Poisoning is the harmful effect that occurs when a toxic substance is swallowed, inhaled, or comes in contact with the skin, eyes, or mucous membranes, such as those of the mouth or nose.
Substances that can potentially cause poisoning include prescription and over-the-counter medications, illicit drugs, gases, chemicals, vitamins, food, mushrooms, plants, and animal or insect venom.
Some poisons cause no permanent health effects, while others can cause severe complications or death.
The diagnosis is based on symptoms, on information from the poisoned person and bystanders, and sometimes on blood and urine tests.
Medications should always be stored in original child-proof containers and kept out of the reach of children.
Treatments include supporting the person's body functions, preventing additional absorption of the poison, increasing elimination of the poison, and sometimes giving a specific antidote.
More than 2 million people suffer some type of poisoning each year in the United States. Drugs and medications—prescription, over-the-counter, and illicit—are a common source of serious poisonings and poisoning-related deaths (see Acetaminophen PoisoningAcetaminophen Poisoning and Aspirin PoisoningAspirin Poisoning). Other common poisons include gases (for example, carbon monoxide), household products (see Caustic Substances Poisoning), agricultural products, plants, heavy metals (for example, iron and lead), vitamins, animal or insect venom, and foods (particularly certain species of mushroom and bony fish and shellfish). However, almost any substance ingested (swallowed) in sufficiently large quantities can be toxic (poisonous).
Accidental poisoning
Poisoning is the most common cause of nonfatal accidents in the home. Young children, because of curiosity and a tendency to explore, are particularly vulnerable to accidental poisoning in the home, as are older adults, often due to confusion about how to take their medications. Because children often share pills and substances they find, siblings and playmates may also be poisoned. Accidental poisoning may also occur due to medication errors and in industrial workers (by exposure to toxic chemicals).
Deliberate poisoning
Poisoning may also be a deliberate attempt to commit murder or suicide. Most adults who attempt suicide by poisoning take more than one medication or drug and also may consume alcohol. Poisoning may be used to disable a person (for example, to sexually assault or rob them). Rarely, parents have a certain type of mental illness that can lead them to poison their children to cause illness to gain medical attention (a disorder called factitious disorder imposed on another, previously called Munchausen syndrome by proxy).
Symptoms of Poisoning
The symptoms caused by poisoning depend on the poison, amount the person is exposed to, and age and underlying health of the person exposed to the poison. Some poisons are not very potent and cause problems only with prolonged exposure or repeatedly being exposed to large amounts. Other poisons are so potent that just a drop on the skin can cause severe symptoms.
Some poisons cause symptoms within seconds, whereas others cause symptoms only after hours, days, or even years. Some poisons cause few obvious symptoms until they have damaged vital organs—such as the kidneys or liver—sometimes permanently.
Ingested toxins and toxins absorbed through the skin or other body tissues generally cause bodywide symptoms, often because they deprive the body's cells of oxygen or activate or block enzymes and receptors. Symptoms may include changes in consciousness, body temperature, heart rate, breathing, and many others, depending on the organs affected.
Caustic or irritating substances injure the mucous membranes of the mouth, throat, gastrointestinal tract, and lungs, causing pain, coughing, vomiting, and shortness of breath.
Skin contact with toxins can cause various symptoms, for example, rashes, pain, and blistering. Prolonged exposures may cause dermatitis (inflammation of the skin).
Eye contact with toxins may injure the eye, causing pain, redness, and loss of vision.
First Aid for Poisoning
The first priority in helping a poisoned person is for bystanders to avoid becoming poisoned themselves.
If the person appears very sick, emergency medical assistance (911 in most areas of the United States) should be called. Bystanders should do cardiopulmonary resuscitation (CPR) if needed. If the person does not appear very sick, bystanders can contact the nearest poison control center for advice. In the United States, the local poison center can be reached at 800-222-1222. More information is available at America's Poison Centers web site (www.poisoncenters.org). If the caller knows or can find out the identity of the poison and the amount ingested, treatment can often be initiated on site if this is recommended by the poison center.
Containers of the poisons and all drugs and medications that might have been taken by the poisoned person (including over-the-counter products) should be saved and given to the doctor or rescue personnel. The poison center may recommend giving the poisoned person activated charcoal before arrival at a hospital and, rarely, may recommend giving syrup of ipecac to induce vomiting, particularly if the person must travel far to reach the hospital. However, unless specifically instructed to, activated charcoal and syrup of ipecac should not be given in the home or by first responders (such as ambulance personnel). Syrup of ipecac has unpredictable effects, often causes prolonged vomiting, and may not remove substantial amounts of poison from the stomach. before arrival at a hospital and, rarely, may recommend giving syrup of ipecac to induce vomiting, particularly if the person must travel far to reach the hospital. However, unless specifically instructed to, activated charcoal and syrup of ipecac should not be given in the home or by first responders (such as ambulance personnel). Syrup of ipecac has unpredictable effects, often causes prolonged vomiting, and may not remove substantial amounts of poison from the stomach.
People exposed to a toxic gas should be removed from the source quickly, preferably out into fresh air, but rescue attempts should be done by professionals. Special training and precautions must be considered to avoid being overcome by the toxic gases or chemicals during rescue attempts. (See also Overview of Incidents Involving Mass-Casualty Weapons.)
In chemical spills, all contaminated clothing, including socks and shoes, and jewelry should be removed immediately. The skin should be thoroughly washed with soap and water. If the eyes have been exposed, they should be thoroughly flushed with water or saline. Rescuers must be careful to avoid contaminating themselves.
Diagnosis of Poisoning
Identifying the poison
Sometimes, urine and blood tests
Rarely, abdominal x-rays
Identifying the poison is helpful to treatment. Labels on bottles and other information from the person, family members, or coworkers best enable the doctor or the poison center to identify poisons. If labels are not available, medications can often be identified by the markings and colors on the pill or capsule. Laboratory testing is much less likely to identify the poison, and many drugs, medications, and poisons cannot be readily identified or measured by the hospital. Urine and blood tests may sometimes help in identification. Blood tests can sometimes reveal the severity of poisoning, but only with a very small number of poisons.
Doctors examine people to look for signs that suggest exposure to a certain type of substance. For example, doctors look for needle marks or track marks suggesting people have injected illicit drugs (see Injection Drug Use). Doctors also examine people for symptoms characteristic of certain kinds of poisoning. Doctors look to see whether people have traces of a drug, medication, or other substance on their skin or whether medication patches for medications absorbed through the skin may be hidden in skin folds, on the roof of the mouth, or under the tongue.
For certain poisonings, abdominal x-rays may show the presence and location of the ingested substances. Poisons that may be visible on x-rays include iron, lead, arsenic, other metals, and large packets of cocaine or other illicit drugs that have been swallowed or placed in body cavities (such as the rectum or vagina) so that the drugs can be smuggled or hidden from law enforcement officers (see For certain poisonings, abdominal x-rays may show the presence and location of the ingested substances. Poisons that may be visible on x-rays include iron, lead, arsenic, other metals, and large packets of cocaine or other illicit drugs that have been swallowed or placed in body cavities (such as the rectum or vagina) so that the drugs can be smuggled or hidden from law enforcement officers (seeBody Packing and Body Stuffing). Batteries and magnets are also visible on x-rays, as are fangs, teeth, cartilaginous spines and other animal parts that may break off and remain embedded in the body after an animal attack or envenomation (animal bite or other contact that result in venom entering a person's body).
Drug testing
Kits to identify illicit drugs in the urine can now be bought over the counter. The accuracy of these kits can vary significantly. Thus, results should not be regarded as proof that a certain illicit drug has or has not been taken. Testing is best done in consultation with a professional. If done without a professional, results should be discussed with a professional who has experience with illicit drug testing. The professional can help people interpret test results and draw the appropriate conclusions.
Prevention of Poisoning
In the United States, widespread use of child-resistant containers with safety caps has greatly reduced the number of poisoning deaths in children younger than age 5. To prevent accidental poisoning, medications and other potentially dangerous substances should be kept in their original containers and the containers kept where children cannot get them. Toxic substances, such as insecticides and cleaning agents, should not be put in drink bottles or cups, even briefly. All labels should be read before taking or giving any medications or using household products. Other preventive measures include
Clearly labeling household products
Storing medications (particularly opioids) and toxic or dangerous substances in cabinets that are locked and out of the reach of children
Using carbon monoxide detectors
Medications that are expired or unused after a treatment is completed should be disposed of safely. Many hospitals, pharmacies, and government organizations provide disposal containers or have programs that allow people to drop off or mail medications for safe disposal. Many medications may be discarded with household trash. They should be removed from their original containers and mixed with a material that will not be attractive to animals (such as dirt, coffee grounds, or cat litter) and put in a trash container that is inaccessible to children. Some medications may be flushed down a sink or toilet, but others are not appropriate for this type of disposal. People can find information on the website of their local or national government health authorities or call a local pharmacy for advice on how to properly dispose of medications.
Limiting the amount of over-the-counter pain reliever in a single container reduces the severity of poisonings, particularly with acetaminophen, aspirin, or ibuprofen. The identifying marks printed on pills and capsules by the medication manufacturer can help prevent confusion and errors by pharmacists, health care professionals, and others.Limiting the amount of over-the-counter pain reliever in a single container reduces the severity of poisonings, particularly with acetaminophen, aspirin, or ibuprofen. The identifying marks printed on pills and capsules by the medication manufacturer can help prevent confusion and errors by pharmacists, health care professionals, and others.
Did You Know...
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Treatment of Poisoning
Some people who have been poisoned must be hospitalized. With prompt medical care, most recover fully.
The principles for the treatment of all poisonings are the same:
Support vital functions such as breathing, blood pressure, body temperature, and heart rate
Prevent additional absorption
Increase elimination of the poison
Give specific antidotes (substances that eliminate, inactivate, or counteract the effects of the poison), if available
Prevent reexposure
The usual goal of hospital treatment is to keep people medically stable and alive until the poison disappears or is inactivated by the body. Eventually, most poisons are inactivated by the liver or are passed into the urine.
Provide supportive care
Poisoning often requires treatment, called supportive care, to stabilize the heart, blood pressure, and breathing until the poison disappears or is inactivated. For example, a person who becomes very drowsy or comatose may need a breathing tube inserted into the windpipe. The tube is then attached to a mechanical ventilator, which supports the person’s breathing. The tube prevents vomit from entering the lungs, and the ventilator ensures adequate breathing.
Treatment also may be needed to control seizures, fever, or vomiting. If a poison causes a high fever, the person may need to be cooled, for example, with a cooling blanket, or sometimes by applying cool water or ice to the skin.
If the kidneys stop working, hemodialysis is necessary. If liver damage is extensive, treatment for liver failure may be necessary. If the liver or kidneys sustain permanent, severe damage, liver transplantation or kidney transplantation may be needed.
Remove poison from the eyes and skin
Poisons in the eyes or on the skin usually should be washed off with large amounts of tap water or a salt and water mixture (saline solution). Sometimes washing the skin with soap and water is helpful.
In addition, for poisons that can be absorb through or can cause damage on contact with the skin or mucus membranes, clothing contaminated with the poisonous substance should be removed carefully to avoid additional exposure.
Prevent absorption of poison
Very few swallowed poisons are absorbed so quickly that measures cannot be tried to keep them out of the bloodstream. However, such measures are effective only for certain poisons and situations.
Activated charcoal is black powder that has been processed so it can be taken for medical purposes, if needed. It is sometimes given in hospital emergency departments to people who have swallowed poisons. Activated charcoal binds to the poison that is still in the digestive tract, preventing its absorption into the blood. Activated charcoal is usually taken by mouth if the person is alert and cooperative. Introducing activated charcoal through a tube placed in the nose or mouth in people who are either uncooperative or lethargic is not recommended. Sometimes doctors give activated charcoal every 4 to 6 hours to help cleanse the body of the poison. Not all poisons are inactivated by charcoal. For example, activated charcoal does not bind alcohol, iron, or many household chemicals. The charcoal passes through the digestive tract and is eventually passed with bowel movements.
Stomach emptying (inducing vomiting or stomach pumping) with syrup of ipecac or using a tube to pour water into the stomach, once commonly done, is now usually avoided because it removes only a small amount of the poison and can cause serious complications. (inducing vomiting or stomach pumping) with syrup of ipecac or using a tube to pour water into the stomach, once commonly done, is now usually avoided because it removes only a small amount of the poison and can cause serious complications.
Whole-bowel irrigation is a treatment method designed to flush a poison from the digestive tract. It is used only occasionally, for example, for serious poisoning caused by poisons that get stuck in the digestive tract or need to be moved physically (such as packets of hidden, smuggled drugs) or poisons that are absorbed slowly (such as some sustained-release medications) or not absorbed by activated charcoal (such as iron and lead).
Increase elimination of poison
If a poison remains life threatening despite the use of activated charcoal and antidotes, more complicated treatments that remove the poison may be needed. The most common treatments are hemodialysis and charcoal hemoperfusion.
In hemodialysis, an artificial kidney (dialyzer) is used to filter the poisons directly from the bloodstream. To do this, small tubes (catheters) are inserted into blood vessels, one to drain blood from an artery and another to return blood to a vein. The blood is passed through special filters that remove the toxic substance before being returned to the body.
Urine alkalinization is sometimes used. With this procedure, a solution containing sodium bicarbonate (the chemical in baking soda) is given by vein to make the urine more alkaline or basic (as opposed to acidic). This can increase the amount of certain medications (such as aspirin and barbiturates) excreted in the urine.is sometimes used. With this procedure, a solution containing sodium bicarbonate (the chemical in baking soda) is given by vein to make the urine more alkaline or basic (as opposed to acidic). This can increase the amount of certain medications (such as aspirin and barbiturates) excreted in the urine.
Antidotes
Although most poisons, drugs, and medications do not have specific antidotes (unlike the popular perception from TV and movies), some do. Some common drugs and medications that might require specific antidotes include acetaminophen (Although most poisons, drugs, and medications do not have specific antidotes (unlike the popular perception from TV and movies), some do. Some common drugs and medications that might require specific antidotes include acetaminophen (antidote is N-acetylcysteineantidote is N-acetylcysteine) and opioids such as heroin and fentanyl (antidote is naloxone). Some poisonous bites and stings also have antidotes (see ) and opioids such as heroin and fentanyl (antidote is naloxone). Some poisonous bites and stings also have antidotes (seeSnakebites). Not everyone who has been exposed to a poison requires its antidote. Many people recover on their own. But with severe poisoning, antidotes can be lifesaving.
Mental health evaluation
People who attempt suicide by poisoning need mental health evaluation and appropriate treatment.
More Information
The following are some English-language resources that may be useful. Please note that The Manual is not responsible for the content of these resources.
America's Poison Centers: Represents the United States-based poison centers that provide free, confidential services (24/7) through the Poison Help Line (1-800-222-1222)
Disposal of Unused Medicines: What You Should Know: Information on how to safely dispose of unused medicines
PoisonHelp.org: For free, confidential online help about specific poisons.
