POISONS
Any substance that impairs health or destroys life when ingested, inhaled,
or absorbed by the body
Reversibility of poisoning is determined by the capacity of tissues to
recover
Affects different organ systems of the body
Pediatric patients need to be protected from accidental poisoning
Older adults also need protection from accidental poisoning
Poison Control Center phone number should be visible
If poisoning is suspected, call the number immediately
INTERVENTIONS
Remove visible materials from the mouth, eyes, or body immediately
Identify type and amount of substance consumed
Call Poison Control Center before attempting intervention
Save vomitus and deliver to the Poison Control Center
Call an ambulance if instructed by the Poison Control Center
Never induce vomiting after lye, household cleaner, grease, or petroleum
ingested
Never induce vomiting if patient is unconscious
INGESTION OF POISONS
LEAD POISONING
Excessive accumulation of lead in the blood
Causes:
Through food, air, or water
Contaminated dust and soil
Most common route is hand-to-mouth
➢ From paint chips, pottery, and ceramic ware
Affects RBCs, bones, teeth, organs, and tissues
Most serious consequences involve the CNS
Blood Lead Level Test
➢ Used for screening and diagnosis
Erythrocyte Protoporphyrin Test
➢ Indicator of anemia
➢ Normal:
< 70 µmol/mol haem
Chelation Therapy
➢ Removes lead from blood, some organs, and tissues
➢ Does not counteract any effects of lead
➢ Medications:
Calcium disodium edetate
Succimer
British anti-Lewisite (BAL) used in conjunction with
ethylenediamine tetraacetic acid (EDTA)
Chelation Therapy
Renal, hepatic, and hematological systems must be monitored
Ensure adequate urinary output before administering
Monitor output and pH of urine after therapy
Give adequate hydration and monitor for nephrotoxicity
Follow-up of lead levels is important
Provide instructions about safety, medications, and follow-up
Confirm that patient will be discharged to a home without lead hazards
ACETAMINOPHEN POISONING
Seriousness of ingestions is determined by amount ingested and length of
time before intervention
In adults, toxicity develops at 7.5 to 10 g/day
Assessment
First 2 to 4 hours:
Malaise
Nausea
Vomiting
Sweating
Pallor
Weakness
• Latent period (24 to 36 hours):
o Improvement of condition
Assessment
Hepatic involvement:
May last 7 days and may be permanent
RUQ pain
Jaundice
Confusion
Stupor
↑ Liver enzyme & bilirubin levels
prolonged PTT
Interventions
Antidote:
N-ACETYLCYSTEINE
Dilute antidote in juice or soda
Loading dose is followed by maintenance doses
If client is unconscious, prepare to perform gastric lavage with activated
charcoal to decrease absorption
Do not use concurrently with N-acetylcysteine
ACETYLSALICYLIC ACID (ASA) or ASPIRIN POISONING
Overdose may be due to acute or chronic ingestion
Acute:
Toxic dose: 200 to 300 mg/kg
Ingestion of 500 mg/kg is potentially lethal
Chronic:
Ingestion of > 100 mg/kg/day for 2 days or more
Assessment
GI: nausea, vomiting, thirst
CNS: hyperpnea, confusion, tinnitus, seizures, coma, respiratory failure,
circulatory collapse
Renal: oliguria
Hematopoietic: bleeding tendencies
Metabolic: diaphoresis, fever, hyponatremia, hypokalemia, dehydration,
hypoglycemia, metabolic acidosis
Interventions
Administration of activated charcoal
Emesis or cathartic measures
IVF administration
Sodium bicarbonate for metabolic acidosis
Other interventions:
External cooling, anticonvulsants, vitamin K, and oxygen
Dialysis if patient is unresponsive to therapy
CORROSIVES
Includes household cleaners, detergents, bleach, paint or paint thinners, and
batteries
Liquid corrosives can cause more damage than other types, such as granular
Assessment:
Severe burning in the mouth, throat, or stomach
Edema of mucous membranes, lips, tongue, and pharynx
Vomiting
Drooling and inability to clear secretions
Interventions:
Dilute corrosive with water or milk as prescribed (usually not more than
4 oz or 120 mL)
Avoid inducing vomiting
Avoid neutralization of ingested corrosive
Educate people to call Poison Control Center immediately if poisoning occurs
POISON IVY, OAK, AND SUMAC
A dermatitis may develop from contact
with URUSHIOL from poison ivy, oak, or
sumac plants
ASSESSMENT
Papulovesicular lesions
Severe pruritus
INTERVENTIONS
Remove plant oils off of skin immediately
Apply cool, wet compresses for itching
Apply topical products for itching and discomfort
Topical or oral glucocorticoids may be
administered
