Principles of Poisoning: Part 3/3

Today's post will conclude my three part series on Principles of Poisonings. There's lots more to talk about in this area so I'm sure I'll have more on this fascinating topic in the future.

For the last part, I'm going to cover basic treatment guidelines of the poisoned patient. We're going to assume the patient arrives to the ED alert and breathing.

1. Obtain the patient's weight. This may seems odd but when we look at whether or not a patient has ingested a toxic amount of the drug it will be determined by the mg/kg of the medicine. For example, if I take 1000mg of acetaminophen, this is a "normal" dose for someone of my weight. And no, I'm not going to tell you my weight. Let's say, a child weighing 10kg took the same amount. This would be 100mg/kg of drug/body weight ratio. A normal dosing guideline for acetaminophen is 10-15mg/kg so this patient is at 10 times the normal dose.

2. Determine the amount of the drug and the time of ingestion. This can be more challenging than it seems. People don't usually know the "exact" amount left in a bottle unless it is a medication they take every day. Also, kids are classic for not really being able to say how much they ingested. We assume worst case scenario and go from that point.

3. Call Poison Control. They are the experts. We go over the above information and generally follow their advice. Most often it will be observation and symptomatic support. Remember, patients will also have effects from the drugs we give as well. We want to minimize this if possible and only use these if the patient has an inherent risk of suffering toxic effects that are life threatening. Generally, if the patient presents within one hour of their ingestion to the ED and we are concerned they will have toxic effects, we will give activated charcoal. Syrup of Ipecac is generally out of vogue and no longer used. Then, we'll obtain a baseline drug level (if it can be measured) and subsequent levels to make sure it is dropping.

Have you experienced a real life overdose/accidental ingestion?