Acute poisonings from the perspective of a family doctor

Abstract

Acute poisonings with chemicals, plants and venoms are emergency medical problems, with medication ingestions as the most common and corrosive poisonings as severe dramatic conditions. The family doctor is often the patient’s first choice for medical consultation. The objective of this study is to present the evidence-based consensus guidelines that the family doctor can use as first line treatment and advice. Common poisonings are drug poisonings, mostly with benzodiazepines, antidepressants, antipsychotics, antiepileptics and others. Anamnesis according to a recommended list of questions can point to the probable severity of poisoning and the treatment emergency. The initial treatment for medication poisoning is the use of medical charcoal. The greatest efficiency is achieved if it is ingested during the first hour postingestion. Recommended doses are 1 g/kg or 25-100 gr, usually 50 g at once. Benzodiazepines induce sedative-hypnotic toxidrome that includes central nervous system (CNS) depression with normal or near-normal vital signs. The dose required to produce respiratory compromise is difficult to quantify. Toxicity depends on multiple factors, including dosage, tolerance, weight, age, coingestants and even genetics. Concomitant ingestion of other CNS depressants (alcohol, antipsychotics, opioids) may result in a more severe CNS depression and life-threatening condition. Corrosive poisoning is always a medical condition which should have in-hospital assessment. In case of the initial consultation with the family doctor, they should be advised not to perform self-lavage and not to take medical charcoal which further complicates the endoscopic evaluation of the severity of the poisoning and thus the appropriateness of the treatment. Conclusion: Acute poisonings are urgent, sometimes life-threatening conditions. Advised treatment from the general practitioner in the first hour of poisoning improves the clinical course and prognosis of poisoning.