistent vomiting preventing oral rehydration
• Bloody diarrhea
• High fever (>101.5°F/38.6°C)
• Extreme lethargy
• Marked pallor
• Signs of shock

Treatment Algorithm

1. Rehydration (Primary Treatment)

• Mild to Moderate Dehydration:

  • Administer ORS in the following amounts:
    • Children <2 years: 50-100 mL after each stool
    • Older children: 100-200 mL after each stool
    • Adults: As much as desired
  • Encourage increased intake of other fluids (water, cereal-based gruels, soup, rice water)
  • Avoid soft drinks due to high osmolality

• Severe Dehydration:

  • Immediate intravenous fluid resuscitation
  • Consider peripheral IV access before oral challenge in high-risk patients

2. Nutrition Management

• Do not restrict food intake - there is no justification for "resting the bowel"
• Resume feeding as soon as appetite returns
• For infants:
  • Continue breastfeeding
  • If formula-fed, dilute formula with equal volume of clean water until diarrhea stops
• For children >4-6 months and adults:
  • Provide energy-rich, easily digestible foods
  • Offer freshly prepared foods including cereal and bean/meat mixtures with small amounts of vegetable oil

3. Medication Considerations

• Antimicrobial Therapy:

  • Not indicated for routine treatment of uncomplicated, watery diarrhea
  • Specific indications for antimicrobials include:
    • Cholera
    • Shigella dysentery
    • Amoebic dysentery
    • Acute giardiasis
  • When indicated, consider:
    • Ciprofloxacin for bacterial causes 2
    • Azithromycin as an alternative, particularly for pediatric patients 3

• Contraindicated Treatments:

  • Anti-diarrheal agents
  • Stimulants
  • Steroids
  • Purgatives
  • Ipecac syrup (should not be used as first aid treatment for poisoning) 4

4. Special Considerations for Chemical Ingestion

• Immediately contact poison control (e.g., 800-222-1222 in US, 112 in Europe)
• Activate emergency medical services for life-threatening symptoms
• Do not administer anything by mouth (including water or milk) unless specifically advised by poison control
• Do not administer activated charcoal without poison control direction 4
• For mushroom poisoning (e.g., Amanita phalloides):
  • Penicillin G and silibinin (silymarin or milk thistle) are accepted antidotes
  • Consider N-acetylcysteine as part of overall management 4

Patient Monitoring

• Monitor vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation
• Watch for signs of stridor, respiratory distress, or oral burns
• Consider laboratory tests in severe cases:
  • Complete blood count
  • Electrolytes
  • Renal function
  • Coagulation profile if significant bleeding is present

Patient Education and Prevention

• Advise patients to seek medical attention if:

  • Symptoms persist or worsen
  • Unable to maintain adequate hydration
  • Passing many stools
  • Extreme thirst
  • Sunken eyes
  • Fever
  • General deterioration

• Preventive measures:

  • Handwashing with soap
  • Proper food storage and preparation temperatures
  • Avoid cross-contamination between raw and cooked foods
  • Ensure thorough cooking of high-risk foods

Common Pitfalls to Avoid

1. Delaying rehydration therapy, which is the cornerstone of treatment
2. Using anti-diarrheal medications in cases of infectious diarrhea, which can prolong illness
3. Administering antibiotics for uncomplicated food poisoning
4. Restricting food during illness, which can worsen nutritional status
5. Failing to recognize signs of severe dehydration requiring IV fluids
6. Not contacting poison control immediately for chemical ingestions

Remember that while most cases of food poisoning resolve with supportive care within a few days, severe cases require prompt medical attention to prevent complications.