Management of the Poisoned Patient:
Eye or skin contamination should be treated with appropriate washing or irrigation. Patients who have recently ingested significant overdoses need further measures to prevent absorption or increase elimination:
Activated charcoal (50 g orally) can be given, if a potentially toxic amount of poison has been ingested < 1 hr before presentation. Agents that do not bind to activated charcoal include ethylene glycol, iron, lithium, mercury and methanol. Whole-bowel irrigation with polyethylene glycol can be used for toxic ingestions of iron, lithium and theophylline, or to flush out packets of illicit drugs. Urinary alkalinisation using IV sodium bicarbonate enhances elimination of salicylates, methotrexate and the herbicide 2,4-D. Haemodialysis is occasionally used for serious poisoning with salicylates, theophylline, ethylene glycol, methanol or carbamazepine. Infusions of lipid emulsion can be used to reduce tissue concentrations of lipid-soluble drugs such as tricyclic antidepressants.
Specific antidotes are only available for a small number of poisons (Box 4.2). In serious cases, meticulous supportive care, including the treatment of seizures, coma and arrythmias, with ventilatory support where required, is critical to good outcome.