Poisoning

STG 2026 lists the antidote and dose for each common poison: atropine and pralidoxime for organophosphates, vitamin K for anticoagulant rodenticides, ethanol for methanol and ethylene glycol, hydroxocobalamin for cyanide, methylene blue for methaemoglobinaemia, N-acetylcysteine for paracetamol, deferoxamine for iron, naloxone for opioids and flumazenil for benzodiazepines.

Shellfish poisoning follows eating oysters, clams, scallops or mussels containing toxins and is amnesic, diarrhoeal, neurotoxic or paralytic. There is no antidote: give activated charcoal early after large ingestion, ORS or IV fluids for dehydration, ondansetron or metoclopramide for vomiting, and ventilation for respiratory paralysis.

Most serious sting reactions come from bees, wasps and ants, with local pain, swelling and itching or, in severe cases, urticaria, angioedema, wheezing and anaphylaxis. Clean the site, scrape out stingers, apply cold compresses, and treat with ibuprofen, prednisolone for severe local swelling, and chlorpheniramine or loratadine for allergy.

Bee and wasp venoms cause local pain, swelling and cellulitis, and multiple stings can cause systemic toxicity with haemolysis, rhabdomyolysis and anaphylaxis. Remove stingers, wash and cool the site, give epinephrine 0.5 mg IM for anaphylaxis, antihistamines and analgesia, and observe for 24 hours after many stings (over 50 in adults or over 1 per kg in children).

Scorpion stings cause severe local pain and, especially in children, systemic toxicity with autonomic signs, pulmonary oedema and cardiogenic shock, graded I to IV. Treat with ABC care, oxygen, paracetamol or ibuprofen, lidocaine infiltration for severe local pain, and scorpion antivenom IV for grade III–IV envenoming.