Suspected intoxications: Immediately call 911! (Call number 112)
Often poisonings are treated purely symptomatically.
General notes
Bring everything that can help determine the cause of poisoning:
- Medication or medication packaging
- Food scraps
- Vomit
- Products that may be the cause of poisoning
General measures
- Always pay attention to self-protection!
- Contact the Poison Information Center (Poison Control: see below).
- Monitoring
- If necessary, resuscitation measures (ensuring vital functions).
- In case of poisoning through the skin, remove clothing, clean skin.
- Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
Absorption-reducing measures
Early, single administration of activated carbon.
- Indications (areas of application): numerous drugs, alkaloids, or vitamin K antagonists.
- Contraindications: ingestion of corrosive substances (eg, inorganic acids), surfactants or liquid hydrocarbons; especially also in airways not protected by intubation.
Gastric lavage
- Indications: Indicated only in cases of life-threatening poisoning within 60 minutes of ingestion of the toxicant.
- Contraindications: for burns with acids and alkalis, liquid hydrocarbons such as gasoline, unsecured airway if protective reflexes are not presentFor burns: As far as possible, rinse the patient’s mouth with non-carbonated water and let him drink a few small sips of water.
- Gastric lavage is to be carried out only by experienced users now
- Rinse portions 200-400 ml; perform until rinsing liquid comes back clear.
- Then add activated carbon and lactulose
Induced vomiting
- No longer indicated as a routine measure
- 30 ml ipecacuanha syrup (adult).
Antegrade colonic irrigation
- When rapid elimination of intestinal contents is required to avoid absorption of potentially lethal (fatal) amounts of active ingredient
- Indications: Retard active ingredients, illegal drugs transported in the intestine.
Laxatives (laxatives)
- The use of sorbitol or sodium sulfate is no longer recommended
Elimination accelerating measures
Repeated administration of activated charcoal
- Indications: life-threatening intoxication with drugs (carbamezepine, quinine, dapsone, phenobarbital, theophylline).
Forced diuresis
- Greatly increased urine production with the help of diuretics (drugs that promote the excretion of water from the body with urine).
- Indications: severe lithium, salicylate, barbital, phenobarbital, thallium intoxication.
- Implementation: crystalloids + furosemide
- Always control of water / electrolyte balance
Urinary alkalinization
- Indications: Salicylate, barbiturate intoxication.
- Implementation: bicarbonate infusion
- Target values: blood pH < 7.55, urine pH 7-8.
Hemodialysis (blood washing).
- Indications: Intoxication with short-chain alcohols (methanol, ethylene glycol) in which acidosis has already occurred; carbamazepine, calcium, lithium, metformin, phenytoin, salicylates, valproate.
Hemoperfusion
- Blood purification procedure hardly used anymore
- Indications: life-threatening intoxication with alkyl phosphates, carbamazepine, quinine, dapsone, herbicides, phenobarbital, theophylline, valproic acid.
Plasmapheresis
- Separation of plasma from the cellular blood components.
- Indicated for hirudin overdose.
Antidota
- See drug therapy or below under “Special therapy”.
Special therapies
Alcohol
- Fomepizole
- Hemodialysis (blood washing)
Analgesics (painkillers)
- Paracetamol – acetylcysteine (ACC)
Designer drugs
- Gamma-hydroxybutyric acid (GHB), 1,4-butanediol, gamma-butyrolactone (liquid ecstasy).
- Methamphetamine and derivatives (including offered as bath salts, plant food, etc.), “Spice“, THC, Aztec sage, hallucinogenic mushrooms, Kratom, Hawaiian Baby Woodrose – symptomatic therapy.
Ethylene glycol (radiator antifreeze).
- Fomepizol
- Hemodialysis (blood washing)
Gases, smoke
- Fire smoke (in addition to carbon monoxide, also hydrogen cyanide) – hydroxocobalamin.
- 4-Dimethylaminophenol (4-DMAP) contraindicated in simultaneous hydrogen cyanide and carbon monoxide poisoning.
Carbon monoxide
- Fire smoke, defective heaters, improper use of charcoal grills; hookah consumption – Oxygen: normo or hyperbaric (> 10 l/min).
Psychotropic substances
- Early gastric lavage or single administration of activated charcoal within the first hour after ingestion (contraindicated in sedation!).
- Raising blood pH with sodium bicarbonate reduces cardiac arrhythmias (cardiac arrhythmias).
Opioids
- Opioid antagonist naloxone
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Nutritional recommendations according to a healthy mixed diet taking into account the age. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grain products).
- Selection of appropriate food based on the nutritional analysis
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
