Swallowed Poisons

Treatment

• Prevent gut absorption
• Empty the stomach (if appropriate)

Only do this if within 4 hours of the poisoning and if the patient is conscious

Do not empty the stomach if:

• A corrosive substance was swallowed, e.g., strong acid or alkali, bleach, paraffin or a petroleum product.
• The patient is unconscious or convulsing
• The subsistence is not known

DO not induce vomiting nor perform gastric lavage in children. This is dangerous practice as it poses risk for aspiration.

• Treat any complications as necessary e.g. hypothermia, hypoglycemia, convulsions, electrolyte or acid/base disturbances

METHODS OF EMPTYING THE STOMACH

• Induction of vomiting: Adults ONLY
• Give Ipecacuanha emetic mixture
• Children < 18 months: 10ml
• Children > 18 months: 15ml
• Adults: 15-30 ml
• Repeat after 20 mins if ineffective
• Follow this with 15 ml/kg of water

Note: It is essential to prevent any vomit from entering the lungs

• Stomach wash-out (gastric lavage): Adults ONLY
• Should only be done by staff familiar with the procedure
• Lie the patient head down on the left side
• Pass a wide gauge soft rubber tube (Ryle's tube) into the stomach
• Tube should be wide enough to allow large particles to pass through. e.g.

tablets

• Pour 300ml tap water down the tube
• For children > 5years: use 100-200 ml water
• For children < 5 years: use normal saline instead of water
• Aspirate the patient with the head down position, taking special note of the airway
• Repeat lavage until aspirated fluid is clear

USE OF ACTIVATED CHARCOAL

• 50-100g Activated Charcoal will prevent absorption of most medicines given within 1 hour of ingestion
• Only effective if given within 4 hours of poisoning when most of the poison is still in the stomach
• Only give Activated Charcoal after vomiting (induced or otherwise) has ceased
• Do not use ordinary charcoal - it will have no effect
• Do not use activated charcoal in the following situations:
• If the patient is vomiting, unconscious, drowsy, or having fits, convulsing because of the risk of choking
• At the same time as, or just before giving Ipecacuanha or any oral antidote as it may bind these and prevent them from working
• For poisoning by acids, alkalis, alcohol, iron, and petroleum products

ADMINISTRATION OF ACTIVATED CHARCOAL

• Add 50 g (children: 1 g/kg) to 400 ml water in a bottle
• Mix well by shaking until all the powder is wet
• Administer by the gastric lavage tube (unless the patient agrees to drink the charcoal slowly)
• Repeat if required after 4-6 hours

Children

NEONATE-12 years: 1 g/kg (max. per dose 50 g) 12-18 years: 50 g

PARAFFIN, PETROL AND OTHER PETROLEUM PRODUCTS

• Includes paint thinners, organic solvents, etc.
• The main danger from these is damage to lung tissue and liquid pneumonitis following aspiration

General Measures

• Treatment is mainly supportive
• There is no special antidote
• Take great care to prevent the substance entering the lungs
• Do not make the patient vomit
• Do not do gastric lavage except:
• Where the amount of paraffin, etc., swallowed was high (> 10 ml/kg) as these levels may cause brain damage
• Only after endotracheal intubation under anesthesia
• Treat any pulmonary oedema and pneumonia as required
• Giving un absorbable oral liquid, e.g., medicinal liquid paraffin