Salicylate (aspirin) Poisoning

Clinical Description

Adults

• Gastric emptying is delayed
• Always empty the stomach
• Give repeated doses of Activated Charcoal to delay absorption of any remaining poison (See Section 22.2.2.1)
• Watch for and treat hypoglycemia, convulsions, and metabolic acidosis

In severe cases:

• Darrow's 1⁄2 strength in Dextrose 5% infusion with added Sodium Bicarbonate (30 mmol/litre) or Ringers Lactate may be needed to increase renal excretion

Children

• Give activated charcoal (1 g/kg) if within 4 hours of ingestion
• “Forced alkaline diuresis” is no longer advised in children due to risks of fluid overload
• Maintain a good urine flow of around 1ml/kg/hour
• Can use sodium bicarbonate to alkalinize urine in severe cases (1mmol/kg NaHCO3 over 4 hours – IV or oral)

ORGANOPHOSPHATE OR CARBAMATE POISONING

• Very toxic chemicals found in insecticides and pesticides, e.g. Some rat poisons
• Poisoning may be by ingestion, inhalation, or absorption through the skin
• Presents with diarrhoea, urination, small pupils, bradycardia, vomiting, lacrimation, secretions, anxiety and restlessness, increased secretions and bradycardia

GENERAL MANAGEMENT: ADULT

• Remove any contaminated clothing
• Establish and maintain airway
• Artificial respiration with oxygen may be required at any stage during the first 24 hours after poisoning
• Empty the stomach if poison swallowed
• If there is skin contact with the poison, wash them thoroughly
• Wear rubber gloves to prevent contamination
• Do not rub the skin
• Shave hair if heavily contaminated
• Give Atropine 1.2mg IV or IM (children: 0.05 mg/kg)
• Then give 0.6 mg (children: 0.05mg/kg) every 10 minutes as required to achieve and maintain atropinisation (hot dry skin, dry mouth, widely dilated pupils, fast pulse)

In severe organophosphate poisoning:

• Give an initial Atropine dose of 4-6mg (children: 2 mg)
• Repeat 2mg every 10 minutes as required to achieve and maintain full atropinisation
• Total needed in first 24 hours is usually < 50 mg
• High dose Atropine may be required for several days

In severe organophosphate poisoning only and in cases not responding to atropine:

• Give Pralidoxime Mesylate 1-2g concurrently with Atropine

Children: 20-40 mg/kg

• Administer by slow IV (over 15-30 minutes) as a 5% solution in water for injections
• If IV not possible: give IM or S/C and repeat once or twice at 4–6-hour intervals if needed
• If possible: monitor treatment by determination of blood- cholinesterase concentrations

Note: Do not give Pralidoxime (or other oximes) in carbamate poisoning

Children

• Irrigate the eyes or skin to remove the chemical if required
• If available and <4 hours since ingestion, administer activated charcoal
• Do not induce vomiting
• If respiratory compromise give oxygen and treat with atropine: 20 micrograms/kg IM or IV. Repeat every 15 minutes until chest is dry.
• May need escalation to peadiatric intensive care for respiratory support and ongoing