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Poisoning

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Poisoning



Introduction 

Poisoning is when a person is exposed to a substance that can damage their health or put their life in danger.

Poisoning is a common health problem, resulting in around 120,000 hospital admissions each year in England. Most cases of poisoning happen at home and children under five have the highest risk of accidental poisoning.

In around one in four reported cases, the person intentionally poisoned themselves as an act of suicide.

Signs and symptoms of poisoning

The symptoms of poisoning will depend on the type of poison and the amount taken in, but general things to look out for include:



vomiting



stomach pains



high temperature



drowsiness and fainting fits



If a child suddenly develops such symptoms, they may have been poisoned, especially if they are drowsy and confused. 

What to do

If you suspect that someone has taken an overdose or has been poisoned do not try to treat them yourself. Get medical help immediately.

If they do not appear to be seriously ill then 

If they are showing signs of being seriously ill, such as vomiting, loss of consciousness, drowsiness or seizures (fits), call 999 for an ambulance or take the person to your local A&E department.

In serious cases, it may be necessary for the person to stay in hospital for treatment. Most people admitted to hospital because of poisoning will survive.

Types of poisons

Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes, or injected.

In the UK, the most common way a person is poisoned is by taking an overdose of medication. This can include both over-the-counter medications such as paracetamol and prescription medications such asantidepressants.

Other potential poisons include:



household products such as bleach



cosmetic items such as nail polish



some types of plants and fungi



certain types of chemicals and pesticides



carbon monoxide



poorly prepared or cooked food, and food that has gone mouldy or been contaminated with bacteria from raw meat (food poisoning)



alcohol, if an excessive amount is consumed in a short period (alcohol poisoning)



insect stings



snake bites



Preventing poisoning

There are several steps you can take to reduce your or your child’s risk of poisoning.

These include carefully reading the patient information leaflet that comes with your medication and making sure any poisonous substances are locked away out of the sight and reach of your children.



Plant dangers in the garden and countryside

Keep your family safe with this guide to plant hazards, and find out what to do if someone is affected

 

Symptoms of poisoning 

The symptoms of poisoning depend on the substance and the amount you take in.

Some poisonous substances, such as carbon monoxide, interfere with the blood's ability to carry oxygen. Others, such as bleach, burn and irritate the digestive system.

Parents and carers should be aware of sudden, unexplained illness in young children, particularly if they are drowsy or unconscious, as poisoning could be the cause.

If you suspect that someone has swallowed a poisonous substance, seek immediate medical advice.

General symptoms

General symptoms of poisoning can include:



feeling sick



being sick



diarrhoea



stomach pain



drowsiness, dizziness or weakness



high temperature of 38°C (100.4°F) or above



chills (shivering)



loss of appetite



headache



irritability



difficulty swallowing (dysphagia)



breathing difficulties



producing more saliva than normal



skin rash



blue lips and skin (cyanosis)



burns around the nose or mouth



double or blurred vision



mental confusion



seizures (fits)



loss of consciousness



coma (in severe cases)



Signs of a medication or drug overdose

Medication overdoses are the most common type of poisoning in the UK. If you take too much of a medicine, you may experience symptoms specific to the medication taken, as well as the more general symptoms listed above.

Some of the most common medications or drugs involved in cases of poisoning are listed below.

Paracetamol

Paracetamol is a widely used over-the-counter painkiller.

Specific signs of paracetamol poisoning include:



yellowing of the skin and the whites of the eyes (jaundice)



loss of co-ordination



low blood sugar (hypoglycaemia), which can cause symptoms including sweating, trembling and irritability



Aspirin

Aspirin was used as a painkiller in the past but is now increasingly used for its blood-thinning properties to prevent blood clots.

Specific signs of aspirin poisoning include:



sweating



rapid breathing



ringing in the ears (tinnitus)



temporary hearing loss



Tricyclic antidepressants

Tricyclic antidepressants are used to treat depression as well as a number of other mental health conditions such as panic disorder andobsessive compulsive disorder (OCD). Some types of tricyclic antidepressants can also be used to treat nerve pain.

Specific signs of poisoning with tricyclic antidepressants include:



excitability



dry mouth



large pupils



irregular or rapid heartbeat



low blood pressure, which can cause symptoms including lightheadedness and fainting



Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a newer type of antidepressant that are also used to treat a number of other mental health conditions such as OCD and anxiety disorder.

Specific signs of SSRI poisoning include:



feeling agitated



tremor (shaking)



uncontrolled movement of the eyes (nystagmus)



severe muscle tension



Beta-blockers

Beta-blockers are used to treat a number of conditions that affect the heart or blood such as high blood pressure, angina and heart failure.

Specific signs of poisoning with beta-blockers include:



low blood pressure, which can cause symptoms including lightheadedness and fainting



a slow heartbeat (below 60 beats a minute)



Calcium-channel blockers

Calcium-channel blockers are used in the treatment of high blood pressure and angina.

Specific signs of calcium-channel blocker poisoning include:



feeling agitated



low blood pressure, which can cause symptoms including lightheadedness and fainting



chest pain



a slow heartbeat (below 60 beats a minute)



Benzodiazepines

Benzodiazepines are a type of tranquiliser often used on a short-term basis to treat anxiety and sleeping problems (insomnia).

Specific signs of poisoning with benzodiazepines include:



co-ordination and speech difficulties



uncontrolled movement of the eyes (nystagmus)



shallow breathing



Opioids

Opioids are a type of stronger painkillers used to treat moderate to severe pain. Opioids include codeine and morphine as well as the illegal drug heroin.

Specific signs of opioid poisoning include:



small pupils



shallow breathing



Stimulant overdose

If you take too much of a stimulant-like drug such as cocaine, amphetamine, crack or ecstasy, overdose signs can include:



anxiety and paranoia (feeling that people are out to get you)



feeling restless or agitated



hallucinations (seeing or hearing things that are not real)



high temperature



chest pain



rapid breathing



irregular or fast heartbeat



Cannabis overdose

If you smoke (or eat) too much cannabis then you may experience the following symptoms:



paranoia



hallucinations



numbness in your arms and legs



Causes of poisoning 

In the UK, medications are the most common cause of poisoning and are responsible for almost two in every three cases.

The medications most commonly linked to poisoning are:



paracetamol



aspirin



tricyclic antidepressants



selective serotonin reuptake inhibitors (SSRIs)



beta-blockers



calcium-channel blockers



benzodiazepines



opioids



However, all medications have the potential to be harmful if taken at too high a dose or taken by someone who has not been prescribed them.

Household products

The second most common cause of poisoning is household products, which account for up to one in four cases.

These can include:



cleaning products, such as bleach, caustic soda and disinfectant



cosmetics, such as baby oil, shampoo and nail varnish remover



DIY products, such as paint, glue and wallpaper paste



garden products, such as weedkiller and rat poison



Carbon monoxide

Carbon monoxide is a poisonous, odourless gas produced by the incomplete burning of fuels, such as gas, wood or petrol. These types of fuels are used in many household appliances, such as heaters and cookers.

If appliances are not regularly serviced and well maintained, carbon monoxide can leak from them without you realising, which can cause loss of consciousness and death.

Insects and snakes

Bees and wasps inject poison into your skin when they sting you, which can cause pain, swelling and itchiness.

Bites from poisonous snakes can cause diarrhoea and sickness. The adder is the only poisonous snake that lives in the UK.

How severely you are affected by a poisonous bite or sting depends on the amount of venom (poison) injected and whether you are allergic to it.

Food

Food can sometimes cause poisoning if:



it goes mouldy



it becomes contaminated with bacteria from raw meat



it has not been prepared or cooked properly



Alcohol

Drinking too much alcohol in a short space of time can also lead to poisoning.

Who is at risk?

Poisoning can affect anyone at any age, but children younger than five who are able to walk are most at risk.

This is because they often put things in their mouths without realising it may be harmful. Also, as their bodies are smaller, they are more vulnerable to the harmful effects of certain substances.

The most common substances involved in cases of child poisoning are:



cosmetics



cleaning products



painkillers



medications that come in cream, lotion or ointment form



foreign bodies, such as small coins or batteries



cough and cold medications



plants



vitamin supplements



antibiotics



Older children and adults who self-harm or have suicidal thoughts may intentionally poison themselves. It's estimated that around one in every four cases of poisoning are intentional.

What to do if someone has been poisoned 

Being poisoned can be life threatening. If someone has swallowed a poisonous substance, do not try to treat them yourself. Seek medical help immediately.

If they are showing signs of being seriously ill, call 999 for an ambulance or take them to your local A&E department.

Symptoms associated with serious poisoning include:



being sick



dizziness



sudden, noticeable heartbeats (palpitations)



breathing difficulties



uncontrollable restlessness or agitation



seizures (fits)



drowsiness or loss of consciousness



If a person does not appear to be seriously ill, 

Helping someone who is conscious

If you think someone has been seriously poisoned and they are still conscious, ask them to sit still and stay with them while you wait for medical help to arrive.

If they have been poisoned by swallowing something, try to get them to spit out anything remaining in their mouth.

If a harmful substance has splashed onto their skin or clothes, remove any contaminated items and wash the affected area thoroughly with warm or cool water. 

Helping someone who is unconscious

If you think someone has swallowed poison and they appear to be unconscious, try to wake them and encourage them to spit out anything left in their mouth. Do not put your hand into their mouth and do not try to make them sick.

While you are waiting for medical help to arrive, lie the person on their side with a cushion behind their back and their upper leg pulled slightly forward, so they do not fall on their face or roll backwards. This is known as the recovery position.

Wipe any vomit away from their mouth and keep their head pointing down to allow any vomit to escape without them breathing it in or swallowing it. Do not give them anything to eat or drink.

If the person is not breathing or their heart has stopped, begin cardiopulmonary resuscitation (CPR) if you know how to 

Poisonous fumes

If you think someone has inhaled poisonous fumes, assess the situation first and do not put yourself in danger.

If the person you think may have inhaled poisonous fumes is conscious, you should try to encourage them to make their way out of the contaminated area if at all possible. Once they are out into fresh air, check to see if they are OK and call 999 if they have signs of serious poisoning (see above).

If the person is unconscious or for any reason unable to get out the affected area, call 999 immediately. You should not enter any enclosed areas to remove the person yourself because toxic gases and fumes can be very dangerous if inhaled.

How to help medical staff

Medical staff will need to take a detailed history to effectively treat a person who has been poisoned. When the paramedics arrive or when you arrive at A&E, give them as much information as you can, including:



What substances you think the person may have swallowed.



When the substance was taken (how long ago).



Why the substance was taken – whether it was an accident or deliberate.



How it was taken (for example, swallowed or inhaled).



How much was taken (if you know).



Give details of any symptoms the person has had, such as whether they have been sick. If they have been sick, collect a sample of their vomit as it may help medical staff to identify the poison.

Medical staff may also want to know:



The person's age and estimated weight.



Whether they have any existing medical conditions.



Whether they are taking any medication (if you know).



If possible, give medical staff the container that the substance came in to give them a clear idea of what it is. If you do not know what caused the poisoning, blood tests may be needed to identify the cause.

Hospital treatment

Some people who have swallowed a poisonous substance or overdosed on medication will be admitted to hospital for examination and treatment.

Possible treatments that can be used to treat poisoning include:



Activated charcoal – healthcare professionals sometimes use a substance called activated charcoal to treat someone who has been poisoned. The charcoal binds to the poison and stops it from being further absorbed into the blood.



Antidotes – these are substances that either prevent the poison from working or reverse the effects of the poison.



Sedatives – these may be given if the person is agitated.



A ventilator (breathing machine) – this may be used if the person stops breathing.



Anti-epileptic medicine – this may be used if the person has seizures.



 Tests and investigations 

Investigations may include blood tests and an electrocardiogram.

A blood test can be used to check the levels of chemicals and glucose in a person’s blood. They may be used to perform a toxicology screen (tests to determine how many drugs or medication a person has taken) and a liver function test (which indicates how damaged the liver is).

Go to the Lab Tests Online website for more information on liver function tests.

An electrocardiogram (ECG) is an electrical recording of the heart to check that it is functioning properly.

 Preventing poisoning in children  

The most common form of poisoning in the UK is from medication. The following advice should help prevent accidental poisoning by medication:



Always read the patient information leaflet that comes with your medication carefully and take your dosage exactly as recommended.



If you are unsure about any of the instructions or have further questions, ask your pharmacist or GP for advice.



Some medications should not be taken with alcohol or certain types of food. Check if this is the case for your medication.



Some medications can react unpredictably if taken with other medications, including herbal remedies. Always check before combining different medications.



Never take a medication that has been prescribed for somebody else.



Keep all medication out of reach of children.



Keeping children safe

Children under five have a particularly high risk of poisoning. The following advice should help reduce the risk for your children:



Make sure all medicines, cleaning products, chemicals and potentially harmful cosmetics, such as nail varnish, are locked away out of the sight and out of reach of children.



Do not store medicines, cleaning products or chemicals near food.



Keep all chemicals in their original containers and never put medicines or chemicals, such as weedkiller, in soft-drinks bottles.



When encouraging children to take medicine (when they are sick), do not refer to tablets as sweets.



Do not leave old medicines lying around. Take them to your local pharmacist to dispose of safely.



Keep cigarettes and tobacco out of reach of children and do not smoke in front of children.



Small batteries, such as those used for television remote controls, can be easily swallowed, so keep them out of the reach of children.



Whenever possible, buy medicines that come in child-resistant containers.



Rinse out medicine or cosmetic containers and dispose of them in a place where children cannot reach them.



Do not take or give medicines in the dark to avoid taking an incorrect dosage.



If you have young children, be extra careful when you have guests to stay or when you go to visit other people. If your friends and relatives do not have children, they may not think to keep certain items out of the reach of children and their home is unlikely to be childproof.

Keep an eye on your children at all times and politely ask guests to keep items such as alcohol and cigarettes out of their reach.
Poisoning