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Routes of cxposurc to toxins

Direct eye contact

Eye

Eye irrigation

Methods of preventing absorption or enhancing elimination

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articles from palpebral fissures. If pain persists, luorescein drops and slit lamp examination for corneal damage are essential

Remove contact lenses. Wash eyes thoroughly least 15 minutes with normal salinę or water. Re

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Lungs

Inhalation

Gl tract

Gastric lavage

has been ingeste for acids, alkalis or petroleum distillates

Activated charcoal

guinine and theophylline

Whole bowel irrigation

Oxygcn and bronchodilators

Give high-flow oxygen, e.g. 12 l/min. Nebulised p2-adrenoceptor agonists if patient wheezy

Only if a potentially life*threatening amount of toxin

i inoested within the last hour. Not to be used

50g can be given to an adult orally if a potentially toxic amount of poison has been ingested within the last hour. but only if the toxin is absorbed by charcoal.

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Multiple doses of charcoal are given (50g every 4

hours) in poisoning by carbamazepine. dapsone, inyllin

Polyethylene glycol solution is given for potentially toxic ingestions of iron. lithium and theophylline, and to elear packets of drugs from bodypackers

Inoculation

Direct skin contact

Urinary alkalinisation

Removal of clothing/skin washing

Enhances elimination of salicylates and some pesticides. e.g. 2-4D. Give 1 litre of 1.26% sodium bicarbonate i.v. over 3 hours. Check urine pH remains between 7.5 and 8.5. Avoid use of large volumes, i.e. forced diuresis. and watch for hypokalaemia

Extracorporeal methods of elimination, e.g. haemodialysis or haemoperfusion

For serious poisoning with salicylates, theophylline, ethylene glycol, methanol, carbamazepine

Wash with copious amounts of soap and water for Chemical or pesticide exposures

© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com