Poisoning

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Poisoning is the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in contact with the skin, eyes, or mucous membrance such as those of the mouth, vagina, or penis. Fewer than 3,000 of the more than 12 million known chemicals cause most accidental and deliberate poison-ings. However, almost any substance ingested in large quantities can be toxic.

Common sources of poisons include drugs, household products, agricultural products, plants, industrial chemicals, and food substances. Identifying the poison and accurately assessing its danger are crucial to successful treatment. Information on treating poisoning from various substances is available from the nearest Poison Control Center, whose telephone number is fisted in the local directory or can be obtained from directory assistance.

Poisoning can be an accident or a deliberate attempt to commit murder or suicide. Children, especially those under age 3, are particularly vulnerable to accidental poisoning, as are the elderly (from confusion about their medications), hospitalized patients (from medication errors), and industrial workers (from exposure to toxic chemicals).

Symptoms

The symptoms of poisoning depend on the poison, the amount ingested, and certain characteristics of the per-son who takes it. Some poisons aren't very potent and require prolonged exposure or repeated ingestion of a large amount to cause a problem. Others are so potent that just a drop on the skin can cause severe damage. Genetic makeup may affect whether a substance is poisonous to a particular person. Some normally nonpoisonous substances are poisonous for people who have a certain genetic makeup. Age may affect how much of a substance can be ingested before poisoning occurs. For example, a young : child can ingest larger amounts of acetaminophen before becoming ill from it than an adult can. A benzodiazepine, a sedative, may be toxic to an elderly person at doses that a middle-aged adult could ingest without a problem.

Symptoms may be minor but bothersome-such as itching, dry mouth, blurred vision, and pain-or they may be serious-such as confusion, coma, abnormal heart rhythms, difficulty in breathing, and severe agitation. Some poisons produce symptoms within seconds, while others produce symptoms only after hours or even days. Some poisons produce few obvious symptoms until they have permanently damaged the function of vital organs such as the liver or kidneys. Thus, the symptoms of poisoning are as myriad as the poisons themselves,

Diagnosis and Treatment

After calling the Poison Control Center, family members or coworkers of poisoning victims can start first aid while waiting for professional help.

They should determine whether the victim is breathing and has a heartbeat and should begin cardiopulmonary resuscitation (CPR), if needed.

Because treatment is best accomplished when the poison is known, containers and samples of vomit should be saved and given to the doctor.

When the poison isn't known, doctors try to identify it with laboratory tests. A blood test may help, but analysis of a urine sample is usually more helpful. Doctors may remove material from the stomach by suctioning and send it to the laboratory to be analyzed and identified.

When a person has swallowed a poison, vomiting should be induced quickly, unless the poison could cause further damage if vomited. Examples of substances that should not be vomited are sharp objects, petroleum products, lye, and acids.

If the person is very drowsy, unconscious, or having seizures, vomiting should not be induced because the person may choke. Syrup of ipecac is commonly used to induce vomiting; dosage instructions are printed on the bottle's label. If ipecac isn't available, soapy water can be used.

At a hospital, medical personnel use other techniques to clear the stomach of poisons. They may pump out the stomach by inserting a tube through the mouth or nose into the stomach and washing the stomach with water (gastric lavage).

They may give activated charcoal through the stomach tube or may have the patient swallow it. This compound binds with a significant amount of the poison, preventing its absorption into the blood-stream.

Anyone who has been exposed to a toxic gas should be removed from the area as quickly as possible, preferably into fresh air. Emergency medical personnel usually give oxygen to the victim as soon as they arrive.

In chemical spills, all contaminated clothing, including shoes and socks, is usually removed immediately. The skin should be thoroughly washed and the eyes flushed with water if they have been exposed. Rescuers should be careful to avoid contaminating themselves.

Once poison has been absorbed through the gastrointestinal tract, skin, or lungs, it quickly spreads throughout the body.

Eventually, most poisons are detoxified by the liver or excreted in the urine. Doctors try to accelerate the detoxification and elimination of poisons while simultaneously trying to reverse their toxic effects.

Fluids are usually given intravenously to keep the poi-son victim well hydrated and to maintain urine production. Mild acids or bases may be added to these fluids to increase the amount of poison excreted into the urine. Chemicals that bind to certain poisons, particularly heavy metals such as lead, may be given intravenously to help neutralize and eliminate the poison. Dialysis may be needed to remove poisons that aren't readily neutralized or eliminated from the blood.

If a specific antidote is available, it's given as quickly as possible. Examples are antidigoxin antibodies for an overdose of digoxin and the drug naloxone for an over-dose of morphine or heroin.

Poisoning often requires additional treatment depending on the symptoms and the substance ingested. A respirator may be needed if breathing stops, as may happen after an overdose of morphine, heroin, or barbiturates.

The brain often swells after poisoning from sedatives, carbon monoxide, lead, or other chemicals that depress the nervous system. Drugs given to reduce the swelling include corticosteroids and mannitol. Poisoning can cause kidney failure, which may be severe enough to require dialysis.

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