CLINICAL PHARMACOLOGY 2003 (PART 11)

Deliberate and accidental self-poisoning Principles of treatment Poison-specific measures General measures Specific poisonings: cyanide, methanol, ethylene glycol, hydrocarbons, volatile solvents, heavy metals, herbicides and pesticides, biological substances (overdose of medicinal drugs is dealt with under individual agents) Incapacitating agents: drugs used for torturedrugs, and psychotropic drugs is increasing. Repeated episodes are not rare.1 Prescribed drugs are used in over 75% of episodes but teenagers tend to favour nonprescribed analgesics available by direct sale, e.g. paracetamol, which is important bearing in mind its potentially serious toxicity. The mortality rate of self-poisoning is very low (less than 1% of acute hospital...
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CLINICAL PHARMACOLOGY 2003 (PART 11) 9 Poisoning, overdose, antidotes SYNOPSIS drugs, and psychotropic drugs is increasing. Re- peated episodes are not rare.1 Prescribed drugs are Deliberate and accidental self-poisoning used in over 75% of episodes but teenagers tend to Principles of treatment favour nonprescribed analgesics available by direct Poison-specific measures sale, e.g. paracetamol, which is important bearing General measures in mind its potentially serious toxicity. Specific poisonings: cyanide, methanol, The mortality rate of self-poisoning is very low ethylene glycol, hydrocarbons, volatile (less than 1% of acute hospital admissions), but solvents, heavy metals, herbicides and completed suicides by poisoning still number 3500 pesticides, biological substances (overdose of per annum in England and Wales. medicinal drugs is dealt with under individual Accidental self-poisoning causing admission to agents) hospital occurs predominantly amongst children Incapacitating agents: drugs used for torture under 5 years, usually with medicines left within their reach or with domestic chemicals, e.g. bleach, detergents.Self-poisoning Principles of treatmentDeliberate self-poisoning. A curious by-product Successful treatment of acute poisoning depends onof the modern drug and prescribing explosion a combination of speed and common sense, as wellis the rise in the incidence of nonfatal deliberate as on the nature of the poison, the amount takenself-harm. The majority of people who do this lack and the time which has since elapsed. The majorityserious suicidal intent and are therefore termed of those admitted to hospital require only observa-parasuicides. In over 90% of instances in the UK, tion and medical and nursing supportive measurespoisoning is the means chosen, usually by medi-cines taken in overdose and these amount to at least 170 000 hospital admissions per annum in England An extreme example is that of a young man who, over aand Wales (population 51 million). Two or more period of 6 years, was admitted to hospital following 82 episodes of self-poisoning, 31 employing paracetamol; hedrugs are taken in over 30% of episodes, not had had a disturbed, unhappy upbringing and had beenincluding alcohol which is also taken in over 50% expelled from both the Danish Navy and the British Army.of the instances; the use of hypnotic and sedative Prescott L F et al 1978 British Medical Journal 2: 1399. 151 9 POISONING, OVERDOSE, ANTIDOTESwhile they metabolise and eliminate the poison. the toxic environment, the contaminated clothingSome require a specific antidote or a specific removed and the skin cleansed.measure to increase elimination. Intensive carefacilities are needed by only a few. In the UKthe centres of the National Poisons Information From the gutService provide information and advice over thetelephone throughout the day and night.2 Oral adsorbents. Activated charcoal (Carbomix, Medicoal) reduces drug absorption better than syrup of ipecacuanha or gastric lavage, is easiest to administer and has fewest adverse effects. It Poison-specific measures consists of a very fine black powder prepared from vegetable matter, e.g. wood pulp, coconut shell,IDENTIFICATION OF THE POISON(S) which is activated by an oxidising gas flow at high temperature to create a network of fineThe key pieces of information are: (10-20-nm) pores to give it an enormous surface• the identity of the substance(s) taken area in relation to weight (1000 m 2 /g). This binds• the dose(s) to, and thus inactivates, a wide variety of• the time that has since ...