Poisonings symptomatic measures

Apart from specific antidotes (if they exist), the treatment of poisonings also calls for symptomatic measures (control of blood pressure and blood electrolytes monitoring of cardiac and respiratory function prevention of toxin absorption by activated charcoal). An important step is early emptying of the stomach by gastric lavage and, if necessary, administration of an osmotic laxative. Use of emetics (saturated NaCl solution, ipecac syrup, apomorphine s.c.) is inadvisable. 

Symptomatic measures for the treatment of exposure to trichothecene mycotoxins are modeled after the care of casualties of mustard poisoning.85 Irrigation of the eyes with large volumes of isotonic saline may assist in the mechanical removal of trichothecene mycotoxins, but would have limited useful therapeutic effects. After the skin has been decontaminated, some erythema may appear, accompanied by burning and itching. Most casualties whose skin has been treated with soap and water within 12 hours of exposure will have mild dermal effects these should be relieved by calamine and other lotion or cream, such as 0.25% camphor and methanol. 

Toxicology is an interesting medical discipline. The principles of management are prevention, toxicovig-ilance and careful assessment of the clinical features of the poisoned patient, and providing timely and appropriate therapy. In most cases, these are symptomatic and supportive measures, on top of decontamination, elimination of the poison, and provision of specific antidotes. 

Only symptomatic treatment is available. Adequate measures should be taken to maintain fluid and electrolyte balance and keep the body temperature within tolerable limits. Measures should be taken to remove the poison from the body through gastric lavage and saline cathartic. Gastrointestinal absorption may be... 

In symptomatic patients, intravenous access should be established and blood should be taken for measurement of erythrocyte cholinesterase activity to confirm the diagnosis. If the characteristic features of nerve agent poisoning are present, however, antidotal treatment should not be delayed until the result is available. 

Table 7-2 shows the oral doses of atropine causing undesirable responses or symptoms of overdosage. Measures to limit intestinal absorption should be initiated without delay if the poison has been taken orally (see Chapter 64). For symptomatic treatment, intravenous physostigmine rapidly abolishes the delirium and coma caused by large doses of atropine, but carries some risk of overdose in mild atropine intoxication. Since physostigmine is metabolized rapidly, the patient may again lapse into coma within 1-2 hours, and repeated doses may be needed (see Chapter 8). 

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