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POISONS & ANTIDOTES

Stedman’s Shorter Medical Dictionary

by T. L. Stedman, M.D., Wilcox & Follett Co., 1942

In all cases of poisoning by substances taken by way of the stomach there are five indications for immediate treatment.

1. Act quickly.

2. Empty the stomach by lavage or emetic - the first even if the poison itself has caused vomiting, but not the second when corrosives have been taken.

3. Neutralize by the appropriate antidote whatever remains in the stomach, despite emetics or lavage, bearing in mind that somepoisons are secreted again in the stomach after having been absorbed.

4. Aid elimination by the bowels and kidneys of what has been absorbed.

5. Treat the condition resulting from the action of the poison.

The giving of whites of eggs is useful in most cases of poisoning, and tannin is antidote to all alkaloids.

ACETANILID (ANTIFEBRIN)

Symptoms : Weakness, faintness, pallor or cyanosis of the face, weak and rapid pulse, slow and shallow respiration.

Treatment: Lavage or emetics; recumbent position; warmth to body, cold to head; heart stimulants, caffeine or strong black coffee, strychnine, ammonia; artificial respiration, oxygen inhalations.

 

ACIDS, CORROSIVE

Symptoms: Cauterization of visible mucous membranes; intense burning pain from lips to epigastrium, extending over abdomenwhich is tender on pressure; vomiting of dark brown or black grumous matter, strongly acid; severe thirst, painful deglutition, difficulty in breathing.

Treatment: Abstain from lavage and emetics; give bicarbonate of soda, chalk, soap, or other non-corrosive alkalies, large and

repeated draughts of water, white of egg, demulcents; recumbency, heat to body, heart stimulants; morphine and atropine hypo-

dermically to relieve pain.

 

ACONITE

Symptoms: Tingling of the mouth and numbness, soon extending to the entire surface of the body; strangling sensation in the throat and difficult swallowing; sense of sinking and pain in the epigastrium; nausea and salivation followed by violent vomiting; great prostration, cold extremities, staring eyes.

Treatment: Lavage with water containing iodine; or potassium iodide, artificial respiration; warmth to surface of the body; stimulants, ammonia, brandy by enema or hypodermically.

 

ALCOHOL

Symptoms: Loquacity, hilarity, quarrelsomeness, mumbling speech; depression, somnolence, staggering gait; flushed eyes, dilated pupils, dizziness, vomiting; slow and feeble pulse, slow and snoring respirations; coma.

Treatment: Lavage or emesis by apomorphine; caffeine or strong hot coffee; solution or acetate of ammonia.

 

ALKALIES, CORROSIVE

Symptoms: Cauterization of the visible mucous membranes which are greatly swollen; soapy taste and violent pain in the mouth and throat; vomiting of slimy matter of alkaline reaction, often tinged with blood.

Treatment: No emetics or lavage; vegetable acids, vinegar, lemon juice; milk; recumbency, heat to surface, coffee, caffeine, or strychnine; white of egg, mucilaginous drinks.

 

AMMONIA

Symptoms: Burning pain in mouth; retching and vomiting of bloody matter having an odor of ammonia.

Treatment: Same as for corrosive alkalies.

 

ANTIPYRINE

Symptoms: Drowsiness, tinnitus aurium, headache; rapid respiration and weak and rapid pulse; profuse perspiration; faintness.

Treatment: Keep patient lying down; give cardiac stimulants, caffeine or coffee, strychnine, coramine or cardiazol; warmth to the surface.

 

ARSENIC

Symptoms: Two forms: (1) Heat and irritation in throat and stomach; vomiting, purging with rice-water stools; cramps in calf muscles, restlessness, even convulsions, prostration, fainting. (2) Somnolence, dizziness, delirium, extreme prostration, coma.

Treatment: Lavage or emetics—apomorphine, zinc sulfate, mustard, ipecac, magnesia; emetics continued at intervals for two days, then castor oil.

 

ATROPINE

Symptoms: Strange indescribable feelings with giddiness, yawning, staggering or falling on attempting to walk; dryness of mouth and throat, sense as of suffocation, swallowing difficult, voice husky; face at first pale later suffused with a scarlatiniform rash which extends to the body; pupils widely dilated; pulse, at first bounding and rapid, later becomes irregular and faint.

Treatment: Lavage of stomach, also colonic irrigation; morphine in repeated small doses hypodermically; amyl nitrite by inhalation, artificial respiration.

 

BARBITAL GROUP

Symptoms: Somnolence, ataxia, cyanosis, slow and noisy respiration, rise of temperature, occasionally a measleslike rash.

Treatment: Lavage or emetics; large draughts of water; cardiac stimulants, caffeine, strychnine, coramine, cardiazol, epinephrine,

pituitrin.

 

BARIUM AND ITS SALTS

Symptoms: Acid taste in the mouth; epigastric pain, nausea, copious vomiting and purging; small and irregular pulse.

Treatment: Lavage of stomach; Epsom salts, demulcent drinks; recumbent position; morphine and atropine, strychnine; artificial

respiration, oxygen.

 

CAMPHOR

Symptoms: Sore throat; flushed face followed by pallor; dilated pupils and injected conjunctivae; psychic symptoms resembling those of alcoholic intoxication; smell of camphor in the breath.

Treatment: Lavage or emetics; warmth to body, cold to head; bromides, strong coffee, chloral.

 

CANTHARIDES

Symptoms: Burning pain in mouth, throat, and stomach; intense thirst, difficulty in deglutition; vomiting; strangury and passage of bloody urine; rapid pulse, dyspnea; pupils dilated; headache, vertigo, delirium.

Treatment:Lavage or emesis by apomorphine; saline purgatives; morphine; mucilaginous drinks; no oil.

 

CARBOLIC ACID

Symptoms: Pain in mouth and throat; tongue and fauces greatly swollen, appearing first white, later brown; skin pale and livid;

pupils, first contracted, later dilated; unconsciousness, stertorous respiration, coma; low body temperature.

Treatment: Lavage of stomach; spray of mouth and fauces with alcohol and water; sulfate of magnesia or of soda, whiskey or

brandy; avoid oil.

 

CARBON MONOXIDE

Symptoms: Stupor or coma; labored breathing; pulse small and irregular; face cyanotic; pupils dilated.

Treatment: Artificial respiration, fresh air, oxygen; ammonia stimulants; transfusion of blood or saline solution; recumbency;

warmth to body with friction of the extremities.

 

CHLORAL

Symptoms: Burning pain from lips to stomach; moderate excitement followed by deep sleep; stertorous respiration, muscular relaxation; pupils contracted;pulse and respiration weak.

Treatment: Lavage with alkaline water; warmth to body; strychnine, adrenalin; artificial respiration, oxygen.

 

CHLOROFORM

Symptoms: During inhalation there is first excitement with sharpened sensations, then depression and loss of consciousness; finally paralysis, stertorous breathing, blue lips, slow, weak, and irregular pulse, widely dilated pupils. When swallowed there is burning pain in throat and stomach, followed soon by exhilaration, then unconsciousness; the vomitus has odor of chloroform and is sometimes bloody.

Treatment: Hypodermic injection of strychnine, whiskey, or ammonia: enema of strong coffee and whiskey; artificial respiration and oxygen; when swallowed, use stomach lavage.

 

COCAINE

Symptoms: “Queer” feelings, restlessness, incoherent speech; purposeless movements of extremities; dryness of throat, with feeling of constriction and choking, difficulty in swallowing; tingling in hands and feet, staggering gait; pupils usually dilated, severe headache with burning sensation and difficult respiration.

Treatment: Lavage of stomach with tannin in the water; recumbency heat to the extremities: stimulants, hot strong coffee, strychnine in failure of respiration, artificial respiration and oxygen, inhalation of amyl nitrite; morphine and atropine hypodermically

 

COLCHICUM

Symptoms: Buming in mouth and throat with dryness and difficult swallowing; nausea and incessant vomiting and purging; pulse small and irregular, pupils dilated, great prostration.

Treatment: Lavage of stomach, castor oil, tannin, demulcents; stimulants, strychnine, caffeine, morphine and atropine.

 

CONIUM

Symptoms: Burning in mouth with scratching sensation in throat; prickling sensation and weakness in lower extremities extending later to the upper; nausea, frontal headache; thick speech and difficult swallowing.

Treatment: Emetics or gastric lavage, tannin, demulcents; recumbency with heat to surface; ammonia, morphine, strychnine; artificial respiration, oxygen.

 

COPPER

Symptoms: Metallic taste in mouth, pain in epigastrium spreading over abdomen; repeated vomiting of greenish matter; purging

with liquid stools and cramps in legs; pulse, first strong, then weak; frontal headache.

Treatment:: Potassium ferrocyanide cautiously; demulcents, white of egg or milk, magnesia; heat to surface, opium, stimulants;

emetics or lavage if profuse vomiting has not occurred.

 

CROTON OIL

Symptoms: Intense burning pain in mouth, throat, and abdomen; excessive salivation, vomiting and diarrhea with tenseness and

passage of blood.

Treatment: Morphine, cardiac stimulants, caffeine, camphor, hyoscine; warmth to abdomen.

 

DIGITALIS

Symptoms: Pain in stomach, nausea, violent vomiting, vertigo, muscular stiffness, fatigue, pain in the head, somnolence; pulse at

first rapid and violent, but soon weak and irregular; dilated pupils, dimness of vision, may be delirium.

Treatment: Gastric lavage with tannin or Epson salts in the water; recumbency, warmth to chest and abdomen; stimulants,

ammonia, strychnine, brandy; artificial respiration, oxygen.

ERGOT

Symptoms: Salivation, vomiting, diarrhea; physical and mental depression; tremors, staggering gait, labored breathing; pupils first

contracted, later dilated; pulse rapid; abdominal cramps, numbness and coldness of extremities.

Treatment: Emetics or lavage with tannin in water; recumbency; castor oil, stimulants, inhalation of amyl nitrite.

 

GELSEMIUM

Symptoms: Giddiness, nausea, paralysis of muscles of mouth and throat, indistinct speech, difficult or impossible deglutition; pre-

cordial oppression, difficulty of respiration; delirium.

Treatment: Emetics or gastric lavage; recumbency, heat to body, cold to head; strychnine, morphine, atropine,

caffeine, nitroglycerin.

 

HYDROCYANIC ACID

Symptoms: Hot, bitter taste on swallowing followed by constriction in throat, oppression of chest, suffocation, dizziness, heaviness, pain, and pressure in head; mind confused; sight dimmed; pulse rapid, respiration slow; face pale, finger tips cyanosed.

Treatment: Magnesia in water followed by tincture of chloride of iron or sulfate of iron in water; chlorinated lime (bleaching powder); inhalation of ammonia, artificial respiration, oxygen.

 

IODINE

Symptoms: Lips and tongue stained, odor of iodine in breath; pain in throat and stomach: vomiting, watery stools; face pale, pupils slightly dilated and insensitive to light; pulse weak and irregular.

Treatment: Stomach lavage with starch or flour in water; heat to body; stimulants, amyl nitrite by inhalation.

 

LEAD

Symptoms: Sweetish metallic taste in mouth, salivation, burning pain in stomach, vomiting usually of blood-stained matter, abdominal cramps, vertigo, cold sweats, headache, muscular weakness, cramps in thecalves of the legs.

Treatment: Emetics or lavage with Epson salts; heat to the surface; caffeine, starch water, milk.

 

LOBELIA

Symptoms: Resemble those of nicotine (see tobacco), except that there is no pronounced motor excitement.

Treatment: Emetics or lavage; tannin, castor oil; heat to surface, stimulants, opium.

 

MERCURIC SALTS

Symptoms: Burning pain in throat and stomach, throat spasm, retrosternal pain; nausea, bilious vomiting; pale face, cold and clammy skin; weak and irregular pulse, shallow and rapid breathing.

Treatment: Empty stomach (not by tube); give white of eggs, castor oil, demulcent drinks, large draughts of water to flush the kidneys; morphine and atropine hypodermically; caffeine, strychnine, camphor.

 

NITROGLYCERIN

Symptoms: Severe throbbing headache, nausea, vomiting, diarrhea; dizziness, twitching of the muscles, difficult breathing.

Treatment:Emetics and cathartics; recumbency, cold to head; atropine, ergot, strychnine; ephedrine, inhalation of oxygen.

 

OPIUM

Symptoms: Drowsiness; slow strong pulse; slow and shallow breathing; strongly contracted pupils; at first can be easily aroused and is mentally rational, but sleep quickly returns and finally passes into coma.

Treatment: Emetics or preferably lavage with tannin or potassium permanganate (1% solution) in the water, repeated every 15 minutes; keep patient awake by walking, electricity, flagellation, or cold douches; heat to surface of body; strong hot coffee, strychnine, amyl nitrite inhalation, artificial respiration.

 

OXALIC ACID

Symptoms: Severe pain in throat and stomach extending to shoulders and lower back; vomiting of blood-tinged matter; gastroenteric inflammation; cyanosis, clammy skin; dilated pupils: very feeble pulse.

Treatment: Emetics or lavage with lime water, chalk, or magnesia in the water (no bicarbonate of soda); long draughts of alkaline water (without sodium salts); stimulants if indicated—black coffee or caffeine, strychnine, ammonia; heat to surface of body.

 

PHOSPHORUS

Symptoms: (late in appearance): Pain in the stomach, eructations and vomiting of phosphorescent matters with odor of phosphorus; after an interval of some hours, or even days, there is a return of symptoms; bloody vomiting and diarrhea, headache, aching in limbs, coated tongue, fetid breath, weakness, yellow conjunctivae.

Treatment: Sulfate of copper emetic or lavage with Epsom salts in the water; repeat lavage with Epsom salts solution every

hour; give repeated small doses of sulfate of copper and large doses of bicarbonate of soda. Oxygen inhalation, external

heat, camphor, old oil of turpentine, permanganate of potassium.

 

PHYSOSTIGMA

Symptoms: Muscular weakness and twitchings, dizziness, increased reflexes, strongly contracted pupils, dyspnea, nausea

and vomiting, slow pulse, frequently intestinal cramps and diarrhea.

Treatment: Lavage or emetics; atropine followed by artificial respiration and oxygen; the nitrites.

 

PICROTOXIN

Symptoms: Salivation, vomiting, sweating, slow pulse, contracted pupils, muscular twitchings passing on to epileptiform

convulsions followed by unconsciousness.

Treatment: Evacuation of stomach; chloral or other sedatives.

 

STRYCHNINE

Symptoms: Increased reflexes, “jumping” of the muscles when touched, first clonic, then tonic, very painful spasms; pupils

dilated, eyes widely opened, asphyxia, cyanosis.

Treatment: Empty stomach by emetics or lavage with tannin, charcoal, or permanganate of potassium in the water; recumbent position, chloroform or ether inhalation with artificial respiration; bromides, chloral, or morphine.

 

SULFONAL, TRIONAL

Symptoms: Vomiting, abdominal pain, muscular weakness, tremors; reddish discoloration of the urine.

Treatment: Emetics or stomach tube, Epsom salts, ammonia, caffeine or black coffee, atropine, strychnine, external heat.

TANSY OIL

Symptoms: Burning in mouth and throat, numbness of extremities, giddiness; dilated pupils, bright red cheeks; sometimes vomiting, clonic spasms followed by coma.

Treatment: Emetics or gastric lavage; stimulants, coffee, strychnine;

cathartics, external warmth with cold to the head.

 

TARTAR EMETIC

Symptoms: Nausea and vomiting; later tinged with bile or blood; epigastric pain, purging; pulse first rapid then failing; cramps in the extremities, vertigo, syncope.

Treatment: Wash out the stomach, then give tannin, strong coffee, white of egg, milk and other demulcents; opiates to relieve pain.

 

TOBACCO

Symptoms: Nausea and vomiting, restlessness, muscular cramps and twitchings, palpitation and rapid pulse, dizziness, contracted pupils.

Treatment: Emetics or lavage of stomach, tannin, recumbency, heat to surface of the body, cold to the head; stimulants, caffeine; morphine and atropine hypodermically, strychnine, ammonia.

 

VERATRUM VIRIDE

Symptoms: Vomiting, burning pain in mouth, esophagus, and stomach; headache, vertigo, pulse very slow but irritable, muscular weakness, shallow and difficult respiration.

Treatment: Emetics or gastric lavage rarely needed; recumbency, heat to the surface; opium, stimulants-ether, caffeine, strychnine; calcium chloride; artificial respiration.

 

ZINC SALTS

Symptoms: Styptic and metallic taste in the mouth, vomiting, sometimes passage of blood-stained stools, abdominal cramps, thready pulse, collapse.

Treatment: Lavage of stomach with tannin, sodium bicarbonate, or chalk in the water; white of egg, milk, soap, mucilage; recumbency, external heat; strychnine and atropine hypodermically, strychnine, caffeine or strong hot coffee.

 

 

 

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