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  • image Poisoning can result from exposure to excessive doses of any chemical, with medicines being responsible for most childhood and adult poisonings.

  • image The total number and rate of poisonings have been increasing, but preventive measures, such as child-resistant containers, have reduced mortality in young children.

  • image Immediate first aid may reduce the development of serious poisoning, and consultation with a poison control center may indicate the need for further therapy.

  • image The use of ipecac syrup, gastric lavage, whole bowel irrigation, and cathartics has fallen out of favor as routine therapies, whereas activated charcoal remains useful for gastric decontamination of appropriate patients.

  • image Antidotes can prevent or reduce the toxicity of certain poisons, but symptomatic and supportive care is essential for all patients.

  • image Acute acetaminophen poisoning produces severe liver injury and occasionally kidney failure. A determination of serum acetaminophen concentration may indicate whether there is risk of hepatotoxicity and the need for acetylcysteine therapy.

  • image Anticholinesterase insecticides may produce life-threatening respiratory distress and paralysis by all routes of exposure and can be treated with symptomatic care, atropine, and pralidoxime.

  • image An overdose of calcium channel antagonists will produce severe hypotension and bradycardia and can be treated with supportive care, calcium, insulin with supplemental dextrose, and glucagon.

  • image Poisoning with iron-containing drugs produces vomiting, gross gastrointestinal bleeding, shock, metabolic acidosis, and coma and can be treated with supportive care and deferoxamine.

  • image Acute opioid poisoning and overdose can produce life-threatening respiratory depression that can be treated with assisted ventilation and naloxone.

  • image Chemicals can be used for mass poisonings by acts of terrorism and warfare and typically produce life-threatening effects within minutes to hours, which warrant emergency preparedness at healthcare facilities and communities.

Poisoning is an adverse effect from a chemical that has been taken in excessive amounts. The body is able to tolerate and, in some cases, detoxify a certain dose of a chemical; however, toxicity ensues once a critical exposure threshold is exceeded. Poisoning can produce minor local effects that may be treated readily in the outpatient setting or systemic life-threatening effects that require intensive medical intervention. Virtually any chemical can become a poison when taken in sufficient quantity, but the potency of some compounds leads to serious toxicity with small quantities (Table e9-1). Poisoning by chemicals includes exposure to drugs, industrial chemicals, household products, plants, venomous animals, agrochemicals, and weapons for warfare and terrorism. This chapter describes some examples of the spectrum of toxicity, outlines means to recognize poisoning risk, and presents principles of treatment.

TABLE e9-1Serious Toxicity in a Child Associated with Ingestion of One Mouthful or One Dosage Unit

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