Critical care and Emergency Nursing Poisoning Poisoning an overdose of drugs, medicaments, chemicals and biological substances

Assess airway patency Place patient in supine position Chin-lift and jaw thrust maneuver Remove foreign body (dentures, etc) Ensure Cervical fracture is r/o before intubation administer humidified air Bronchial toilet Breathing

Self-poisoning and parasuicide deliberate ingestion of more than the therapeutic dose of a drug or a substance not intended for consumption

Cause of inadequate O2 Ventilatory failure Hypoxia Bronchospasm

Accidental poisoning a non-intentional ingestion, overdose or exposure to substances

Substance abuse/dependence maladaptive pattern of substance use with impairement or distress

General approach for poisoned individual

Emergency Stabilization Clinical Evaluation Elimination of the Poison Excretion of Absorbed Substance Administration of Antidotes Supportive Therapy and Observation Disposition

Common cause of hypoxia Alcohol Cyanide Organophosphates Carbon monoxide Opiates Quinines management ABG determination O2 via nasal cannula, face mask, mech. Vent. Administration of bronchodilators O2 may be contraindicated for the following:
Watusi Zinc phosphate paraquat

Emergency Stabilization ABCs of Life Support for Poisoning Airway Breathing Circulation Treat Convulsion

Circulation Inadequate circulation may be due to the direct effect of the substance Hypotension (SBP <80mmHg; <age 40, SBP <90mmHg; >age 40)

Correct Metabolic Abnormalities Treat Coma Complications of Poisoning Airway obstruction Management Elevate legs by about 15 cm from horizontal plane (trendelenburg) Fluid challenge with 200 ml 0.9 NaCl (adults) FC D5 0.3 NaCl at 10ml/kg (children) Correct ventilation problems

Breathing Difficulties Circulatory Inadequacy Drug induced CNS depression Electrolyte or metabolic Abnormalities

Airway

Severe poisonig (circulation) Insert CVL

Monitor hydration status Infuse plasma expanders Dopamine 1.0 2.5 ug/kg/min

form precipitate due to Na Benzoate !

Phenytoin 15-20mg/kg SIV LD not exceeding 50mg/min. Maintenance of phenytoin at 100mg PO/IV q 6-8 hours

Recommended iv fluids Hypotention: 0.9 NaCl, Crystalloid Solution adult maintenance: 0.9 NaCl, D5LR Pediatric Maintenance: D5 0.3 NaCl

Treat convulsion Effect of poison (INH) Cerebral hypoxia Hypoglycemia Muscle spasm Withdrawal reaction Decreased seizure threshold in epileptic patients

Note: Never dilute phenytoin in Dextrose containing IVF to avoid crystallization For unknown etiology, Pyridoxine (B6) may be used until seizure cease Correct metabolic abnormalities

Poisons associated with convulsions Aminophyline Amphetamine Carbon monoxide Cocaine Cyanide Ethylene glycol Hypoglycemic agents INH Lead Lithium MAO inhibitors (monoamine Oxidase) Mefenamic Acid Opioids Organophosphates Phenothiazine Salicylates

Common Metabolic and Electrolyte Abnormalities Hypokalemia Hyperkalemia Hypothermia Hyperthermia Hypoglycemia Hypocalcemia Hypokalemia Causes NaHCO3 Bronchodilators Corticosteroids Diuretics (Furosemide) mAnagement Infusion of KCL (40meq/hour, not to exceed 60meq/L)

Strychnine Theophylline Tricyclic Antidepressant (TCAD) Withdrawal from narcs, diazepam, ethanol

Hook patient on telemetry/ cardiac monitor and monitor waveforms Monitor I and O Monitor V/S Watch out for signs of Hyperkalemia Hyperkalemia

Management Treatment of etiology (metabolic abnormality correction, secondary effect of poison) Maintain adequate oxygenation Diazepam 5mg (adult); 0.3mg/kg (pediatrics) slow Iv push up to 20mg (intubate px prior to further administration of diazepam) Note: never dilute diazepam with any fluid, it will

Substances that can cause Hyperkalemia ACE inhibitors Beta Blockers Cardiac Glycosides carbon Monoxide Cyanide Oral Potassium K+ sparing diuretics Management Glucose-insulin infusion (50ml D50-50 and 10 units of insulin) Sodium bicarbonate/ calcium gluconate

Dialysis monitor I and O Monitor V/S Monitor ECG

Common in watusi and jatropa seed ingestion Maybe complication from animal and insect bites Management Calcium Chloride over Calcium Gluconate for better retention of calcium; 2.25-4.5 mmol SIV; 100300mg/kg/day IV for pediatric

Hypothermia Core temp <30 C Drugs associated Alcohol Carbon monoxide Opioids Sedative-hypnotics GA Phenothiazines TCAs Hyperthermia Core temp >40 C Drugs Associated Antihistamines amphetamines Isoniazid Phenytoin Salicylate Xanthines

Treating Coma Antidote for Comatose poisoned px with unknown etiology Naloxone: 2.0mg IV (A); 10ug/kg IV (P) Glucose: for suspected diabetic coma Thiamine: 100mg IV followed by 50-100ml D50-50 (for possible alcohol intoxication) Coma with known etiology Opiate overdose Naloxone: 2mg IV (caution needed for opiate abusers)

Anticholinergics Cocaine Phenothiazines Quinidine Sulfonamides

management Sponge bath Fanning Iced gastric or colonic lavage Iced water immersion Hypoglycemia Common in alcohol and salicylate toxicity due to prolonged glucose utilization and hepatic glycogen store depletion Management D50-50 at 50- 100 ml Monitor V/S Monitor I and O Monitor Pxs LOC

Clinical evaluation Information to be elicited during history taking Time of exposure Mode of exposure Intake of other substances Circumstances prior to poisoning Current medication Past medical history Home remedies Poisons with delayed manifestation Ethyl glycol 6h Salicylate 12h Paracetamol 36h Paraquat 48h Methanol 48h Thyroxine 4wks Physical exam Tachycardia I- iron C- carbon monoxide, cyanide O- organophosphates P- phenothiazine E- ethyl glycol, ethanol F- free-base cocaine A- anticholinergics, antihistamines, amphetamine S- sympathomimetics, salicylate,solvent T- theophylline Hypertension C- cocaine T- theophylline

Hypocalcemia

S- sympathomimetics C- caffeine A- anticholinergics N- nicotine

Hypotension C- clonidine R- reserpine and other antihypertensive A- antidepressant S- sedative hypnotics H- heroin and other opiates Bradycardia P- propanolol (Beta-blocker) A- anticholinesterase C- clonidine, calcium channel blocker, codeine E- ethanol D- digitalis
Examine the Pxs skin Cutaneous bullae Diaphoresis Jaundice Dry skin and hyperpyrexia flushing Check characteristic of Pxs breath odor Bitter almonds- cyanide, DKA, isoprop. Wintergreen- methylsalicylate Rotten egg- sulfur dioxide, hydrogen sulfide Pear- chloral hydrate Garlic- arsenic, organophosphates, DMSO Mothball- camphor Auscultate the patients lungs Rales may indicate apiration pneumonia or edema Pulmonary edema: pesticides, INH, Opiate,B-blocker, TCAD toxicity Aspiration pnenumonia: hydrocarbon ingestion Auscultate Patients heart- check for presence of irregular rhythm or arrhyhtmia

A- anticholinergics Hyperventilation C- carbamates O- organophosphates M- methanol E- ethylene glycol T- theophylline S- salicylates

Hypoventilation C- clonidine O- opioids M- metals (heavy) B- Beta Blockers A- Aromatic Hydrocarbons T- TCADs T- Theophylline and other xanthines S- Sedatives Q- quinidine D- digitalis Toxidromes Anticholinergics/ Antidepressants Hot as a hare (hyperthermia) Dry as a bone (dry Mucus) Red as beet (Flushed skin Blind as a bat (dilated pupils) Mad as a hatter (confusion/delirium)
Cholinergics (organophosphates, carbamates) D- diarrhea, diaphoresis U- urination M- miosis, muscle fasciculations B- bradycardia, bronchoconstriction E- emesis L- lacrimation S- salivation Sympthomimetics (cocaine, amphetamines) M- mydriasis T- tachycardia H- hypertension H- Hyperthermia S- seizures

Neurological Evaluation- assess patients neurological status using the GCS Neurologic sign that can aid in etiologic agent identification Miosis C- cholonergics, clonidine O- opiates, orgamophosphates P- phenothyazines, pilocarpine S- sedayive-hypnotics Mydriasis A-antihistamines, antidepressants S- sympathomimetics, methamphetamine, cocaine I- INH

Narcotics/ opiates M- miosis B- bradycardia H- hypotension

H- hypoventilation C- coma Laboratory Examination Bedside Toxicology- may be used to give ideas to diagnostic possibilities in a poisoning case. Ea: Urine exam- adding agents to pxs urine and evaluating the change in its color Specimen Collection- properly secure all collected specimen it not immediately examined. Blood: 5-10 ml either heparinized and clotted should be extracted and placed on ice Urine: 200ml (preferably first void) and sealed on a container and placed on ice All specimen collected should be placed on a sealed container and stored in freezer. Toxicology Laboratory Uses confirm clinical impression predict prognosis determine therapy monitor therapy predict time course Toxicology Screen obtain to confirm history/clinical impression or for unknown agents or inconsistency between history and clinical effects substances detected vary depending on lab know what a negative result means!

Radio- opaque drugs C chloral hydrate H heavy metals (arsenic, lead, iron) I - iodides P psychotropics (TCADS, Phenothyazines) E Enteric Coated Medications (Salicylates) Conditions or Agents Predisposing to Metabolic Acidosis / Elevated ANION gaps M methanol E ethyl glycol T toluene, theophylline A alcoholic ketoacidosis L lactic acidosis A aminoglycosides (uremic agents) C- cyanide, carbon monoxide I isoniazod, iron D diabetic Ketoacidosis G grand mal seizures A aspirin (salicylates) P paraldehyde, phenoformin

Elimination of the Poison

External Decontamination Discard pxs clothing and thoroughly bathe or shower the patient when there is dermal exposure Copious irrigation of the eyes with free flowing water for 30 mins Health personnel involved in decontamination should wear protective devices Empty the stomach Induction of Emesis- effective for patients who had ingested poison within an hour Mechanical emesis instruct patient to take 1-2 glasses of warm water, then induce emesis by applying pressure on the posterior pharynx Ipecac Syrup 30ml (A), 10-15ml (P) in one glass water

Radiographic Examination limited usefulness for visualizing toxins a. iron, lead b. foreign bodies General Laboratory Examination CBC Urine pH Urine SG FBS BUN Creatinine Electrolytes ABG ECG Liver Function Test PT PTT Chest X-Ray Abdominal X-Ray

Contraindication to Emesis Depressed sensorium Impaired gag reflex Late pregnancy Cardiac disease and aneurysm

Ingestion of caustics, hydrocarbons, convulsants, arrhythmogenic agents

Gastric Lavage- benefits those patients 6-12 hours post-ingestion Insert NGT (Fr 16), placed px on trendelenburg with head turned to the left while inserting the tube and then place the pax on left lateral decubitus position. Done with 50-60ml (A), 10-20 ml (P) lukewarm/ tepid water, repeat until return flow is clear Contraindication of gastric lavage Ingestion of caustics or kerosene Frank convulsion LIMIT gi aBSORPTION May be decreased by use of activated charcoal, neutralizing agents, and cathartics. Activated Charcoal lavage Activated charcoal is not systemically absorbed, drugs and chemicals binds to its surface. 10 parts coal to 1 part chemical 50-100 g in 200ml water (A) 1g/kg or 30-50 g in 100pl water (P) Antidotes POISON ANTIDOTES acetaminophen N-acetylcysteine anticholinergics physostigmine Benzodiazepines flumazenil beta blockers glucagon calcium channel calcium, glucagon blockers carbamates atropine carbon monoxide oxygen cyanide sodium nitrite/ sodium thiosulfate digoxin digoxin immune Fab ethylene glycol ethanol, fomepizole heavy metals DMSA, BAL, CaEDTA, penicillamine iron deferoxamine Isoniazid pyridoxine lead DMSA, BAL, CaEDTA, penicillamine methanol ethanol, fomepizole nitrates/nitrites methylene blue opiates naloxone organophosphates atropine, pralidoxime snakes(pit viper) Crotalidae antivenin, CroFab Chelating Agents Dimercaprol (BAL) Calcium Disodium Edetate (EDTA) Deferoxamine (Desferal) Penicillamine (Cuprimine) Dimercaprol (BAL) Dimercaprol (2,3-dimercapto-1-propanol) is a water-

insoluble compound with an offensive odor. Compounds that contain the -SH group are known as mercaptans and are responsible for the strong odors associated with certain animals, such as skunks and ferrets. The chelated metal cannot enter living cells and is rapidly excreted from the body. Since dimercaprol is water insoluble, it is dissolved in an oil base (often peanut oil) and injected intramuscularly. Mercury Arsenic Gold Calcium DisodiumEdetate (EDTA) ETHYLENEDIAMINETETRAACE TIC ACID It is only slightly soluble in water. However, its sodium salts are quite soluble in water. The commercial preparation: calcium disodium. As an antidote for lead poisoning, calcium disodium EDTA exchanges its chelated calcium for lead, and the resulting lead chelate is rapidly excreted in the urine. The calcium salt of EDTA, administered intravenously, is also used in the treatment of acute cadmium and iron poisoning. Lead Cadmium Iron Zinc Manganese Beryllium copper Treatment IV 15- 25 mg/kg (not more than 50 mg/kg/d) In 250- 500 ml of dextrose 5% Over 1-2 hour period Twice daily Courses: drug 5-day/ rest period 2 days Deferoxamine (Desferal) Iron It is usually given only if the serum iron level exceeds 400- 600 g/dl IV 40 mg/kg Over 4 hours (15 mg/kg/h) Penicillamine (Cuprimine) Copper Lead mercury Orally half an hour before meals (capsules) 4 doses

FIRST AID FOR POISONING Poison is any substance: solid, liquid or gas, that tends to impair health or cause death when introduced into the body or onto the skin surface. A poisoning emergency can be life threatening. Causes: 1. Common in suicide attempts. 2. Occasional accidental poisoning. Ways in which poisoning may occur ingestion- by mouth inhalation- by breathing injection- by animal bites, stings, syringes absorption- by skin contact Common Household Poison 1. Sleeping pills 2. Pain relievers 3. Insect and rodent poisons 4. Kerosene 5. Denatured alcohol 6. Lye and acids including boric 7. Poisonous plants 8. Contaminated water 9. Fume

Instances when vomiting should not be induced 1. If unresponsive. 2. Cannot maintain an airway open.

3. Has ingested an acid, a corrosive lye, or a

petroleum product such as gosoline or furniture polish.

4. Has a medical condition that could be complicated by vomiting, such as heart attack, seizures and pregnancy. First Aid 1. Try to identify the poison. 2. Place the victim on its left side. 3. Save any empty container, spoiled food analysis.

4. Save any vomitus and keep it with the victim if

the person is taken to an emergency facility.

INHALED POISON is a poison breathed into the lungs.

Signs and Symptoms 1. History of inhaling poisons. 2. Breathing difficulty. 3. Chest pain. 4. Cough, hoarseness, burning sensation in the throat. 5. Cyanosis (bluish discoloration of skin and mucous membranes). 6. Dizziness, headache. 7. Seizures, unresponsiveness (advance stages). First Aid 1. Remove the victim from the toxic environment and into fresh air immediately.

INGESTED POISON is one that is introduced into the digestive tract by way of the mouth. One form of ingestion poisoning is food poisoning, a general form that covers a variety of conditions.
Suspect food poisoning if:

1. the victim ate food that "didn't taste right" or

that may have been old, improperly prepared, contaminated, left at room temperature for a long time, or proceesed with an excessive amount of chemicals.

2. Seek medical attention.

ABSORBED POISON, also known as contact poison is a poison that enters the body through the skin.
Signs and Symptoms 1. History of exposures. 2. Liquid or powder on the skin 3. Burns. 4. Itching, irritation. 5. Redness, rashes, blisters. First Aid 1. Remove the clothing.

2. several people who ate together become ill.

Signs and Symptoms 1. Altered mental status. 2. History of ingesting poisons. 3. Burns around the mouth. 4. Odd breath odors. 5. Nauseas, vomiting. 6. Abdominal pain. 7. Diarrhea.

2. With a dry cloth, blot the posion from the skin.

If the poison is a dry powder, brush it off. 3. Flood the area with copious amount of water.

3. Clean and bandage the wound. 4. Call emergency number, if necessary. 4. Snake bite Signs and Symptoms Bite mark Pain Comparative Characteristics of Snake CHARACTERISTIC VENOMOUS NONVENOMOUS

4. Conrinually monitor the patient's vital signs.

INJECTED POISON is a poison that enters the body through a bite, sting, or syringe. 1. Bee sting Signs and Symptoms Stingers may be present. Pain Swelling Possible allergic reaction First Aid 1. Remove stinger. 2. Wash wound. 3. Cover the wound. 4. Apply a cold pack. 5. Watch for signals of allergic reaction 2. Spider bite Signs and Symptoms Nite mark Swelling Pain Nausea and vomiting Difficulty breathing or swallowing. First Aid 1. Wash wound. 2. Apply a cold pack. 3. Get medical care to receive antivenin. 4. Get local emergency number, if necessary. 3. Marine Organisms Signs and Symptoms Possible marks. Pain Swelling Possible allergic reaction. First Aid 1. If jellyfish- soak area in vinegar pain goes away.

Movement Head Body Skin Pupil Ways/ manner of attack Bite marks First Aid 1. Wash wound.

Cortina, side Semicortina locomotion winding curvature Semi-angular Rectangular Rough Vertical Nonconstrictor Oblongated Circular Smooth Round Constrictor Horeshoe shape

With fang marks

2. Keep bitten part still, and lower than the heart. 3. Call local emergency number. 5. Dog bite Signs and Symptoms Bite mark Bleeding First Aid 1. If bleeding is minor- wash wound. 2. Control bleeding. 3. Apply antibiotic ointment. 4. Cover the wound.

5. Get medical attention if wound bleeds severly

or if you suspect animal has rabies.

6. Call local emergency nunber or contact animal

control personnel. General Care for Poisoning 1. Survey the scene.

2. If sting ray- soak in nonscalding hot water until

2. Remove the victim from the source of the poison. 3. Do a primary survey. 4. Care for any life threatening condition. 5. If the victim is conscious, do a secondary survey.

example, high blood pressure, migraine headache prevention, social phobia, and certain types of tremors. In excess, they can cause difficulty breathing, coma, and heart failure.

6. Do not give the victim anything by mouth

unless advised by medical professionals Poison is anything that kills or injures through its chemical actions. Most poisons are swallowed (ingested). The word poison comes from the Latin word - potare - meaning to drink. But poisons can also enter the body in other ways: By breathing Through the skin By IV injection From exposure to radiation Venom from a snake bite Poisoning Causes Poisons include highly toxic chemicals not meant for human ingestion or contact, such ascyanide, paint thinners, or household cleaning products. Many poisons, however, are substances meant for humans to eat, including foods and medicines. Foods Some mushrooms are poisonous Drinking water contaminated by agricultural or industrial chemicals Food that has not been properly prepared or handled

Warfarin (Coumadin): Coumadin is a blood thinner used to prevent blood clots. It is the active ingredient in many rat poisons and may cause heavy bleeding and death if too much is taken. Vitamins: Vitamins, especially A and D, if taken in large amounts can causeliver problems and death. Poisoning Symptoms The signs and symptoms seen in poisoning are so wide and variable that there is no easy way to classify them.

Some poisons enlarge the pupils, while others shrink them. Some result in excessive drooling, while others dry the mouth and skin. Some speed the heart, while others slow the heart. Some increase the breathing rate, while others slow it. Some cause pain, while others are painless. Some cause hyperactivity, while others cause drowsiness. Confusion is often seen with these symptoms. When the cause of the poisoning is unknown A big part of figuring out what type of poisoning has occurred is connecting the signs and symptoms to each other, and to additional available information. Two different poisons, for example, may make the heart beat quickly. However, only one of them may cause the skin and mouth to be very dry. This simple distinction may help narrow the possibilities. If more than one person has the same signs and symptoms, and they have a common exposure source, such as contaminated food, water, or workplace environment, then poisoning would be suspected. When two or more poisons act together, they may cause signs and symptoms not typical of any single poison. Toxidromes

Drugs Drugs that are helpful in therapeutic doses may be deadly when taken in excess. Examples include:

Beta blockers: Beta blockers are a class of drugs used to treat heart conditions (for example, angina, abnormal heart rhythms) and other conditions, for

Certain poisons cause what toxicologists call toxidromes - a contraction of the words toxic and syndrome. Toxidromes consist of groups of signs and symptoms found together with a given type of poisoning.

hepatitis, appendicitis, head injuries, and many others. Almost every possible sign or symptom of a poisoning can also be caused by a nonpoison-related medical problem.

For example: Jimson weed, a plant smoked or ingested for its hallucinogenicproperties, produces the anticholinergic toxidrome: Rapid heart rate, large pupils, dry hot skin, retention of urine, mental confusion, hallucinations, andcoma. Most poisons either have no associated toxidrome or have only some of the expected features of the toxidrome. Delayed onset of symptoms A person can be poisoned and not show symptoms for hours, days, or months. Cases of poisoning with a prolonged onset of symptoms are particularly dangerous because there may be a dangerous delay in obtaining medical attention.

Exams and Tests A combination of history, physical examination, and laboratory studies will help reveal the cause of most poisonings. Frequently, treatment must begin before all information is available. History: As a family member or friend of a poisoned person, you can greatly assist the doctor and provide valuable clues by telling the doctor about these details: Everything the person ate or drank recently Names of all prescription and over-the-counter medications the person is taking Exposure to chemicals at home or at work Whether others in the family or at work have been similarly ill or exposed Whether the person has any psychiatric history to suggest an intentional ingestion (suicide attempt) Testing: Many poisons can be detected in the blood or urine. However, a physician cannot order "every test in the book" when the diagnosis is unclear. The tests ordered will be based on information revealed in the history and physical exam.

Acetaminophen (Tylenol) is considered one of the safest drugs but is toxic to the liver when taken in large quantities. Because it acts so slowly, 7-12 hours may pass before the first symptoms begin (no appetite when normally hungry, nausea, and vomiting). The classic example of a very slow poison is lead. Before 1970, most paints contained lead. Young children would eat paint chips and, after several months, develop abnormalities of the nervous system. When the illness may be poisoning - or may not be poisoning Some signs and symptoms of poisoning can imitate signs and symptoms of common illnesses.

For example, nausea and vomiting are a sign (vomiting) and symptom (nausea) of poisoning. However, nausea and vomiting can also be found in many illnesses that have nothing to do with poisoning. Examples include:

A toxicology screen or "tox" screen looks for common drugs of abuse. Most toxicology screens will detect:

acetaminophen, aspirin, marijuana, opioids (heroin, codeine), benzodiazepines (Valium, Librium), amphetamines (uppers),

stroke, heart attack, stomach ulcers, gallbladder problems,

cocaine, and alcohol. A specific blood test will give serum levels of some drugs, including phenytoin(Dilantin), theophylline (TheoDur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), digoxin (Lanoxin), lithium (Lithobid), and acetaminophen. Some drugs affect the electrical activity of the heart. An electrocardiogram (ECG) may reveal toxicity. Sometimes a person is unconscious for no obvious reason. A CT scan of the brain will help tell if there has been a structural change in the brain, such as astroke. Do not induce vomiting or give syrup of Ipecac.

the charcoal in theintestine, the poison cannot get absorbed into the bloodstream. Activated charcoal has no taste, but the gritty texture sometimes causes the person to vomit. To be effective, activated charcoal needs to be given as soon as possible after the poisoning. It does not work with alcohol, caustics, lithium (Lithobid), or petroleum products.

Whole bowel irrigation requires drinking a large quantity of a fluid calledGolytely. This flushes the entire gastrointestinal tract before the poison gets absorbed.

Antidotes: Some poisons have specific antidotes. Antidotes either prevent the poison from working or reverse the effects of the poison.

Ipecac was previously used to induce vomiting in poisoned patients where there was a chance to get the toxin out of the body. Several advisory bodies such as the American Association of Poison Control Centers and the American Academy of Pediatrics have recommended that Ipecac NOT be used and that it should not even be kept in the household. For more information on this subject go to: http://www.poison.org/prepared/ipecac.asp

Atropine is an antidote for certain nerve gases and insecticides. During Operation Desert Storm, all military personnel were issued atropine injectors when it was feared that the enemy would use nerve gas. A common antidote is N-acetylcysteine (Mucomyst), which is used to neutralize acetaminophen (Tylenol) overdoses. Acetaminophen, in normal doses, is one of the safest medications known, but after a massive overdose, the liver is damaged, and hepatitis and liver failure develop. Mucomyst works as an antidote by bolstering the body's natural detoxification abilities when they are overwhelmed. It may also be possible to reverse the harmful effect of a drug even if no antidote exists.

Do not give activated charcoal at home. Allow medical personnel to decide if this treatment is appropriate. The poison control center will instruct you what to do or if an antidote is readily available. Medical Treatment Elimination: Get rid of the unabsorbed poison before it can do any harm.

If a person with diabetes takes too much insulin, a dangerously low blood sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death. Sugar given by mouth or IV is an effective treatment until the insulin wears off. When the poison is a heavy metal, such as lead, special medicines (chelators) bind the poison in the bloodstream and cause it to be eliminated in the urine. Another "binder" is sodium polystyrene sulfonate (Kayexalate), which can absorb potassium and other electrolytes from the bloodstream.

If the person is unconscious, the doctor will put a flexible, soft, plastic tube into thewindpipe to protect the person from suffocating in his or her own vomit and to provide artificial breathing (intubation). Once the poison has moved past the stomach, other methods are needed.

Activated charcoal acts as a "super" absorber of many poisons. Once the poison is stuck to

General supportive measures: When there are no specific treatments, the physician will treat signs and symptoms as needed.

If the person is agitated or hallucinating, a sedative can be given to calm the person until the drug wears off. A ventilator can be used to breathe for anyone who has stopped breathing from a poisoning. Antiseizure medicines can be used to treat or prevent seizures.