Clinical management of General Poisoning in Uganda

General Principles

Refer patients with signs of poisoning to hospital for admission. Send a note of what is known about the poison and treatment given. Refer even if asymptomatic for slow-acting poisons: acetylsalicylic acid, iron, paracetamol, tricyclic antidepressants, paraquat, modified-release products.

Airway and Breathing (HC2/HC4)

Ensure airway is cleared and maintained. Insert airway cannula if necessary. Position patient semi-prone to minimise risk of vomit aspiration. Assist ventilation if necessary. Administer oxygen.

Blood Pressure — Hypotension (HC2)

Systolic BP <70 mmHg may cause irreversible brain or renal damage. Carry patient head-down on stretcher. Set up IV Normal Saline line. Note: fluid depletion without hypotension is common after prolonged coma and aspirin poisoning (vomiting, sweating, hyperpnoea).

Blood Pressure — Hypertension (HC3)

Less common. May occur with sympathomimetic poisoning (amphetamines, cocaine, pseudoephedrine). Manage accordingly.

Body Temperature — Hypothermia (HC2)

May develop with prolonged unconsciousness especially after barbiturate or phenothiazine overdose. Monitor temperature. Treat by covering with blanket.

Body Temperature — Hyperthermia

May occur with anticholinergics and sympathomimetics. Treat with tepid sponging and antipyretics.

Convulsions (HC2/HC3)

Diazepam 10 mg rectally, repeated if necessary. Adult IV: 5–10 mg slow IV, repeat if necessary (max 30 mg). Child rectally: <1 month: 1.5–2.5 mg; 1 month–2 years: 5 mg; 2–12 years: 5–10 mg. Child IV: 200 micrograms/kg (max 10 mg).

Gastric Decontamination — Removal from Stomach

Do NOT induce vomiting. Gastric lavage only useful within 2 hours of ingestion (4–6 hours for salicylates or anticholinergics). Contraindications: drowsy/comatose patients, corrosive or petroleum product poisoning.

Activated Charcoal — Absorption Prevention (HC2)

Activated charcoal powder 50 g (child: 0.5–1 g/kg) mixed with 100–200 ml water. Give by mouth or gastric tube if patient cannot swallow. Most effective the sooner given; may work up to 2 hours after ingestion (longer for modified-release products and anticholinergics).

Activated Charcoal — Active Elimination

Repeated doses beneficial for: acetylsalicylic acid, carbamazepine, phenobarbital, phenytoin, quinine, theophylline. Give 50 g every 4 hours. If intolerant: reduce to 25 g every 2 hours or 12.5 g every hour. Treat any vomiting as it reduces charcoal effectiveness.

Psychosocial

Counsel patient and family about poisoning. Psychiatric evaluation necessary if poisoning was intentional.