Accidental Poisoning

Introduction

Accidental poisoning is common among young children, who are curious and ingest.

Poisoning is also common among older children, adolescents, and adults attempting suicide;

• Alcohol
• Acetaminophen
• And other OTC drugs, may be involved

Accidental poisoning may occur in the elderly because of confusion, poor eyesight, mental impairment, or multiple prescriptions of the same drug by different physicians

People are poisoned by someone who intends to kill or disable them (e.g. to rape or rob them). Drugs used to disable (e.g., scopolamine, benzodiazepines, γ-hydroxybutyrate) tend to have sedative or amnestic properties or both.

Rarely, parents, who may have some medical knowledge, poison their children because of unclear psychiatric reasons or a desire to cause illness and thus gain medical attention. This disorder is called Munchausen syndrome by proxy or Factitious disorder imposed on another (FDA ).

Signs and symptoms

Symptoms and signs vary depending on the substance.

Also, different patients poisoned with the same substance may present with very different symptom

Symptoms typically begin soon after contact but, with certain poisons, are delayed. The delay may occur because only a metabolite is toxic rather than the parent substance (e.g., methanol, ethylene glycol, hepatotoxins). Ingestion of hepatotoxins (e.g., acetaminophen).

(Iron, Amanita phalloides mushrooms) may cause acute liver failure that occurs one to a few days later. With metals or hydrocarbon solvents, symptoms typically occur only after chronic exposure to the toxin

Obtaining a history

Symptoms and signs vary depending on the substance.

Also, different patients poisoned with the same substance may present with very different symptom

Symptoms typically begin soon after contact but, with certain poisons, are delayed. The delay may occur because only a metabolite is toxic rather than the parent substance (e.g., methanol, ethylene glycol, hepatotoxins). Ingestion of hepatotoxins (e.g., acetaminophen).

(Iron, Amanita phalloides mushrooms) may cause acute liver failure that occurs one to a few days later. With metals or hydrocarbon solvents, symptoms typically occur only after chronic exposure to the toxin

. Consider a poisoning if

1. Determine product name, amount, time since exposure, route of exposure,

age/weight, symptoms, reason for exposure, previous therapy

. Consider a poisoning if

a. Abrupt onset

b. At risk age group

c. Previous poisonings

d. Multiorgan system involvement

e. Altered mental status

Physical Exam

Focus on poison specific symptoms

​2. Rule out other medical conditions/trauma

​3. Are signs/symptoms consistent with history?

Toxicology Laboratory Uses

Confirm clinical impression

Predict prognosis

Determine therapy

Monitor therapy

Predict time course

Laboratory tests

Electrolytes

Creatinine

Blood urea nitrogen (BUN)

Urinalysis (e.g., oxalate crystals with ethylene glycol poisoning)

Serum acetaminophen and ethanol quantitative levels should be determined in all patients with drug overdoses.

Electrocardiography