Poisoning

Inhalation, ingestion, or injection of or skin contamination from any harmful substance is a common problem. In the United States, about 1 million people are poisoned annually, 800 of them fatally. The prognosis depends on the amount of poison absorbed, its toxicity, and the time interval between poisoning and treatment.

Causes

Because of their curiosity and ignorance, children are the most common poison victims. In fact, accidental poisoning, usually from the ingestion of salicylates (aspirin), cleaning agents, insecticides, paints, cosmetics, and plants, is the fourth leading cause of death in children.

In adults, poisoning is most common among chemical company employees, particularly those in companies that use chlorine, carbon dioxide, hydrogen sulfide, nitrogen dioxide, and ammonia, and in compnies that ignore safety standards. Other causes of poisoning in adults include improper cooking, canning, and storage of food; ingestion of or skin contamination from plants (for example, dieffenbachia, mistletoe, azalea, and philodendron); and accidental or intentional drug overdose (usually barbiturates) or chemical ingestion.

Symptoms

• abdominal pain, vomiting, diarrhea, or nausea
• dizziness, weakness or drowsiness
• fever
• chills (shivering)
• burns around the nose or mouth
• double or blurred vision
• seizures (fits)
• stupor or unconsciousness
• loss of appetite

Diagnostic tests

Toxicologic studies (including drug screens) of poison levels in the mouth, vomitus, urine, stool, or blood or on the victim's hands or clothing confirm the diagnosis. If possible, have the family or patient bring the container holding the poison to the emergency department for comparable study. In inhalation poisoning, chest X-rays may show pulmonary infiltrates or edema in petroleum distillate inhalation, X-rays may show aspiration pneumonia. Abdominal X-rays may reveal iron pills or other radiopaque substances.

Treatment

Initial treatment includes emergency resuscitation; support for the patient's airway, breathing. and circulation; and prevention of further absorption of poison. After this, treatment consists of continuing supportive or symptomatic care and, when possible, administration of a specific antidote.

A poisoning victim who exhibits an altered level of consciousness (LOC) routinely receives oxygen, glucose, and naloxone. Activated charcoal is effective in eliminating many toxic substances. The specific treatment depends on the poison.

Prevention

• Store medicines, vitamins and other potential poisons out of the reach of children. Every household should have a lockable cabinet for this purpose.
• Do not block air vents, flues or chimneys and don't have indoor fires or stoves without proper ventilation to the outdoors.
• Never store dangerous products in everyday containers such as milk bottles or drinking glasses. A child may associate these with food or drink and try them out. Check the garden for poisonous plants and berries and remove them.

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