Home Poisoning First Aid

The Easter holidays are fast approaching. This usually means more quality time with our loved ones. For most homes this could lead to a full house with so much fun, wining and dining. The holidays are usually the time to be more careful especially in homes with little children because children are known to have a habit of ingesting anything in their immediate line of vision. This is the reason they must be supervised in the home and beyond. Most household fluids and substances are potential poisons, care should be taken to store these out of the reach of children.

In the management of poisoning and toxicity, the importance of time cannot be overemphasized this is why it’s important that every individual should have a basic knowledge of pre-hospital toxicity management. In the event of a poisoning, what can be  done? The first step is knowing what has been ingested. This can be done by looking around the victim for obvious signs like a bottle or container of any sort so as to be able to show and tell the health care provider what has been taken in details. It is important to know that the pre-hospital management should be done as professional help is on the way.

In the case of topical contamination, remove the victim from the offending substance and get rid of the clothes if affected, wash copiously with running water to eliminate any excess contaminant. If the eyes are affected, wash also with running water for fifteen minutes. With your knowledge of chemistry, never think of neutralizing an acid on the skin with a base…it doesn’t work that way in the real world.

In the case of some drug overdose, activated charcoal can decrease the absorption of a wide variety of drugs and toxins in the stomach and intestinal tract. The use of activated charcoal is most likely to help people who may have ingested carbamazepine, dapsone, phenobarbital, quinine, theophylline, salicylates, phenytoin, or valproic acid. Activated charcoal interrupts the enterohepatic and enteroenteric recirculation of drugs in the gut lumen. It does this by the adsorption of the drug on it’s surface  thereby preventing further absorption of the drug in the system. A dose of 1 to 2 g per kg is usually recommended for children. The first dose is often given with a cathartic agent, such as sorbitol, to improve taste and hasten the transit of the toxin through the intestinal tract. Care should be taken in the administration of multiple doses of sorbitol to a child as this may cause excess diarhoea  leading to electrolyte and fluid abnormalities. Activated charcoal is unlikely to benefit patients who ingested alcohols, strong acids or bases, minerals, iron, lithium, or hydrocarbon

Syrup of Ipecac has also been used over time as a means of detoxification because it causes emesis (vommiting) in the patient. The use of this has declined greatly in modern times because some caustic agents are better prevented from passing the gastrointestinal tract a second time. It is also contraindicated to induce vomiting in a person that is unconscious as this may lead to suffocation.

Some poisons however have specific antidotes that directly neutralizes the offending agaent. Examples of which are N-acetylcysteine, which is used to neutralize paracetamol overdose. Paracetamol , in normal doses, is one of the safest medications known, but after a massive overdose, the liver is damaged, and hepatitis and liver failure develop. N-acetylcysteine  works as an antidote by helping the body's natural detoxification abilities when they are overwhelmed.

If a person with diabetes takes too much insulin, a dangerously low blood sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death. Sugar given rapidly by mouth or IV is an effective treatment until the insulin wears off. This can be life saving.

In the case of Opoid overdose, Naloxone has been shown to be a specific antidote because it competitively competes for opoid receptors thereby minimizing the binding of opiod to the receptors and decreasing the effect of the opoid in the system.

Deferoxamine is a specific antidote to ferrous salts. This is very important for new mothers who keep their routine drugs scattered around the whole house. The ferrous sulphate you see as nothing can be life threatening to your baby if he lays his hand on them.

 

Atropine is a specific antidote to cholinesterase inhibitors. Cholinesterase inhibitors are the major ingredients of most insecticides used in the home. When inhaled in very high concentrations, this can ultimately lead to paralysis. The next time you use the insecticide at home for the mosquitoes and cockroaches, be sure to keep it away from your infants.

Nothing is as true as the old saying, “prevention is better than cure”. This simply means that we should devote more time and energy in preventing these emergency scenarios so that the festive season can be for merry and not for crying.