Management of self poisoning

doi:10.1136/bmj.319.7222.1414

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Alison L Jones, consultant physician (aj@medtox.demon.co.uk),
Glyn Volans, director

National Poisons Information Service (London), Medical Toxicology Unit, Guy's and St Thomas's NHS Trust, London SE14 5ER

Correspondence to: A L Jones

Introduction

Around 15%-20% of the workload of medical units and 10% of the workload of accident and emergency departments in the United Kingdom are due to self poisoning. 1 2 Episodes of self poisoning in the United Kingdom continue to rise, particularly in young men, and alcohol is often taken with the overdose.2 In general the severity of poisoning has diminished over the past 10 years with the introduction of safer drugs, such as newer serotonin reuptake inhibitors, but the total number of deaths from poisoning in the United Kingdom remains steady at 4000 per year, and the commonest cause of death by poisoning is carbon monoxide. 2 3 This article highlights several specific advances in the management of poisoning over the past two or three years.

Methods

We searched Medline and Embase with the keywords “poisoning,” “intoxication,” “toxin,” and “overdose.” We included topics as a result of discussion with colleagues in clinical toxicology in the United Kingdom, Europe, Australia, and the United States.

New guidelines on gut decontamination

The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists have recently produced new guidelines on gut decontamination on the basis of consensus and evidence based statements.4^–6 It is important to understand the advances in understanding and changes in practice that come from the guidelines, but the evidence base for them is limited.4^–7

Activated charcoal

Activated charcoal should be given as a single dose (50 g for an adult, 1 g/kg body weight for a child up to 12 years) up to 1 hour after ingestion of a substantial amount of toxin.4 Beyond this time adsorption is reduced. 4 8 What constitutes a substantial amount of toxin depends on the toxin but in general it is a dose expected to cause moderate to severe toxicity. The …