1. Chapter 108 Management of Poisoning

2. Poisoning • Over 2 million cases reported in the U.S. annually • 23,618 deaths in 2005 from accidental poisonings • 5833 deaths in 2005 from intentional poisonings • Most cases caused by drugs • 75% of suicides caused by drugs

3. Management of Poisoning • Poisoning – pathologic state caused by toxic agent • Sources – medications, plants, environmental sources, pollutants, and drugs of abuse • Entry – oral, inhalation, injection, absorption through skin • Unintentional or accidental • Symptoms often mimic a disease

4. Fundamentals of Treatment • Poisoning is an emergency that requires rapid treatment • Supportive care • Identification of poison • Prevention of further absorption • Poison removal • Antidotes

5. Drugs and Procedures Used to Minimize Poison Absorption • Activated charcoal • Syrup of ipecac • Gastric lavage and aspiration • Whole-bowel irrigation • Catharsis • Surface decontamination

6. Drugs and Procedures Used for Poison Removal • Drugs that enhance renal excretion • Sodium bicarbonate • Ammonium chloride • Nondrug methods of poison removal • Peritoneal dialysis • Hemoperfusion • Exchange transfusion

7. Specific Antidotes • Heavy metal antagonists • Most common poisonings: iron, lead, mercury, arsenic, gold, and copper • Environmental exposure, intentional overdose, therapeutic use of heavy metals • Antidote drugs are “chelating agents” or “chelators” • Interact to form chelates

8. Heavy Metal Poisoning • Drug therapy • Deferoxamine (Desferal) • Deferasirox (Exjade) • Dimercaprol (BAL In Oil) • Edetate calcium disodium (EDTA) • Penicillamine (Depen) • Fomepizole (Antizole)

9. Fig. 108-1. Chelation of mercury by dimercaprol.

10. Poison Control Centers • American Association of Poison Control Centers (AAPCC)