1. Overview Introduction
Poisoning is a serious global public health issue, especially in low-resource and pediatric settings. It can occur accidentally, occupationally, recreationally, or intentionally. Effective management requires quick identification and treatment, often involving specific antidotes. With growing exposure to various toxic agents, timely intervention is crucial. This guide provides a vital reference for healthcare professionals and the public, outlining common poisons and their treatments.
1.1. Global Burden of Poisoning
According to the Global Burden of Disease Study (IHME, 2024), unintentional poisoning accounts for an estimated 2.5 deaths per 100,000 people annually, with higher rates in low- and middle-income countries. The World Health Organization (WHO) reports that only 47% of member states have a functional poison control center, leaving large populations vulnerable to delayed or inadequate treatment. The rise in synthetic drugs, industrial chemicals, and pesticide use has further complicated the landscape of toxic exposures.
1.2. Problem Statement
Despite major advances in toxicology and emergency medicine, poisoning remains a significant yet under-recognized global health crisis. Worldwide, an estimated 2.6 deaths per 100,000 people result from both intentional and unintentional exposures to chemicals, pharmaceuticals, and biological toxins, translating into over 200,000 fatalities each year. Serious poisoning events requiring hospitalization may number as high as 500,000 annually, yet the data are fragmented and underestimate the true burden, especially in resource-limited settings.
Only 47% of WHO Member States maintain functional poison control centers, leaving more than half the world’s population without rapid expert guidance on diagnosis or management of toxic exposures. The lack of centralized data collection, standardized treatment protocols, and public awareness further compounds delays in antidote administration delays that often prove fatal.
The situation is particularly acute in Africa, where poison control infrastructure is sparse, and clinical toxicology expertise is limited. In East African hospitals, acute poisoning cases account for 1.8–2.3% of total admissions, with mortality rates approaching 10% in severe instances. Pesticides, snakebite envenomation, and pharmaceutical overdoses dominate these exposures, yet antidote availability and regulatory oversight remain inconsistent across the region.
In many African countries, weak chemical regulation, frequent stock-outs of life-saving antidotes, and reliance on traditional remedies contribute to preventable deaths and long-term disabilities. Without a comprehensive, evidence-based reference guiding first responders and clinicians through toxin identification and treatment, millions remain at risk. This gap underscores the urgent need for a unified, accessible guide to poisons and their antidotes tailored to both global best practices and the realities of African health systems.
1.3. The African Context
In Africa, the situation is particularly acute. A 2023 review highlights food poisoning outbreaks caused by pathogens like Vibrio cholerae, Shigella flexneri, and E. coli O157:H7, with mortality rates reaching 27% in some outbreaks. The Africa CDC continues to flag poisoning events as high-risk in its weekly surveillance reports. Contributing factors include:
- Inadequate regulation of imported food and chemicals
- Limited toxicology training among healthcare workers
- Sparse poison control infrastructure
- High reliance on traditional remedies, which may delay effective treatment
1.4. Why This Guide Matters
This guide aims to bridge the knowledge gap by providing clear, accessible, and medically accurate information on poisons and their antidotes. It empowers readers to recognize symptoms, understand mechanisms of toxicity, and respond swiftly because in toxicology, time is often the difference between life and death.
2. Prevalence & Classification of Poisoning
2.0. Introduction
Global mortality from unintentional poisoning stands at 2.6 deaths per 100 000 population annually, accounting for roughly 250 000 fatalities each year. Poisoning exposures can be broadly classified into six major types, each with distinct sources and risk patterns.
| Type of Poison | Global Mortality Rate<br>(per 100 000) | Common Sources |
|---|---|---|
| Pharmaceutical overdoses | 1.2 | Opioids (fentanyl, heroin), acetaminophen tablets |
| Pesticide poisoning | 0.8 | Organophosphates (malathion), carbamates, rodenticides |
| Chemical/industrial | 0.3 | Heavy metals (lead, mercury), organic solvents, acids |
| Venomous bites & stings | 0.2 | Snake venoms (vipers, cobras), scorpion & spider toxins |
| Biological toxins | 0.1 | Botulinum toxin, bacterial exotoxins, marine toxins |
| Miscellaneous exposures | 0.2 | Mycotoxins, shellfish toxins, household chemicals |
Sources: WHO Global Health Estimates 2024; IHME GBD Study 2021 via Our World in Data 2024
2.1 Global Burden (WHO, 2024)
- Annual Poisoning Cases: ~7 million (leading to 1.1 million deaths).
- Top Causes: Pharmaceuticals (34%), pesticides (25%), household chemicals (20%).
- Disparity: Low/middle-income countries (LMICs) bear 75% of fatalities due to limited antidote access.
Table 2.1: Types of Poisons, Global Prevalence & Common Sources
| Type of Poison | Global Prevalence | Common Sources | High-Risk Regions |
|---|---|---|---|
| Pharmaceuticals | 34% of poisoning deaths (Lancet, 2025) | Paracetamol, opioids, sedatives | Global (esp. North America, West Africa) |
| Pesticides | 25% (WHO, 2024) | Organophosphates, paraquat, rodenticides | Rural Asia, East Africa |
| Household Chemicals | 20% (IHME, 2023) | Bleach, kerosene, detergents | LMICs (poor storage practices) |
| Biological Toxins | 15% (Africa CDC, 2024) | Snake venom, poisonous plants, fungi | Sub-Saharan Africa, South Asia |
| Heavy Metals | 6% (UNEP, 2023) | Lead (paint, mining), mercury (gold mining) | Africa, South America |
Table 2.2: Africa-Specific Poisoning Data
| Poison Type | Prevalence in Africa | Key Sources | Antidote Access Gap |
|---|---|---|---|
| Pesticides | 40% of poisoning deaths (WHO, 2024) | Farming misuse, suicide attempts | Atropine stockouts in 60% of clinics |
| Snakebites | 20,000 deaths/year (PLoS NTD, 2024) | Cobras, vipers, mambas | Antivenom available in <10% of cases |
| Traditional Herbs | 15% of hepatotoxicity (J. Tox, 2024) | Contaminated "Agbo" mixtures (Nigeria) | No standardized antidotes |
| Opioids (Tramadol) | Epidemic in West Africa (UNODC, 2024) | Illicit tramadol trafficking | Naloxone scarce outside cities |
Key Insights
- Pharmaceuticals dominate in urban areas; pesticides prevail in rural Africa.
- Children <5 years account for 45% of accidental poisonings globally (Global Burden of Disease, 2023).
- Africa’s snakebite crisis is exacerbated by fake antivenoms (30% counterfeit market, Africa CDC).
References (2023–2025)
- WHO Global Report on Poisoning (2024).
- Lancet Study on Pharmaceutical Overdoses (2025).
- Africa CDC Snakebite Report (2024).
- UNEP Heavy Metal Pollution Data (2023).
3. Common Poisons, Symptoms, and Antidotes
3.1. Chemical & Heavy Metal Poisons
| Poison | Antidote/Treatment |
|---|---|
| Cyanide | Hydroxocobalamin (Cyanokit), Sodium thiosulfate, Amyl nitrite |
| Carbon Monoxide | 100% oxygen, Hyperbaric oxygen therapy |
| Arsenic | Dimercaprol (BAL), Succimer (DMSA), Penicillamine |
| Mercury | Dimercaprol, Succimer, Penicillamine |
| Lead | EDTA, Succimer (DMSA), Dimercaprol (for severe cases) |
| Iron | Deferoxamine (Desferal) |
| Cadmium | EDTA (limited efficacy), supportive care |
| Methanol/Ethylene Glycol | Fomepizole or Ethanol, Hemodialysis |
3.2. Pesticides & Organophosphates
| Poison | Antidote/Treatment |
|---|---|
| Organophosphates (e.g., Parathion, Malathion) | Atropine + Pralidoxime (2-PAM) |
| Carbamates (e.g., Aldicarb) | Atropine (Pralidoxime not always needed) |
| Warfarin (Rodenticide) | Vitamin K₁ (Phytonadione), Fresh Frozen Plasma (for severe bleeding) |
| Superwarfarins (Brodifacoum) | Long-term Vitamin K₁ therapy |
| Aluminum Phosphide | No specific antidote; magnesium sulfate & supportive care |
3.3. Drug Overdoses
| Poison | Antidote/Treatment |
|---|---|
| Opioids (e.g., Heroin, Fentanyl) | Naloxone (Narcan) |
| Benzodiazepines (e.g., Diazepam, Xanax) | Flumazenil (limited use due to seizure risk) |
| Acetaminophen (Paracetamol) | N-acetylcysteine (NAC) |
| Beta-blockers (e.g., Propranolol) | Glucagon, High-dose insulin, Vasopressors |
| Calcium Channel Blockers (e.g., Verapamil) | Calcium gluconate, High-dose insulin, Vasopressors |
| Digoxin (Cardiac Glycosides) | Digoxin-specific antibody fragments (Digibind/Digifab) |
| Tricyclic Antidepressants (e.g., Amitriptyline) | Sodium bicarbonate (for QRS widening) |
| Methotrexate | Leucovorin (Folinic acid) |
3.4. Biological & Natural Toxins
| Poison | Antidote/Treatment |
|---|---|
| Snake Venom (e.g., Cobra, Viper) | Species-specific antivenom |
| Black Widow Spider Venom | Antivenom (Latrodectus mactans) |
| Scorpion Sting | Antivenom (species-dependent) |
| Botulinum Toxin | Botulism antitoxin |
| Amanita phalloides (Death Cap Mushroom) | Silibinin (Milk Thistle), Penicillin G, N-acetylcysteine |
| Tetrodotoxin (Pufferfish) | Supportive care (no specific antidote) |
3.5. Miscellaneous Toxins
| Poison | Antidote/Treatment |
|---|---|
| Heparin (Anticoagulant) | Protamine sulfate |
| Warfarin (Anticoagulant) | Vitamin K₁, FFP |
| Methemoglobinemia (Nitrites, Dapsone) | Methylene blue |
| Ciguatera Fish Poisoning | Mannitol (controversial), supportive care |
3.6. Comprehensive List of Poisons and Their Antidotes
| Poison Name | Type / Source | Common Symptoms | Antidote / Treatment |
|---|---|---|---|
| Acetaminophen (Paracetamol) | Overdose from painkillers | Liver damage, nausea, vomiting, confusion | N-acetylcysteine (NAC) |
| Organophosphates | Pesticides, insecticides | Salivation, lacrimation, urination, diarrhea, bradycardia | Atropine + Pralidoxime (2-PAM) |
| Carbon Monoxide (CO) | Car exhaust, fires, faulty heaters | Headache, dizziness, cherry red skin, unconsciousness | 100% Oxygen, Hyperbaric oxygen therapy |
| Cyanide | Smoke inhalation, industrial exposure, certain seeds (apricot pits) | Seizures, coma, cardiovascular collapse | Hydroxocobalamin, Sodium thiosulfate, Amyl nitrite |
| Methanol | Contaminated alcohol, windshield washer fluid | Visual disturbances, metabolic acidosis, coma | Fomepizole or Ethanol + Bicarbonate, Hemodialysis |
| Ethylene Glycol | Antifreeze | Kidney failure, metabolic acidosis, CNS depression | Fomepizole or Ethanol, Hemodialysis, Thiamine, Pyridoxine |
| Iron overdose | Iron tablets (children common accidental ingestion) | Vomiting, abdominal pain, metabolic acidosis | Deferoxamine (iron chelator) |
| Lead | Paint, old plumbing, batteries | Abdominal pain, anemia, neurotoxicity | Dimercaprol (BAL), EDTA, Succimer (DMSA) |
| Arsenic | Pesticides, contaminated water | Vomiting, garlic breath, neuropathy | Dimercaprol (BAL), Succimer (DMSA) |
| Mercury | Thermometers, batteries, industrial waste | Tremor, personality changes, kidney damage | Dimercaprol (BAL), Succimer (DMSA) |
| Digoxin | Digitalis toxicity | GI upset, visual changes (yellow vision), arrhythmias | Digoxin-specific antibody (Digibind) |
| Opioids (morphine, heroin, etc.) | Painkillers, recreational drugs | Respiratory depression, pinpoint pupils, unconsciousness | Naloxone (Narcan) |
| Benzodiazepines | Sedatives (e.g., diazepam, lorazepam) | CNS depression, confusion, slurred speech | Flumazenil (use with caution due to seizure risk) |
| Heparin overdose | Anticoagulant overdose | Bleeding, bruising | Protamine sulfate |
| Warfarin overdose | Anticoagulant overdose | Bleeding, prolonged PT/INR | Vitamin K (Phytonadione), Fresh frozen plasma if urgent |
| Isoniazid (INH) | TB medication | Seizures, metabolic acidosis | Pyridoxine (Vitamin B6) |
| Beta-blockers | Heart medications | Bradycardia, hypotension, hypoglycemia | Glucagon, Atropine, Calcium |
| Calcium Channel Blockers | Antihypertensives (e.g., verapamil, diltiazem) | Bradycardia, hypotension, shock | Calcium gluconate, Glucagon, Insulin + glucose, Vasopressors |
| Sulfonylureas (glipizide, etc.) | Antidiabetic drugs | Hypoglycemia | Glucose, Octreotide |
| Methemoglobinemia agents | Nitrates, benzocaine, aniline dyes | Cyanosis, chocolate-colored blood | Methylene Blue |
| TCA (Tricyclic Antidepressants) | Antidepressants | Arrhythmias, hypotension, seizures, anticholinergic signs | Sodium bicarbonate IV (for QRS widening) |
| Salicylates (Aspirin) | Overdose | Tinnitus, metabolic acidosis, respiratory alkalosis | Sodium bicarbonate, Activated charcoal, Hemodialysis |
| Theophylline | Asthma medication | Nausea, seizures, arrhythmias | Activated charcoal, Beta-blockers (propranolol) |
| Cholinergic toxins | Nerve agents, pesticides | SLUDGE syndrome (Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis) | Atropine, Pralidoxime |
| Anticholinergics (e.g. atropine) | Antihistamines, nightshade plants | Hot, dry, blind, red, mad symptoms | Physostigmine (in severe cases) |
| Snake Venom (Neurotoxic or Hemotoxic) | Snakebite from cobras, vipers, mambas | Local pain, swelling, neurotoxicity, bleeding | Antivenom (based on species) |
| Scorpion Sting (severe) | Bark scorpions, especially in children | Muscle twitching, agitation, seizures | Antivenom, Benzodiazepines for seizures |
| Black Widow Spider Bite | Latrodectus venom | Muscle cramps, pain, sweating | Calcium gluconate, Benzodiazepines, Antivenom (rare) |
| Brown Recluse Spider Bite | Loxosceles venom | Necrotic skin ulcer, fever, malaise | Supportive care, Dapsone (controversial) |
| Amphetamines | Stimulants, ADHD meds, recreational drugs | Agitation, hypertension, seizures | Sedation with benzodiazepines, Cooling, Antihypertensives |
| Cocaine | Illicit drug, local anesthetic | Chest pain, seizures, hallucinations | Benzodiazepines, Nitroglycerin for chest pain |
| Alcohol (Ethanol) overdose | Liquor, spirits | Vomiting, stupor, respiratory depression | Supportive care, Thiamine, Glucose |
| Amanita phalloides (Mushroom) | Death cap mushroom | Delayed liver failure, vomiting, seizures | Silibinin, Penicillin G, Activated charcoal |
| Fluoride poisoning | Dental products, industrial exposure | Hypocalcemia, GI distress | Calcium gluconate, Milk, IV fluids |
| Chlorine Gas | Cleaning products, industrial accident | Coughing, pulmonary edema | Oxygen, bronchodilators, supportive therapy |
| Hydrofluoric Acid | Industrial cleaner, glass etching | Severe pain, electrolyte imbalances, arrhythmias | Calcium gluconate (topical and IV) |
| Aniline Dyes / Nitrites | Industry, drugs | Cyanosis, low O2 sat despite O2 therapy | Methylene blue (for methemoglobinemia) |
| Strychnine | Rodenticides | Convulsions, muscle spasms, hyperreflexia | Benzodiazepines, supportive care |
3.7. Quick Reference by Poison Type
| Category | Example Poisons | Main Antidote |
|---|---|---|
| Heavy Metals | Lead, Mercury, Arsenic | BAL, DMSA, EDTA |
| Sedatives | Opioids, Benzodiazepines | Naloxone, Flumazenil |
| Cardiac Drugs | Beta-blockers, Digoxin, CCBs | Glucagon, Digibind, Calcium |
| Anticoagulants | Warfarin, Heparin | Vitamin K, Protamine sulfate |
| Alcohols | Methanol, Ethylene glycol | Fomepizole, Ethanol |
| Pesticides | Organophosphates | Atropine + Pralidoxime |
| Gas Inhalants | CO, Cyanide | 100% O₂, Hydroxocobalamin |
| Industrial/Household | Fluoride, Hydrofluoric acid, Iron | Calcium gluconate, Deferoxamine |
3.8. Pregnancy-Safe Treatments for Poisoning
Poisoning in pregnancy poses a dual risk both to the mother and the developing fetus. Treatment decisions must balance maternal benefit with fetal safety. Below is a specialized table of common poisons and their safest antidotes in pregnancy:
3.8.1. Pregnancy-Safe Antidotes by Poison
| Poison | Risks in Pregnancy | Preferred Treatment / Antidote | Pregnancy Considerations |
|---|---|---|---|
| Acetaminophen (Paracetamol) | Liver toxicity can harm both mother and fetus | N-acetylcysteine (NAC) | Safe in all trimesters |
| Organophosphates | Cholinergic crisis, risk of fetal hypoxia | Atropine + Pralidoxime (2-PAM) | Generally considered safe; benefits outweigh risks |
| Carbon Monoxide (CO) | Hypoxia to fetus; high fetal affinity for CO | 100% Oxygen, Hyperbaric oxygen | Hyperbaric O₂ is used cautiously; maternal O₂ always prioritized |
| Iron Overdose | Liver damage, GI bleeding | Deferoxamine | Use with caution; potential benefit outweighs theoretical risk |
| Methanol / Ethylene Glycol | Metabolic acidosis, fetal death | Fomepizole (preferred over ethanol), Hemodialysis | Fomepizole is preferred; ethanol may cause fetal alcohol effects |
| Opioids (e.g., morphine) | Respiratory depression in both mother and fetus | Naloxone (Narcan) | Safe in emergencies; monitor fetal distress |
| Benzodiazepines | Sedation, hypotonia, withdrawal syndrome in newborn | Flumazenil (rarely needed) | Use cautiously; monitor fetus for distress |
| Warfarin | Teratogenic (nasal hypoplasia, CNS defects) | Vitamin K (for overdose) | Safe as antidote; warfarin avoided in pregnancy |
| Heparin | Preferred anticoagulant in pregnancy | Protamine sulfate | Safe |
| Lead | Neurodevelopmental delay, miscarriage | Succimer (DMSA) | Not first-line; consult toxicologist; chelation only if severe |
| Cyanide | Rapid fetal hypoxia, death | Hydroxocobalamin | Considered safer than other cyanide kits; prioritize maternal survival |
| Digoxin | Fetal bradycardia, arrhythmia (if overdose) | Digoxin-specific antibody (Digibind) | Safe when indicated |
| Salicylates (Aspirin) | Fetal acidosis, bleeding, premature closure of ductus arteriosus | Sodium bicarbonate, Hemodialysis | Antidotes safe; aspirin use discouraged during late pregnancy |
| Methemoglobinemia | Fetal hypoxia | Methylene blue | Use with caution; may be teratogenic in high doses in 1st trimester |
| TCA Overdose | Fetal arrhythmias, CNS toxicity | Sodium bicarbonate IV | Safe |
| Snake Venom | Uterine contractions, miscarriage, fetal death | Antivenom (species-specific) | Used if benefits outweigh risks; always under specialist care |
| Arsenic/Mercury | CNS defects, miscarriage | Dimercaprol (BAL), DMSA | DMSA is preferred over BAL; only if poisoning is severe |
| Alcohol Poisoning | Fetal alcohol syndrome | Supportive therapy | Thiamine, glucose – safe |
3.8.2. Important Notes:
- Maternal stabilization is priority: Always treat the mother first fetal safety depends on maternal survival.
- Teratogenicity depends on trimester:
- 1st trimester: highest risk for congenital anomalies.
- 3rd trimester: fetal drug effects (e.g., withdrawal, respiratory depression).
- Avoid contraindicated antidotes unless no alternative exists and the benefit outweighs the risk.
- Always consult a toxicologist or maternal-fetal medicine (MFM) specialist in cases of poisoning in pregnancy.
Read also:
- Safeguarding Maternal and Fetal Health: Drugs to Avoid During Pregnancy
- Medications or Drugs: Contraindications and Precautions during Pregnancy
- Nourishing the Bump: A Guide to What Pregnant Women Should Eat and Avoid
- The Incredible Journey of Fetal Development: A Comprehensive Guide for Parents
- Reproductive Health Is Not a Taboo—It’s Power: 7 Truths We All Need to Embrace Today
3.8.3. Safe Antidotes Summary:
| Generally Safe in Pregnancy | Use with Caution | Contraindicated / Avoid if Possible |
|---|---|---|
| Oxygen | Fomepizole | Ethanol (due to fetal alcohol effects) |
| NAC | Deferoxamine | Methylene blue (1st trimester) |
| Vitamin K | DMSA (succimer, only if needed) | Warfarin (as a medication, not antidote) |
| Naloxone | Hydroxocobalamin | BAL (Dimercaprol – 1st trimester caution) |
| Protamine | Pralidoxime |
General Rules
- Stabilize the mother first fetal safety depends on maternal survival.
- Avoid teratogenic drugs unless life-threatening (e.g., ethanol, methylene blue).
- Collaborate with toxicology and obstetrics teams in severe poisonings.
Poisoning in Pregnancy: Safe Management
- Avoid teratogenic drugs (e.g., some antivenoms or chelators).
- Use NAC, oxygen, and supportive care where applicable.
- Ensure close fetal monitoring in moderate-to-severe exposures.
- Seek immediate teratology consultation in suspected exposure.
4. Risk Groups and Common Triggers for Poisoning
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Identifying who is most vulnerable and why
👥 4.1. High-Risk Population Groups
💥 4.2. Common Triggers for Poisoning🧪 Medication-Related
🧴 Chemical & Household Products
🌾 Occupational & Environmental
🧠 Behavioral and Psychological
🌡️ Temperature & Storage Factors
🧬 4.3. Genetic & Physiological Triggers
Triggers include: poor labeling, lack of childproof containers, substance misuse, unsafe storage, and inadequate regulation. Special Considerations in Pregnancy
Key Prevention Tips by Risk Group
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|---|
5. Areas of the Body Affected & Diagnostic Techniques in Poisoning
Understanding systemic effects and how to detect them early
5.1. Common Body Systems Affected by Poisoning
| System / Organ | Affected Poisons | Clinical Signs & Symptoms |
|---|---|---|
| Nervous System (CNS) | Opioids, organophosphates, lead, CO, alcohol, TCAs | Confusion, seizures, coma, hallucinations, tremors |
| Respiratory System | CO, opioids, organophosphates, paraquat, smoke inhalation | Respiratory depression, hypoxia, bronchospasm, ARDS |
| Cardiovascular System | Beta-blockers, calcium channel blockers, TCAs, digoxin | Bradycardia, arrhythmias, hypotension, cardiac arrest |
| Gastrointestinal Tract | Iron, arsenic, alcohol, pesticides | Nausea, vomiting, GI bleeding, diarrhea |
| Renal System (Kidneys) | Ethylene glycol, heavy metals, NSAIDs | Oliguria, hematuria, elevated creatinine, renal failure |
| Hepatic System (Liver) | Acetaminophen, isoniazid, alcohol, amanita mushrooms | Jaundice, hepatomegaly, elevated liver enzymes, coagulopathy |
| Skin & Soft Tissue | Snake venom, chemical burns, corrosives, hydrocarbons | Burns, necrosis, discoloration, blistering |
| Hematologic System | Nitrates, antimalarials, sulfa drugs, warfarin | Methemoglobinemia, bleeding, anemia |
| Fetal System (Pregnancy) | CO, lead, alcohol, mercury | Fetal hypoxia, malformations, developmental delay |
5.2. Diagnostic Techniques in Poisoning
🧬 5.2.1. Laboratory Tests
| Test | Purpose / Target |
|---|---|
| Toxicology screen (urine/blood) | Detects common drugs/toxins (e.g., opioids, benzos, cocaine) |
| Liver function tests (LFTs) | Monitor hepatotoxicity (e.g., acetaminophen, INH) |
| Renal function (creatinine, BUN) | Assess nephrotoxic exposure (e.g., ethylene glycol) |
| Serum electrolytes & ABG | Identify acidosis, electrolyte shifts (e.g., salicylates) |
| Serum osmol & anion gap | Detect toxic alcohols or metabolic poisons |
| Co-oximetry / carboxyhemoglobin | Diagnose carbon monoxide poisoning |
| Methemoglobin level | For nitrate, dapsone, or benzocaine toxicity |
| Whole blood lead level | For chronic lead poisoning in children or adults |
| Drug-specific levels | Paracetamol, digoxin, lithium, salicylate, iron |
🧑⚕️ 5.2.2. Imaging & Other Diagnostics
| Tool | Use in Poisoning |
|---|---|
| Chest X-ray | Detect pulmonary edema (e.g., salicylates), aspiration, foreign body |
| Abdominal X-ray | Visualize radio-opaque toxins (e.g., iron, heavy metals, packets) |
| CT / MRI Brain | Evaluate seizures, coma, neurotoxicity (e.g., CO, lead) |
| ECG (Electrocardiogram) | Detect arrhythmias (e.g., TCAs, digoxin, beta-blockers) |
| Pulse oximetry | For oxygenation; limited in CO/methemoglobinemia |
| Endoscopy | Assess caustic ingestion (e.g., acids, alkalis) |
5.3. Clinical Clues by Body Region
| Region | Visual / Symptom Clues | Suspected Toxins |
|---|---|---|
| Eyes (pupils) | Miosis (constricted): opioids, organophosphatesMydriasis: anticholinergics, amphetamines | Opioids, stimulants, anticholinergics |
| Skin | Dry flushed skin: anticholinergicDiaphoresis: organophosphates | Anticholinergics, cholinergics |
| Mouth | Garlic odor: arsenic, organophosphatesBurns: caustics | Arsenic, acids, alkalis |
| Abdomen | Cramping, vomiting, diarrhea | Iron, salicylates, heavy metals |
| Extremities | Tremors, weakness, paralysis | Lead, organophosphates, snake venom |
5.4. Diagnostic Mnemonics
DUMBELS for cholinergic (organophosphate) poisoning:
- Diarrhea
- Urination
- Miosis
- Bradycardia
- Emesis
- Lacrimation
- Salivation
"Hot as a hare, dry as a bone…" for anticholinergic syndrome:
- Hyperthermia, dry skin, mydriasis, delirium, urinary retention
6. Poisoning Prevention & Home Care Strategies
🛡️ 6.1. General Poisoning Prevention Tips
👩👧 6.2. Child & Family-Focused Measures
🛏️ 6.3. Home Care for Poisoning Recovery
🚫 6.4. What NOT to Do at Home
🆘 5. Emergency Action Plan at Home
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| ⚠️ Never administer milk, vinegar, or oil as “antidotes” without professional guidance. |
7. Comprehensive Treatment Timelines & Management Table
7.1. For Major Poisons and Their Antidotes
| Poison | Onset of Symptoms | Time Window for Antidote Effectiveness | Antidote / Treatment | Supportive Care & Monitoring | Repeat Doses? / Special Notes |
|---|---|---|---|---|---|
| Acetaminophen | 4–24 hours | Best within 8–10 hours post-ingestion | N-acetylcysteine (NAC) | Monitor liver enzymes (AST/ALT), coagulation profile, mental status | Oral or IV NAC protocols available. May repeat based on plasma levels. |
| Organophosphates | Minutes–6 hours | Immediate treatment preferred | Atropine + Pralidoxime (2-PAM) | Airway support, oxygen, IV fluids, seizure control. Monitor cholinesterase levels. | Atropine dosing repeated until secretions dry. PAM often dosed over 24–48 hrs |
| Carbon Monoxide (CO) | Within minutes | Hyperbaric O₂ most effective early (<6 hrs) | 100% Oxygen, Hyperbaric Oxygen | Pulse oximetry not reliable; use carboxyhemoglobin levels. Monitor neurologic status. | Hyperbaric therapy repeated in severe cases |
| Cyanide | Seconds–minutes | Immediate | Hydroxocobalamin (preferred), Sodium thiosulfate | High-flow O₂, BP support, ECG. Monitor for lactic acidosis. | Hydroxocobalamin can cause red discoloration of skin/urine |
| Methanol / Ethylene Glycol | 12–24 hours | Best if within 4–8 hours | Fomepizole or Ethanol + Hemodialysis | Correct acidosis with bicarbonate. Monitor anion gap, osmolar gap, renal function. | May require multiple dialysis sessions |
| Iron | 30 mins–6 hours | Deferoxamine ideally within 6–12 hrs | Deferoxamine | IV fluids, monitor GI bleeding, LFTs, ferritin, anion gap. | Stop Deferoxamine once urine turns pink and symptoms resolve |
| Opioids | Minutes | Naloxone acts within 1–2 minutes | Naloxone (Narcan) | Respiratory support, monitor O₂ sat, ECG, observe for recurrence. | May repeat every 2–3 mins or continuous infusion if long-acting opioids |
| Benzodiazepines | 1–4 hours | Immediate reversal | Flumazenil (use with caution) | Monitor for seizures, especially if chronic BZD user or co-ingestions | Avoid in chronic users – may cause withdrawal/seizures |
| Digoxin | 1–12 hours | Best within 24 hours of toxicity | Digoxin immune Fab (Digibind) | Monitor K+, ECG, serum digoxin. Treat arrhythmias. | Dose based on serum digoxin and body weight |
| Heparin | Immediate–1 hr | Protamine most effective <2 hours post-dose | Protamine sulfate | Monitor aPTT, watch for hypotension or allergy during IV infusion | Dose based on amount of heparin received |
| Warfarin | Days | Antidote works within 6–12 hours | Vitamin K (Phytonadione) | Monitor INR/PT, bleeding risk. Consider FFP or PCC in active bleeding | PO or IV route depending on urgency. Monitor INR for several days |
| TCA Overdose | <2 hours | Within 6–8 hours | Sodium bicarbonate | Monitor ECG for QRS widening. Treat seizures. Cardiac monitoring for 24–48 hrs | Bicarbonate boluses repeated as needed to narrow QRS |
| Salicylates (Aspirin) | 6–24 hours | Dialysis effective in severe cases | Sodium bicarbonate, Dialysis | Correct acidosis, hydrate, monitor salicylate levels, electrolytes | Alkalinize urine; may require repeat dialysis |
| Methemoglobinemia | Minutes–2 hours | Immediate methylene blue administration | Methylene blue | Monitor O₂ saturation (won’t improve with O₂), check ABG, avoid in G6PD deficiency | Repeat dose after 1 hour if symptoms persist |
| Lead | Chronic | Chelation when levels >45 µg/dL | DMSA (Succimer), EDTA, BAL | Neuro checks, CBC, renal function, X-ray (if ingestion suspected) | Chelation cycles may be repeated every 2–3 weeks |
| Arsenic/Mercury | Hours–days | Best within 1–2 days | BAL (Dimercaprol), DMSA | Monitor kidneys, ECG, neuro signs, CBC | Repeat cycles may be needed |
| Sulfonylureas | <1 hour | Octreotide best within first few hours | Octreotide + Glucose | Monitor glucose hourly for 24 hours | Octreotide may be given every 6–12 hrs |
| Beta-blockers | 1–6 hours | Immediate glucagon preferred | Glucagon, High-dose insulin, IV fluids | Continuous cardiac monitoring. May need vasopressors. | Repeat glucagon boluses or continuous infusion |
| Calcium Channel Blockers | 1–6 hours | Treat as early as possible | Calcium gluconate, High-dose insulin | Monitor glucose, BP, calcium, potassium | May need prolonged insulin therapy |
| Snake Venom | 30 mins–6 hours | Antivenom ASAP within 6 hours | Species-specific Antivenom | Monitor for anaphylaxis. CBC, renal, coagulation profiles. Elevate limb. | May require additional antivenom doses |
| Isoniazid (INH) | 30 mins–2 hrs | Vitamin B6 immediate to stop seizures | Pyridoxine (IV) | Seizure control (benzos), acidosis correction | Match mg of INH ingested with B6 dose |
| Amphetamines | <1 hour | No antidote – supportive only | Benzodiazepines, Cooling, Fluids | ECG, agitation control, watch for rhabdomyolysis | No specific antidote, but may need ICU care |
| Cocaine | <1 hour | No antidote – supportive | Benzodiazepines, Nitroglycerin | Treat chest pain, hypertension, avoid beta-blockers | Monitor for MI and arrhythmias |
| Alcohol (Ethanol) | Hours | Supportive care | Thiamine, Fluids, Glucose | Monitor for Wernicke’s encephalopathy, treat hypoglycemia | Banana bag: Thiamine + Folic acid + Dextrose |
📌 Notes:
- Early administration of antidotes improves outcomes.
- Some poisonings (e.g., salicylates, methanol, lithium) may require hemodialysis.
- In pregnant patients, always weigh risks of treatment vs. maternal and fetal outcomes.
- Repeat doses are often necessary for long-acting agents (opioids, TCAs, beta-blockers).
- Use tox screens, serum levels, ECG, and vitals for monitoring effectiveness.
7.2 Comprehensive Poison Management by Clinical Category
🧠 7.2.1. Neurologic and CNS Poisons
| Poison | Onset | Antidote | Best Given | Supportive Management | Notes |
|---|---|---|---|---|---|
| Opioids | Minutes | Naloxone | Within 1–5 mins | Respiratory support, oxygen, monitoring | May need repeat or continuous infusion |
| Benzodiazepines | 1–4 hrs | Flumazenil (caution) | ASAP in acute, recent use | Seizure control, airway, avoid in chronic users | Flumazenil may precipitate withdrawal |
| Isoniazid (INH) | 30 min–2 hrs | Pyridoxine (Vit B6) | Immediate | Benzos for seizures, correct acidosis | Dose matched to INH amount |
| Cocaine | <1 hr | None (supportive) | ASAP | Benzos for agitation, nitroglycerin for chest pain | Avoid beta-blockers |
| Amphetamines | <1 hr | None (supportive) | ASAP | Cooling, fluids, seizure prevention | Watch for rhabdomyolysis |
❤️ 7.2.2. Cardiovascular Poisons
| Poison | Onset | Antidote | Best Given | Supportive Care | Notes |
|---|---|---|---|---|---|
| Beta-blockers | 1–6 hrs | Glucagon, high-dose insulin | Early | Fluids, pacing, inotropes, glucose | May need repeat doses or infusion |
| Calcium Channel Blockers | 1–6 hrs | Calcium gluconate, insulin | Early | Monitor glucose, BP, calcium | Long ICU stays possible |
| Digoxin | 1–12 hrs | Digoxin immune Fab | Within 24 hrs | Monitor ECG, K+, renal status | Dose by serum levels or body weight |
| TCA Overdose | <2 hrs | Sodium bicarbonate | Within 6–8 hrs | ECG for QRS width, seizure control | Repeated bicarb boluses possible |
| Cyanide | Seconds | Hydroxocobalamin, Na thiosulfate | Immediate | High-flow O₂, manage lactic acidosis | Hydroxocobalamin preferred in pregnancy |
🧬 7.2.3. Metabolic & Endocrine Poisons
| Poison | Onset | Antidote | Best Given | Supportive Care | Notes |
|---|---|---|---|---|---|
| Sulfonylureas | <1 hr | Octreotide + glucose | Within 2–3 hrs | Monitor glucose hourly, IV glucose as needed | Repeated octreotide may be needed |
| Iron | 30 min–6 hr | Deferoxamine | Within 6–12 hrs | Monitor GI bleeding, LFTs, urine color | Stop when symptoms resolve |
| Warfarin | Days | Vitamin K | Within 6–12 hrs | Monitor INR, give FFP/PCC for bleeding | Oral/IV depending on severity |
| Heparin | Immediate | Protamine sulfate | Within 2 hrs | Monitor aPTT, allergic reaction risk | Dose depends on heparin amount |
| Salicylates | 6–24 hrs | Bicarbonate, dialysis | Early as possible | Alkalinize urine, manage acidosis | Repeat dialysis if severe |
⚠️ 7.2.4. Toxic Alcohols & Household Chemicals
| Poison | Onset | Antidote | Best Given | Supportive Care | Notes |
|---|---|---|---|---|---|
| Methanol | 12–24 hrs | Fomepizole or ethanol | Within 4–8 hrs | Dialysis, bicarbonate, monitor anion gap | Fomepizole preferred in pregnancy |
| Ethylene Glycol | 12–24 hrs | Fomepizole or ethanol | Within 4–8 hrs | Same as above | May require multiple dialysis sessions |
| Carbon Monoxide | Minutes | 100% Oxygen / Hyperbaric | ASAP, within 6 hrs | Pulse CO-oximetry, neuro-monitoring | Hyperbaric oxygen for severe cases |
| Fluoride/HF Acid | Immediate | Calcium gluconate | Immediate | Topical or IV calcium, EKG, monitor electrolytes | Topical + systemic treatment often needed |
🧪 7.2.5. Heavy Metals & Industrial Poisons
| Poison | Onset | Antidote | Best Given | Monitoring | Notes |
|---|---|---|---|---|---|
| Lead | Chronic | EDTA, BAL, DMSA | If >45 µg/dL | CBC, renal function, neuro symptoms | Chelation repeated in cycles |
| Arsenic | Hours–days | BAL or DMSA | Within 24–48 hrs | Kidney, ECG, neuro checks | Garlic breath is classic sign |
| Mercury | Chronic/acute | DMSA | Early preferred | CBC, renal, neuro status | Elemental vs. organic mercury differ in effects |
🕷️ 7.2.6. Bites, Venoms, and Toxins
| Poison | Onset | Antidote | Best Given | Supportive Care | Notes |
|---|---|---|---|---|---|
| Snake venom | 30 min–6 hrs | Antivenom (species-specific) | Within 6 hrs ideally | Fluids, elevate limb, monitor for DIC | Repeat antivenom if needed |
| Scorpion sting | Immediate | Antivenom | Immediate | Benzos for seizures, monitor vitals | Available in endemic areas |
| Spider bites | Hours | Antivenom if severe (black widow) | ASAP if neurotoxic | Muscle relaxants, pain control | Supportive in brown recluse |
🩺 7.2.7. Miscellaneous and Other Agents
| Poison | Onset | Antidote | Best Given | Supportive Care | Notes |
|---|---|---|---|---|---|
| Methemoglobinemia | Minutes | Methylene blue | Immediate | Avoid in G6PD deficiency, O₂ doesn't help | Chocolate-colored blood |
| Alcohol (Ethanol) | Hours | Thiamine, glucose, fluids | Early | Treat Wernicke’s with thiamine, dextrose | Use “banana bag” in chronic alcoholics |
Summary Tips
- 🔁 Repeat dosing is common in opioid, TCA, and heavy metal poisonings.
- ⏱️ Time is critical: many antidotes work best within 1–6 hours.
- 👶 Pregnancy: prioritize maternal survival, use safest antidotes available (e.g., hydroxocobalamin over nitrites for cyanide).
- 🧪 Activated charcoal is helpful if given within 1–2 hours (unless contraindicated).
- 📞 Always consult local poison control or toxicology centers.
8. Scarring Risk, Outlook, and Mental Health Impact of Major Poisons
| Poison | Scarring / Physical Damage Risk | Outlook / Prognosis | Mental Health Impact |
|---|---|---|---|
| Acetaminophen | High risk of permanent liver damage or failure if untreated | Good if NAC given early; poor if liver failure develops | Guilt and depression common in intentional overdose; anxiety during liver transplant prep |
| Organophosphates | Neurological sequelae (e.g., chronic weakness, neuropathy) possible | Variable: good with fast atropine/pralidoxime; bad with delayed response | PTSD in farmers/workers; fear of recurrence or re-exposure |
| Carbon Monoxide | Brain injury, cognitive decline; no visible scarring | Variable; delayed neurologic syndrome in up to 40% of cases | Memory issues, irritability, depression; common post-exposure cognitive issues |
| Cyanide | Minimal physical scarring unless hypoxia-induced injury occurs | Fatal without prompt antidote; good recovery with early hydroxocobalamin | Anxiety or trauma in survivors of industrial or fire-related exposures |
| Iron Overdose | GI mucosal erosion/scarring from corrosive injury | Good if chelated early; risk of bowel perforation in massive doses | Fear of medication errors, especially in children |
| Opioids | Minimal scarring; injection-related scars in IV abusers | Good if reversed early; high risk of respiratory arrest in severe overdose | High relapse risk, addiction, depression, trauma from near-death experience |
| Methanol / Ethylene Glycol | Blindness (methanol), kidney damage (ethylene glycol) | Poor if not dialyzed quickly; may need lifelong dialysis or visual aids | Grief, disability adjustment, substance use rehab often required |
| Benzodiazepines | No scarring risk; sedation-related injuries possible | Good with supportive care; rarely fatal alone | Dependency, withdrawal anxiety, long-term cognitive effects in elderly |
| Digoxin | No scarring; arrhythmia damage can cause cardiac dysfunction | Good if Digibind used early; poor in elderly with comorbidities | Anxiety due to heart irregularities and fear of medication |
| Warfarin / Heparin | Internal bleeding may cause long-term organ or tissue damage | Good with rapid reversal; poor in cases of massive hemorrhage | Fear of bleeding, poor adherence, panic over INR fluctuations |
| TCA Overdose | No physical scarring; cardiac arrest or brain damage if prolonged hypoxia | Poor if wide QRS not corrected; good with early sodium bicarb | Long-term anxiety, especially if suicide-related |
| Salicylates | Pulmonary edema or ARDS in late stages; no visible scarring | Fair to good if alkalinized quickly; poor with renal failure | Often linked to suicidal intent; depression and psychosocial issues |
| Lead / Arsenic / Mercury | Neurological impairment, chronic GI distress, gum discoloration | Poor in chronic exposure; variable recovery | Depression, concentration problems, behavioral changes (especially in children) |
| Sulfonylureas | No scarring; risk of hypoglycemia-related injury | Good with octreotide and glucose; hypoglycemic coma possible | Anxiety in diabetics about future hypoglycemia |
| Snake Venom | Severe scarring, tissue necrosis, loss of limb in delayed cases | Good with early antivenom; bad with hemorrhagic/necrotic species | PTSD, fear of nature, phantom pain in amputees |
| Cocaine / Amphetamines | Myocardial damage, stroke risk, chronic nasal or injection site scarring | Risk of MI or CVA high; prognosis poor in chronic users | Addiction, paranoia, hallucinations, depression |
| Alcohol (Ethanol) | Liver scarring (cirrhosis), pancreatitis scarring | Progressive in alcohol use disorder; reversible in early stages | Anxiety, withdrawal psychosis, depression, suicide risk |
| Methemoglobinemia | No physical scarring; transient hypoxia-related symptoms | Excellent with methylene blue; life-threatening if untreated | Minimal unless linked to chronic exposure or misdiagnosis |
8.1. Summary by Category
| Category | Risk of Physical Scarring | Mental Health Burden |
|---|---|---|
| CNS Depressants (Opioids, Benzos) | Low | High: addiction, trauma, withdrawal |
| Household / Industrial Agents | Moderate–High | High: PTSD, occupational anxiety |
| Environmental Gases (CO, Cyanide) | Low–Moderate | Moderate–High (cognitive changes) |
| Heavy Metals | Low (physical), High (neuro) | High: behavioral and emotional impact |
| Cardiac Poisons | Low | Moderate: fear of relapse or heart issues |
| Envenomations | High (visible and functional) | High: trauma, limb loss, anxiety |
| Alcohol & Recreational Drugs | Internal scarring only | Very High: depression, psychosis |
🧠 Clinical Notes:
- Early psychological intervention improves recovery, especially in attempted suicide or chronic poisoning.
- Counseling and rehabilitation referrals should be part of discharge planning.
- Monitor for delayed neurologic symptoms in CO, lead, methanol, and arsenic poisoning.
- Include dermatology/surgery consults in visible scarring cases like snake bites or corrosives.
Psychosocial care, detox programs, and psychiatric evaluations are often needed post-poisoning, especially in intentional cases.
9. Daily Living and Recovery Advice After Poisoning
🧘 9.1. Physical Recovery Guidelines
| Area | Advice |
|---|---|
| Nutrition | Eat antioxidant-rich foods (fruits, leafy greens); hydrate well (2–3 L/day). |
| Liver-friendly diet | If liver was affected (e.g., acetaminophen): avoid alcohol, fatty foods. |
| Renal care | For kidney-affected poisonings (e.g., ethylene glycol, arsenic): reduce sodium, protein, and stay hydrated. |
| Respiratory support | After CO or smoke exposure, avoid dust/pollutants; consider breathing exercises. |
| Exercise | Begin light activities (walking, yoga) once cleared; avoid strenuous workouts until cleared by a doctor. |
| Skin / wound care | Apply prescribed creams to scarring or venom injury sites; avoid sun exposure on healing skin. |
🧠 9.2. Mental and Emotional Recovery
| Common Challenges | Advice |
|---|---|
| Anxiety / Panic | Practice deep breathing; consider counseling or mindfulness techniques. |
| Depression or guilt (suicide attempt) | Seek professional therapy; join support groups; involve family or community support. |
| Post-Traumatic Stress | Avoid triggers (e.g., certain smells, sounds); gradual exposure with guidance. |
| Cognitive fog (after CO, lead, or alcohol poisoning) | Memory aids, puzzles, and cognitive rehab exercises may help. |
💊 9.3. Medication and Follow-Up
| Advice |
|---|
| Take all prescribed antidotes and medications exactly as instructed. |
| Do not self-medicate, always consult your doctor or pharmacist. |
| Keep a toxicology discharge summary with you for future reference. |
| Schedule and attend all follow-up visits: labs, imaging, or rehab. |
🔄 9.4. Preventing Recurrence
| Environment / Home | Action |
|---|---|
| Remove unused meds or chemicals | Safely dispose via pharmacy take-back programs. |
| Install CO and smoke detectors | Especially after CO poisoning or house fires. |
| Use child-proof locks | If poisoning occurred in a pediatric case. |
| Label containers clearly | Prevent mix-ups with pesticides, fuels, or household agents. |
| Avoid alcohol or drug relapses | Engage in rehab or AA/NA programs if substance abuse was involved. |
👩👧 9.5. Pregnancy and Child Recovery Tips
| Situation | Advice |
|---|---|
| If poisoned during pregnancy | Follow up with OBGYN and toxicologist; monitor fetal growth and development. |
| Children post-poisoning | Pediatric follow-up, developmental screening if brain-impacting toxin (e.g., lead, CO). |
| Lactating mothers | Wait to breastfeed until cleared by physician if exposed to medications or chemicals. |
✅ Quick-Access Checklist for Survivors
- Drink 6–8 glasses of water daily
- Take medications on schedule
- Schedule mental health follow-up
- Avoid all known toxin sources
- Get fresh air and moderate exercise
- Keep emergency contacts and poison control number visible
- Discuss future prevention with your family or caregiver
📞 Helpful Resources
| Service | Contact |
|---|---|
| Poison Control (Global) | WHO: +41 22 791 21 11 |
| Rwanda Poison Center | Rwanda FDA / Health Hotline |
| Mental Health Emergency | SAMU or nearest mental facility |
| Local Counseling & Rehab | Government hospitals or NGOs |
10. Final Thoughts
Poisoning is preventable, diagnosable, and treatable. Prompt access to antidotes, education, and behavioral interventions is key. Whether you're a healthcare provider, caregiver, or a general reader, recognizing symptoms and understanding management can save lives.
🧰 Final Clinical Tips
- ✅ Supportive care is critical: airway, breathing, circulation come first.
- ⚠️ Always identify the substance and estimate the time and dose.
- 🧪 Activated charcoal is useful within 1–2 hours of ingestion (not for all poisons).
- 🧠 Clinical mnemonics help in emergencies.
- 📞 Call poison control or local toxicologist for unknown exposures.
📌For emergencies, call your regional Poison Control Center immediately.
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