2.10 : Prevention of Further Absorption of Poison

In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to the GI tract to limit further absorption. Emesis, or inducing vomiting, is one method to expel poison from the stomach, typically using ipecac syrup or saltwater and pharyngeal stimulation. However, emesis should be avoided in specific situations to prevent complications, such as when a patient has consumed a corrosive substance or is unconscious, delirious, or has ingested a central nervous system stimulant. Gastric lavage is another technique to cleanse and remove stomach contents, including toxins, using an orogastric tube. For comatose patients, airway protection with an endotracheal tube is necessary to prevent aspiration. Activated charcoal effectively adsorbs many drugs or toxins due to its large surface area, but it poorly adsorbs metals, alcohols, and cyanides. Lastly, cathartic agents like polyethylene glycol electrolyte solution can enhance gut decontamination by promoting whole bowel irrigation and removing toxins from the GI tract. This solution is administered until the rectal effluent appears clear.

Prevention of further absorption of injected toxins requires immediate medical attention and specific interventions. The entry point should be promptly cleaned and disinfected, and if applicable, sealed with sterile dressings. Control of bleeding at the injection site is essential to minimize further toxin spread. Elevation of the affected limb may help reduce systemic dissemination. Administering antidotes or specific treatments to counteract the toxins' effects is crucial if available. Oral activated charcoal might be used to prevent toxin absorption from the gastrointestinal tract. Vigilant monitoring of vital signs and providing supportive care are vital to managing complications and mitigating adverse effects caused by the injected toxins.