Ingestion is the most common route of poisoning worldwide. Toxic exposure should be suspected in any patient presenting with unexplained altered mental status, metabolic derangement, or multi-system symptoms, regardless of a reported history of ingestion.

Poisoning severity depends on:

• Type of toxin (drug, pesticide, hydrocarbon, plant, heavy metal)

• Dose and concentration

• Time since ingestion

• Co-ingestion (alcohol or multiple drugs)

• Patient age, comorbidities, and nutritional status

Because many patients (especially children, suicidal attempts, intoxicated individuals) provide unreliable histories, management is primarily clinical and supportive rather than history-dependent.

Risk Factors

Patient-related

• Children <5 years (exploratory ingestion)

• Adolescents (intentional self-harm)

• Psychiatric illness

• Substance abuse

• Elderly with polypharmacy

• Chronic kidney or liver disease

Environmental

• Improper storage of chemicals

• Use of unlabeled containers

• Agricultural pesticides in households

• Traditional/herbal medicines

Drug-related

• Narrow therapeutic index drugs

• Sustained-release formulations

• Polypharmacy interactions

Signs and Symptoms

Poisoning manifestations depend on the toxidrome (toxic syndrome).

General Clinical Features

• Nausea and vomiting

• Drowsiness

• Blurred vision

• Dizziness

Central Nervous System Toxicity

• Altered level of consciousness

• Acute confusion

• Convulsions

• Coma

Renal Toxicity

• Acute kidney injury

• Papillary necrosis

• Oliguria or anuria

Metabolic Derangement

• Metabolic acidosis

• Respiratory acidosis

• Hypoglycemia

Allergic Reactions

• Urticaria

• Angioedema

• Anaphylaxis

Hematological Toxicity

• Aplastic anemia

• Agranulocytosis

Diagnostic Criteria

Diagnosis is clinical + laboratory supportive:

1. History or suspicion of ingestion

2. Compatible toxidrome

3. Laboratory abnormalities

4. Exclusion of other causes

Recognition of toxidromes:

Investigations

Initial Emergency Tests (All Patients)

• Blood glucose (immediate bedside)

• Arterial blood gas

• Serum electrolytes

• Renal function tests

• Liver function tests

• Complete blood count

• Urinalysis

Toxicology

• Serum drug levels (paracetamol, salicylate, lithium)

• Blood alcohol level

• Toxicology screen (if available)

Additional Tests

• ECG (cardiotoxic drugs)

• Serum osmolality & osmolar gap

• Lactate

• Coagulation profile

• Pregnancy test in females

Imaging

• Chest X-ray (aspiration)

• Abdominal X-ray (metal ingestion, drug packets)

• CT brain if persistent coma

Treatment

Non-Pharmacological Management

Initial Stabilization (Always First)

Airway – Breathing – Circulation (ABC)

• Secure airway

• Provide oxygen

• IV access and fluids

• Monitor ECG

• Correct hypoglycemia immediately

• Control seizures

Gastrointestinal Decontamination

Most effective within 1 hour of ingestion

Gastric Lavage

Indications

• Life-threatening ingestion

• Within 1 hour

• Performed by trained staff only

Procedure

• Position: left lateral, head down

• Insert large nasogastric tube

• Use 10 ml/kg warm 0.9% saline repeatedly

• Continue until clear return

• Suction apparatus ready

• Intubate if aspiration risk

Contraindications

• Unprotected airway

• Corrosive ingestion

• Hydrocarbons (kerosene, petrol)

• GI bleeding

• Perforation or obstruction

Important Notes

• Never use salt as emetic (fatal hypernatremia)

• Do NOT induce vomiting after corrosives or hydrocarbons

• Observe patient 4–24 hours depending on toxin

Pharmacological Treatment

Activated Charcoal (Single Dose)

Indication Within 1 hour of ingestion of adsorbable toxins

Dose

• <1 year: 1 g/kg

• Children 1–12 years: 25–50 g

• Adolescents/adults: 25–100 g

Administration Mix in 8–10× waterGive orally or via NG tube

Contraindications

• Corrosives

• Hydrocarbons

• Ileus or obstruction

• Unprotected airway

Antidotes (When Specific Poison Identified)

Supportive Therapy

• IV fluids

• Electrolyte correction

• Seizure control (benzodiazepines)

• Vasopressors for shock

• Mechanical ventilation

• Hemodialysis (dialyzable toxins)

Prevention

Do’s

• Store medicines safely

• Use child-resistant containers

• Keep products in original packaging

• Read labels carefully

Don’ts

• Do not transfer chemicals to drink bottles

• Do not leave containers open

• Do not remove labels

• Do not refer to medicines as sweets

• Avoid taking medicine in front of small children