Swallowed Poisons

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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