What is the treatment for food poisoning?

Food Poisoning Treatment

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

Assessment and Severity Determination

• Evaluate for signs of dehydration:

  • Mild to moderate: Dry mucous membranes, decreased skin turgor, sunken eyes
  • Severe: Lethargy, altered mental status, tachycardia, hypotension 1

• Assess for high-risk factors:

  • Age (very young, elderly)
  • Immunocompromised status
  • Comorbidities (diabetes, liver cirrhosis) 2

Treatment Algorithm

1. Rehydration (Primary Treatment)

• Mild to Moderate Dehydration:

  • Oral rehydration solution (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 1
  • Encourage increased intake of other fluids (water, cereal-based gruels, soup, rice water)

• Severe Dehydration:

  • Immediate intravenous fluid resuscitation
  • Consider peripheral IV access before oral challenge in high-risk patients 1

2. Nutrition Management

• Do not restrict food intake - "resting the bowel" is not justified
• Resume feeding as soon as appetite returns
• Provide energy-rich, easily digestible foods
• For infants:
  • Continue breastfeeding
  • If formula-fed, dilute formula with equal volume of clean water until diarrhea stops 1

3. Antimicrobial Therapy

• Not indicated for routine, uncomplicated food poisoning
• Consider only for specific indications:
  • Cholera
  • Shigella dysentery
  • Amoebic dysentery
  • Acute giardiasis 1
  • High-risk patients (elderly, immunocompromised, diabetes, liver cirrhosis) 2

4. Contraindicated Treatments

• Do not use:
  • Anti-diarrheal agents
  • Stimulants
  • Steroids
  • Purgatives
  • Ipecac syrup 3, 1

Special Considerations

Severe or Life-Threatening Cases

• Immediately contact poison control
• Activate emergency medical services
• Do not administer anything by mouth unless specifically advised by poison control 1

Mushroom Poisoning

• Consider specific antidotes:
  • Penicillin G
  • Silibinin (silymarin or milk thistle)
  • N-acetylcysteine 1

Pitfalls and Caveats

1. Avoid dehydration underestimation: Dehydration can progress rapidly, especially in children and elderly. Aggressive early rehydration is crucial for preventing complications 1, 2.

2. Avoid unnecessary antimicrobials: Most cases of food poisoning are self-limiting and do not require antibiotics. Inappropriate use can worsen certain conditions and contribute to antimicrobial resistance 1.

3. Avoid anti-diarrheal medications: These can prolong the illness by preventing elimination of toxins and pathogens 3, 1.

4. Don't restrict food unnecessarily: Early feeding helps maintain nutritional status and supports recovery 1.

5. Recognize when to escalate care: Severe symptoms (high fever, bloody diarrhea, severe abdominal pain, signs of severe dehydration) require immediate medical attention 4, 2.

Food poisoning symptoms typically resolve within hours to several days with appropriate supportive care 4. The cornerstone of management remains adequate hydration and electrolyte replacement, with most patients recovering completely with this approach alone 1, 2.