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Management of Ingested Poisons



Ingested toxins is suspected in any patient with signs and symptoms irrespective of reported dose ingested

Risk Factors

Signs and symptoms

Diagnostic criteria

• General clinical features-Nausea, vomiting, drowsiness, blurred vision, and dizziness
• Central Nervous System toxicity-Altered level of consciousness ,convulsions, acute confusion and coma,
• Renal Toxicity-Acute kidney injury/failure and papillary necrosis
• Metabolic derangement-Metabolic acidosis, respiratory acidosis, hypoglycemia.
• Allergic Reactions:-Urticaria, angioederma, anaphylaxis
• Haematological toxicity:-Aplastic anaemia, agranulocytosis



  • Non-pharmacological

    • Gastric decontamination within one hour of ingestion.

    Gastric Lavage

    • Gastric lavage should not be employed routinely in the management of a poisoned patient
    • Only do it in health care facilities if staff has experience in the procedure, and if the ingestion was within one hour and is life threatening, and there has been no ingestion of corrosives or petroleum derivatives
    • Make sure a suction apparatus is available in case the patient vomits
    • Place the patient in the left lateral/ head down position
    • Insert a large NGT. Ensure the tube is in the stomach
    • Perform lavage with 10 ml/kg body weight of warm .9% sodium chloride (0.9%). The volume of lavage fluid returned should approximate to the amount of fluid given.
    • Lavage should be continued until the recovered lavage solution is clear of particulate matter. Note that tracheal intubation may be required to reduce risk of aspiration.
    • General care: Keep the patient under observation 4–24 hours depending on the poison swallowed

    Contraindications to Gastric Lavage:

    • An unprotected airway in an unconscious patient
    • Ingestion of corrosives or petroleum products e.g. kerosene
    • Bowel obstruction
    • Bowel perforation
    • GI bleeding
    • Identify the specific agent and remove or adsorb it as soon as possible.


    • Treatment is most effective if given as quickly as possible after the poisoning event, ideally within 1 hour.
    • If the patient has swallowed kerosene, petrol or petrol-based products (note that most pesticides are in petrol-based solvents) or if the patient’s mouth and throat have been burned (for example with bleach, toilet cleaner or battery acid) do not vomit the patient but give water orally?
    • Never use salt as an emetic as this can be fatal.
  • Pharmacological

    • Activated charcoal, single dose (if available) within one hour of ingestion and do not induce vomiting; give by mouth or NG tube according to the dosage below:


    • Children below one year : 1 g/kg Children 1 to 12 years of age:
    • 25–50g Adolescents and adults: 25–100g

    Content mixing:

    • Mix the charcoal in 8–10 times the amount of water, e.g. 5 g in 40 ml of water.
    • If possible, give the whole amount at once; if the child has difficulty in tolerating it, the charcoal dose can be divided.
    • If charcoal is not available, then induce vomiting but only if the patient is conscious by rubbing the back of the patient throat with a spatula or spoon handle


Educate the patient on Dos and Don’ts of poisoning prevention.


• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake


• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy

Updated on,

14 Novemba 2020 15:03:48


    1. STG
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