Treatment Approach for Poisoning
The treatment of poisoning requires specialized interventions including antidotes and supportive care, with immediate consultation with a medical toxicologist or regional poison center to facilitate rapid and effective therapy. 1
Initial Management
- Contact a poison control center or medical toxicologist immediately for expert guidance on treatment protocol 1, 2
- Assess and stabilize airway, breathing, and circulation as the first priority in any poisoning case 3
- Remove all contaminated clothing and thoroughly wash exposed skin with soap and water to prevent continued absorption for dermal exposures 2, 4
- Avoid inducing vomiting as this may worsen the condition and delay care 2, 4, 5
Decontamination Methods
- Single-dose activated charcoal is the gastrointestinal decontamination modality of choice for many ingestions, but should not be used universally 3
- Do not administer activated charcoal unless specifically advised by poison control, particularly in patients with altered mental status due to risk of aspiration 2, 4
- For eye exposures, immediately flush with copious amounts of tepid water for at least 15 minutes 4
Specific Antidotes and Treatments
- For opioid overdose (the leading cause of poisoning deaths in North America), administer naloxone to reverse respiratory depression 1
- For β-blocker and calcium channel blocker poisoning, high-dose insulin therapy is recommended early in treatment 1
- For cocaine or sodium channel blocker toxicity, standard advanced life support with sodium bicarbonate administration is appropriate 1
- For suspected cyanide poisoning, treat immediately with hydroxocobalamin (preferred) or sodium nitrite plus sodium thiosulfate without waiting for confirmatory testing 1
- For digoxin poisoning, administer digoxin-specific immune antibody fragments to reverse life-threatening dysrhythmias 1
- For local anesthetic toxicity, use 20% intravenous lipid emulsion, especially for bupivacaine toxicity 1
- For sympathomimetic poisoning with severe agitation, provide sedation to manage hyperthermia, acidosis, and prevent rhabdomyolysis 1
- For acetaminophen poisoning, administer N-acetylcysteine within 8 hours of ingestion for best outcomes 6, 7
Enhanced Elimination Techniques
- For severe barbiturate poisoning, consider extracorporeal treatment (ECTR) with intermittent hemodialysis as the preferred modality 1
- Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be lifesaving for patients with cardiogenic shock or refractory dysrhythmias; start early in patients not responding to other therapies 1
Monitoring and Supportive Care
- Evaluate for electrolyte imbalances, liver and renal function through basic laboratory studies 3, 8
- Monitor for toxidromes (symptom complexes related to specific toxin classes) to help identify unknown ingestions 5, 8
- Provide respiratory support if necessary and place unconscious patients in the left lateral head-down position 7
- For seizures, administer benzodiazepines; for extreme agitation, use appropriate sedatives 2, 7
Common Pitfalls to Avoid
- Do not delay treatment while waiting for confirmation of specific poisoning; treat based on clinical presentation 2
- Avoid using high concentrations of oxygen without specific guidance, as this may worsen certain toxicities 2
- Do not rely solely on ingested dose or serum concentrations for treatment decisions 1
- Never administer syrup of ipecac as it has no clinical advantage and may cause intractable vomiting 4, 5, 7
Special Considerations
- Children may experience more profound effects from small amounts of medication 3
- For intentional poisonings, evaluate the risk of short-term suicide relapse even when the condition is not life-threatening 7
- Consider hospital admission and monitoring for potentially severe poisonings, including those with delayed effects 7, 9