Diagnosis of acute exogenous poisonings
Making an accurate diagnosis in poisonings relies on two equivalent stages:
- Clinical assessment: taking the medical history, studying the circumstances of the incident, and identifying specific toxicromes.
- Laboratory verification: qualitative and quantitative chemical-toxicological analysis of biological fluids performed in specialized laboratories.
Basic treatment algorithm
Therapeutic tactics for exogenous poisonings are comprehensive and implemented in four consecutive steps:
- Blockade of further poison absorption.
- Specific neutralization of the toxin using antidotes.
- Stimulation of clearance for accelerated elimination of the substance from the body.
- Supportive, syndromic, and symptomatic therapy.
Prevention of poison absorption upon oral administration
Removal of the toxin from the gastrointestinal tract is a priority task. The main methods include induction of vomiting and tube gastric lavage.
- Induction of vomiting: effective at the pre-hospital stage in case of ingestion of large fragments (berries, mushrooms, undissolved pills).
- Tube lavage: the "gold standard" of GI tract cleansing. The insertion depth of the tube is calculated from the front incisors to the xiphoid process (processus xiphoideus).
- Contraindications: vomiting must not be induced in poisonings with caustic liquids and volatile hydrocarbons, as well as in cardiotoxic poisonings due to the risk of vagus nerve stimulation and fatal bradycardia.
Antidote therapy and specific cases of poisoning
Specific care consists of using antidotes and functional antagonists:
- Anxiolytics: in case of overdose, drowsiness, ataxia, coma, and respiratory depression are observed. The antidote is Flumazenil.
- Cholinolytics: to neutralize substances penetrating the blood-brain barrier (e.g., atropine), physostigmine is used.
- Ophthalmology: physostigmine is also used in closed-angle glaucoma due to its powerful miotic effect, surpassing pilocarpine.
Decontamination algorithm: "Charcoal orally, measured tube, vomiting — only without acids and petroleum!"
Class and exam questions
What are the absolute contraindications to the induction of vomiting?
Induction of vomiting is strictly contraindicated in poisonings with caustic liquids (strong acids and alkalis) and volatile hydrocarbons due to the high risk of aspiration and secondary burns of the respiratory tract.
How to properly calculate the insertion depth of the tube for gastric lavage?
For the safe execution of the procedure, the length of the inserted part of the tube is measured from the patient's front incisors to the xiphoid process of the sternum (processus xiphoideus).
What antidote is used in severe anxiolytic poisoning?
In case of anxiolytic overdose, flumazenil is used as a specific functional antagonist.
What else to study on this topic
- Methods of extracorporeal detoxification (hemodialysis, hemosorption, plasmapheresis)
- Features of cholinolytic poisoning and pharmacodynamics of physostigmine
- Symptomatic hemodynamic and respiratory support in severe coma
- Side effects and pain syndrome during ophthalmological use of miotics
- Organization of specialized toxicological centers
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