Principles of Treatment of Acute Drug Poisoning
Acute drug poisoning is a medical emergency requiring prompt, systematic treatment to reduce morbidity and mortality.
Initial Assessment and Stabilization
Follow the ABCs of emergency care:
A – Airway
- Ensure the airway is open and unobstructed.
- Use suction, oropharyngeal/nasopharyngeal airway, or endotracheal intubation if needed.
B – Breathing
- Administer supplemental oxygen.
- Provide assisted ventilation in cases of respiratory depression or arrest.
C – Circulation
- Monitor heart rate, blood pressure, and perfusion.
- Establish IV access.
- Administer IV fluids or vasopressors if hypotension is present.
Decontamination
1. Remove Contaminated Clothing
- Especially in dermal or inhalation exposures.
- Wash exposed skin with soap and water.
2. Gastric Lavage
- Consider within 1 hour of ingesting a life-threatening dose, and if no contraindications (e.g., unprotected airway).
3. Activated Charcoal
- Adsorbs many toxins if given within 1 hour.
- Only use if the patient is awake and can protect airway.
Mechanism:
- Activated charcoal binds toxins in the GI tract.
- Prevents absorption into systemic circulation.
4. Whole Bowel Irrigation (WBI)
- Useful for:
- Sustained-release or enteric-coated drugs
- Iron, lithium, or substances not well adsorbed by charcoal
Mechanism:
- Polyethylene glycol electrolyte solution flushes entire GI tract.
- Reduces systemic absorption of drugs.