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19 sept 2018
• Recognition of poisoning requires a high index of
• History may be misleading or non-indicative
• Types and dosage of drugs ingested should be
sought from patient’s family, friends and GP to
assessed potential toxicity of the suspected
• If possible, try to obtain the bottle or container
that held the ingested drug/ substances
Supportive care
• Airway, breathing and circulation must be
• Endotracheal intubation may be required to
protect the airway especially if gastic lavage is
indicated in a drowsy patient
Paraquat poisoning
Clinical features
Ingestion followed quickly by hypotension,
restlessness and death
Otherwise, after ingestion , an initial period of
nausea and vomiting
Followed by a period of relative wellbeing for
up to 24 hr
Contaminated clothing should be removed
Contaminated skin should be washed with soap
and water
Insert nasogastric tube
Stomach washout as soon as possible
300ml of fuller’s earth (15% suspension) via NG
tube as soon as possible
Then 20ml of fuller’s earth every hr until
diarrhoea and PR passage of fuller earth
Investigation and Monitoring
• Send gastric lavage/ aspirate, urine and blood
for toxicology screening.
• Send gastric lavage/ aspirate and urine for
• Result urine for paraquat
a. Dark blue colour (severe poisoning)
b. Blue (moderate poisoning)
c. Light blue (mild poisoning)
• Strict I/O charting
• Cardiac monitoring
• Close GCS chating
• Assess chest and CVS for sign of fluid oveload
Organophosphate and Carbamate
• Organophosphate incude
malathion,parathion,dichlorvos and diazinon

• Carbamate include methomyl and aldicarb

• Organophosphate can be absorbed through

the skin,lung and GI tract

1. Blood ix shows decrease plasma darah and

cholinestertase on RBC
2. Reaction on
 atropin 0.5-2mg given iv every 5-10 min until
atropinization is adequate (dry mouth, skin)
 Pralidoxime 1-2g iv in 100ml normal saline
over 30 min (only be started after maximal
Drug manipulation
• Prevention of drug absorption
 Ipecacuanha syurp is a useful emetic in
children (in doses of 10-30ml repeated once
in 20 min if necessary)
 It is less effective and is seldom used in adult
Gastric lavage

 Useful if performed < 1 hour of ingestion

which slow down peristalsis
 Lavage with 200 ml boluses of warm saline
repeated until the effluent is clear and
offending substance has been removed
 Lavage is contraindicated in petroleum
product poisioning

 If administered promptly within 1 hr and in

sufficient quantity, activated charcoal
significantly reduces GI absorption
 The usual adult dose of activated charcoal is
50g initially then 25g every 4 hr
 Activated charcoal should not be given in
conjunction with an oral antidote as it may
bind and inactivate these agent

 The added efficacy of a cathartic is not clear,

but it does decreased transit time through
the intestine
 Acceptable forms include magnesium sulfat
4ml/kg (300ml maximum)
Magnesium sulfat 250mg/kg or 15-20g
Magnesium salts should not be given in renal
Whole bowel irrigation
• Administer bowel preparation solution
(CoLyte, GoLightly) at 2 liter per hr by gastric
tube untul effluent is clear

• Stop administration after 4 liter if no rectal

effluent has appeared
The end