Poisoning - Acute Guidelines For Initial Management
Burns / management of burn wounds
Acute pain management
Foreign body ingestion
- Alkali ingestion can often be asymptomatic early and this does not exclude serious injury
- Absence of mouth or pharyngeal ulcers does not preclude gastro-oesophageal lesion
- Nasogastric insertion should only be performed by an endoscopist
- If threatened airway, consider early intubation
- If inhalational exposure, respiratory symptoms can be delayed
|| Acids |
| Common agents
Automatic dish washing liquids & powder, pod
Anti-rust products/metal cleaners
Inhalation, ingestion and / or topical injury (skin/eye involvement)
o pH of >11 or
<2 is likely to cause significant GI ulceration
o liquid preparations can travel further than powders
Usually odourless liquids
Liquefactive necrosis – deep penetration of tissues (hours to days)
Often bitter taste and painful
Coagulative necrosis – depth of burn is limited by scar / eschar formation
Children requiring assessment
All patients with deliberate self-poisoning or significant accidental ingestion
Any symptomatic patient
Any patient whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.
Intentional overdose or accidental
Stated or likely dose taken
Find the following information (where possible)
- Obtain container to check contents and strength of substance/photos
- Check preparations with the Victorian Poisons Information Centre (13 11 26) to determine the corrosive potential of the product with severe toxicity.
Co-ingestants eg paracetamol
- May be minimal and / or delayed
- Pain, nausea & vomiting, drooling or refusing to eat and drink
- Stridor, respiratory distress
- Splash burns (skin / eyes)
- Systemic features – circulatory collapse and / or multi-organ failure
Investigations (if symptomatic)
- Blood tests may be required if systemic features
- Endoscopy (best method for assessing GI injury within 12 - 24 hours) in symptomatic patients and is required in spite of a normal chest x-ray and lab investigations
Paracetamol concentration in all intentional overdoses
Depends on type of injury
Ingestion / Inhalational
Decontamination: Activated charcoal / GI decontamination / neutralisation procedures are contraindicated
Standard resuscitation may be required in severe
If asymptomatic – observe, trial of oral intake at 4 hours after exposure, earlier if low suspicion or likely benign ingestion after discussion with Poisons Information Centre
If any symptoms admit for oesophagoscopy (within 24 hours) (PIPER, local paed surg)
- Keep NBM
- Commence intravenous PPI
Analgesia – see
Acute pain management. If opiate or parenteral analgesia required, please consult local pain management service.
Remove clothing / particulate matter.
Copious low pressure water for minimum 10-15 minutes, or until pH of skin is normal (pH 6 – 7 in children).
Recheck pH of affected areas after a period of 15-20 minutes and repeat irrigation if abnormal (several hours may be required).
Then treat as per thermal injury (see Burns CPG)
exposure is an ophthalmic emergency.
Remove contact lenses if present. Use topical anaesthetic (if available), immediate irrigation with 1L normal saline (via a giving set) for minimum 10-15 minutes regardless of pH.
This procedure may require sedation to ensure prompt management.
Aim for a final conjunctival pH of 7.5 - 8.0; or similar to other eye if unaffected.
The conjunctivae may be tested with indicator paper.
Retest 20 minutes after irrigation; repetitive irrigation may be necessary.
Record Visual Acuity (if possible) and assess presence of corneal damage with fluorescein uptake.
Prompt referral to ophthalmology services.
with local paediatric team when
- All symptomatic patients
- Admission should be considered for all children and young people with an intentional overdose
Consult Contact Victorian Poisons Information Centre 13 11 26 for
When to consider transfer
to a tertiary centre
- Patients requiring escalation of care beyond the comfort of the hospital and local paediatric team.
- Any patient requiring intensive care
For emergency advice and paediatric or neonatal ICU transfers, call
the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137
Consider discharge when
If asymptomatic after 4 hours and able to eat and drink the patient can be safely discharged.
Suspected non-accidental injury / mental health concerns may independently warrant admission and need to be addressed.
For deliberate ingestion a risk assessment should indicate that the patient is at low risk of further self-harm in the discharge setting.
Discharge information and follow-up
Poisoning prevention for children Parent information
Victorian Poisons Information Centre: 13 11 26
Intentional self –harm: Referral to local mental health services eg Orygen Youth Health: 1800 888 320
Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685
Last updated January 2019