OTCs Today
Daniel L. Krinsky, RPh, MS
Poisoning is the leading cause of injury death in the United States, surpassing motor vehicle traffic deaths and deaths from firearms. It is also a major public health problem, and with more people quarantining, the risks are greater than ever. Nonprescription medications pose a risk for poisoning among all age groups, but especially those at the extremes of age.
Most poisonings in young children are unintentional, whereas poisonings in other age groups may be unintentional or intentional (e.g., suicide attempts, substance abuse, medication misuse). The majority of poisonings are a result of ingestion of a substance, but poisonings may also occur after a toxin is inhaled or comes in contact with the skin and eyes. First aid for poisonings focuses on minimizing the extent of the exposure and stemming the progression or development of toxicity.
Nonprescription products such as analgesics, cough and cold preparations, topical preparations, vitamins, and antihistamines are among the most common substances ingested by young children. Other common substances involved in poison exposures in children younger than 6 years include cosmetics and personal care products, cleaning substances, foreign bodies or toys, pesticides, and plants. Most unintentional poison exposures in small children result in minimal, if any, adverse effects and require no treatment other than observation.
Self-treatment
Although self-treatment may be appropriate, health care providers, caregivers, and patients are encouraged to seek counsel from the nearest poison control center before attempting any treatment. Poison control centers offer 24-hour access for poison information, clinical toxicology consultation, and poison prevention education.
The nationwide toll-free telephone number to access a poison control center is 800-222-1222. WebPoisonControl.org is a free application that can help consumers and health care providers determine whether to call their poison control center.
Signs of poisoning
Signs and symptoms of poisoning can range in severity from mild to life-threatening. The primary goal of home or prehospital therapy is to prevent absorption of toxins and stem the progression of toxicity to minimize morbidity and mortality. The objectives of self-treatment are 1) to minimize exposure and reduce development of toxicity by moving the patient to fresh air, irrigating the skin or eyes, or preventing absorption of potentially toxic agents in the GI tract and 2) to treat patients with minimally toxic ingestions at home under the direction of a poison control center.
The first steps in assessing a potential poison exposure are to determine whether the patient has symptoms and whether the exposure puts the patient at risk of toxicity. Many exposures are nontoxic or minimally toxic because either the substance has a very low inherent toxicity or the amount consumed is too low to cause toxicity.
A decision regarding the option for self-treatment depends on the reason or circumstance of the poison exposure, toxicity of the agent, and general health status of the patient. Self-treatment should be considered only if the ingestion is unintentional and the potential for toxicity is assessed as minor.
What to tell your patients
The majority of individuals who do not require immediate hospital referral are managed with on-site observation only and no specific treatment. In some instances, the approach is to attenuate the exposure by irrigation or prevention of further absorption. Activated charcoal may prevent or reduce the absorption of some ingested substances. However, its routine use is not recommended without consultation with a poison control center as there is no convincing evidence that activated charcoal improves patient outcomes.
Administration of oral fluids after ingestion of a drug is not recommended because the fluids are likely to result in spontaneous vomiting, which is risky in some situations. The fluids theoretically may facilitate dissolution of a solid dosage form, thereby enhancing its absorption. However, administering fluids should be considered for drugs known to pose a high risk of renal injury owing to dehydration, such as ibuprofen or other NSAIDs. Key exclusions for self-treatment include central nervous system depression, difficulty breathing, advanced age, suspected suicide, substance abuse, or poor gag reflex.