19 sept 2018
Diagnosis
• Recognition of poisoning requires a high index of
suspicion.
• 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
poison.
• If possible, try to obtain the bottle or container
that held the ingested drug/ substances
Supportive care
• Airway, breathing and circulation must be
maintained
• 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
Management
Contaminated clothing should be removed
immediately
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
paraquat
• Result urine for paraquat
a. Dark blue colour (severe poisoning)
b. Blue (moderate poisoning)
c. Light blue (mild poisoning)
• FBC, ABG, LFT, CREATININE AND CXR
• Strict I/O charting
• Cardiac monitoring
• Close GCS chating
• Assess chest and CVS for sign of fluid oveload
Organophosphate and Carbamate
poisoning
• Organophosphate incude
malathion,parathion,dichlorvos and diazinon