John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Elimination: Get rid of the unabsorbed poison before it can do any harm.
If the person is unconscious, the doctor will put a flexible, soft, plastic tube into the
windpipe to protect the person from suffocating in his or her own vomit and to provide artificial breathing
Once the poison has moved past the stomach, other methods are needed.
Activated charcoal acts as a "super" absorber of many poisons. Once the poison is stuck to the charcoal in the
intestine, the poison cannot get absorbed into the bloodstream. Activated charcoal has no
taste, but the gritty texture sometimes causes the person to vomit. To be effective, activated charcoal needs to be given as soon as possible after the poisoning. It does not work with alcohol, caustics, lithium
(Lithobid), or petroleum products.
Whole bowel irrigation requires drinking a large quantity of a fluid called
Golytely. This flushes the entire
gastrointestinal tract before the poison gets absorbed.
Antidotes: Some poisons have specific antidotes. Antidotes either prevent the poison from working or reverse the effects of the poison.
Atropine is an antidote for certain
nerve gases and insecticides. During
Operation Desert Storm, all military personnel were issued atropine injectors when it was feared that
the enemy would use nerve gas.
A common antidote is N-acetylcysteine (Mucomyst), which is used to neutralize
acetaminophen (Tylenol) overdoses. Acetaminophen, in normal doses, is one of the safest medications known, but after a massive overdose, the liver is damaged, and hepatitis and liver failure develop. Mucomyst works as an antidote by bolstering the body's natural detoxification abilities when they are overwhelmed.
It may also be possible to reverse the harmful effect of a drug even if no antidote exists.
If a person with diabetes takes too much
insulin, a dangerously
low blood sugar (hypoglycemia) will cause weakness, unconsciousness, and eventually death. Sugar given by mouth or IV is an effective treatment until the insulin wears off.
When the poison is a heavy metal, such as lead, special medicines (chelators) bind the poison in the bloodstream and cause it to be eliminated in the urine.