ROLE OF PHARMACIST IN

EMERGENCY TREATMENT
OF POISONING

Prof. P.M.K.Reddy, M.Pharm, Ph.D

School of Pharmacy, KIU-WC
pmkr67@gmail.com
 Simple diagnosis, first aid of patients
exposed to toxic levels of –

 Drugs
 Household products
 Industrial and
 Agricultural chemicals.
 General care:
 Often, it may not to be possible to know the
identity of the poison and size of the dose.
 Only a few poisons, and drugs have specific
antidotes.
 In most patients, treatment is directed at
managing symptoms as they arise.
 Nevertheless, knowledge of the
 TYPE and
 TIMING of poisoning can help in anticipating
course of events.
 Such information can be sought from the
poisoned individual and from carers or
parents.
 A poison information centre should be
consulted where there is doubt.
 Respiration
 Most poisons, that impair consciousness also
depress respiration.
 An obstructed airway require immediate
attention.
 In the absence of trauma, the airway should be
opened with simple measures such as
 chin lift or
 jaw thrust.
 Assisted ventilation by
 mouth-to-mouth or
 Ambu-bag inflation may be needed.

 Respiratory stimulants do NOT help.

 Body temperature
 Hypothermia
 Treated by wrapping the patient.
 Hyperthermia
 Managed by removing all unnecessary
clothing and using a fan.
 Sponging with tepid water, iced water should
NOT be used.
 Convulsions
 Single short-lived convulsions do not require
treatment.
 If convulsions recur frequently, lorazepam 4
mg or diazepam up to 10 mg should be given
by slow iv injection into a large vein.
 Removal from GIT
 Gastric lavage - only if a life-threatening
amount has been ingested within the previous
hour.
 It should be carried out only if the airway can
be protected adequately.
 Contra-indicated if a
 corrosive substance or
 a petroleum distillate has been ingested.

 Induction of emesis with ipecacunha.

 Prevention of absorption
 Activated charcoal
 It may still be effective up to 1 hour after
ingestion.
 It is relatively safe
 Caution: drowsy or comatose patient

 NOT for petroleum distillates, corrosive

substances, alcohols, malathion.
 Dose: 50 – 100 g
 ALCOHOL
 Acute intoxication is common in adults.
 The features- ataxia, dysarthria, nystagmus,
and drowsiness, which may progress to coma,
with hypotension and acidosis.
 Patients are managed supportively with
 a clear airway
 measures to reduce the risk of aspiration of gastric
contents.
 The BG is measured.
 ANALGESICS
 Aspirin:
 the chief features are hyperventilation, tinnitus,
deafness, vasodilation and sweating.
 Treatment must be in hospital where plasma
salicylate, pH, and electrolyte can be measured;
 Fluid losses are replaced and sod bicarb (1.26%)
given to enhance urinary salicylate excretion
 Hemodialysis is the treatment of choice for severe
salicylate poisoning.
 Ibuprofen:
 Cause nausea, vomiting and tinnitus
 Activated charcoal
 Syptomatic measures.
 Paracetamol:
 As little as 10-15 g (20-30 tabs) or 150 mg/kg
taken within 24 h may cause severe
hepatocelular necrosis.
 Nausea and vomiting.
 Liver damage is maximal 3-4 days after
ingestion and may lead to
 encephalopathy,
 hypoglycemia,
 cerebral edema and
 Death.
 Therefore, patient should be transferred to
hospital urgently.
 Admn of activated charcoal should be
considered if P in excess of 150 mg/kg or 12 g
within the previous hour.
 Acetylcysteine protects the liver if infused
within 24 h of ingesting P.
 Initially 150 mg/kg over 15 min.
 In remote areas- methionine (2.5 g) by mouth.
 Opioids
 cause coma, respiratory depression and
pinpoint pupils.
 The specific antidote naloxone is indicated if
there is coma.
 Dose: 0.4-2 mg i.v., to max of 10 mg; it leads
to improvement in respiration.
 ANTIMALARIALS
 Overdosage with chloroquine and
hydroxycholoroquine is extremely hazardous
and difiuclt to treat.
 Life-threatening features include arrhythmias
and convulsions.
 Urgent advice from a poisons information
centre is essential.
 HYPNOTICS AND ANXIOLYTICS
 B taken alone cause drowsiness, ataxia,
dysarthria and short-lived loss of
consciousness.
 They potentiate the effects of other CNS
depressants taken concomitantly.
 Use of B antagonist flumazenil can be used on
expert advice.
 IRON SALTS
 It is a commonest in childhood.
 The symptoms are nausea, vomiting,
abdominal pain, diarrhea, haematemesis, and
rectal bleeding.
 Later, coma and heptocellular necrosis occur
 Gastric lavage within 1 h.
 Mortality is reduced with desferrioxamine (15
mg/kg/hour iv infusion).
 NOXIOUS GASES
 Carbon monoxide
 Due to inhalation of smoke, car exhaust or
fumes caused by blocked or incomplete
combustion of fuel gases in confined spaces.
 Toxic effects are due to hypoxia.
 The person should be moved to fresh air, the
airway cleared.
 Oxygen 100% administered through a tight-
fitting mask.
 PESTICIDES
 Paraquat (10-20% paraquat) extremely toxic.
 It has local and systemic effects.
 Splashes in the eyes irritate and ulcerate the cornea
 Skin irritation, blistering and ulceration can occur
from prolonged contact.
 Inhalation of spray, mist, or dust may cause nose
bleeding.
 Ingestion cause nausea, vomiting, diarrhea, painful
ulceration of the tongue, lips.
 Treatment should be started immediately.
 The single most useful measure is oral
administration of activated charcoal.
 Gastric lavage is doubtful value.
 P absorption can be confirmed by a simple
qualitative urine test.
 Organophosphorous insecticides:

 All are absorbed through the bronchi and

intact skin as well as through the gut and
inhibit ChE.
 Anxiety, restlessness, dizziness, headache,
miosis, nausea, hypersalivation, vomiting ,
abdominal colic, diarrhea, bradycardia,
sweating, copious bronchial secretions.
 Convulsions, coma, pulmonary oedem.
 Gastric lavage may be considered.
 Atropine is given in a dose of 2 mg.
 Pralidoxime mesilate: used as an adjunct in
severe poisoning.
 It improves muscle tone within 30 min of admn.
 SNAKE BITE
 Envenoming from snake bite is common in
tropical areas.
 The bite may cause local and systemic effects.
 Local effects- pain, swelling, and tender
enlargement of regional lymph nodes.
 Early anaphylactioid symptoms should be
treated with adrenaline.
 Venom antiserum is given by iv inj.
 TOXBASE:
 is a primary clinical toxicology database of the
National Poisons Information Service (NPIS).
 http://www.toxbase.org/
END
 References
 BNF 50
 INSECT STINGS:
 Stings from ants, wasps, and bees cause local pain
and swelling but seldom cause severe toxicity.
 The stings from these insects are usually treated by
cleaning the area.
 Bee stings should be removed as quickly as possible.
 Anaphylactic reactions require immediate treatment
with im adrenaline.
 For management of anaphylaxis, a short course of an
oral antihistamine or topical corticosteroid may help
to reduce inflammation and relieve itching.
 CS Spray
 It is used for riot control, irritates the eyes and
respiratory tract; symptoms normally settle
spontaneously within 15 min.
 If symptoms persist, the patient should be removed to
a well ventilated areas, and exposed skin washed with
soap and water after removal of contaminated
clothing.
 Eye symptoms should be treated by irrigating the
eyes with physiological saline or water.
 Patients with features of severe poisoning,
particularly respiratory complications should be
admitted.
 ANTIDEPRESSANTS
 cause dry mouth, coma of varying degree,
hypotension, convulsions, respiratory failure,
and arrhythmias.
 Activated charcoal may be given.
 Supportive measures to ensure a clear airway
and adequate ventilation during transfer are
mandatory.
 ETHYLENE GLYCOL AND METHANOL
 Ethanol is used.
 Fomepizole available on named patient basis
also been used.