General Measures in the Management of Acute Pesticide Poisoning

III. Elimination of the Poison

A. External Decontamination
Discard the patient’s clothing and thoroughly bathe or shower the patient using alkaline soap in cases of dermal exposure to pesticides. Eye contamination should be managed by copious irrigation of the eyes with free flowing water for 30 minutes. It is imperative that health personnel involved in the decontamination process wear protective equipment (e.g., gloves, face masks, apron) to prevent contamination.

B. Empty the Stomach
Induction of emesis and gastric lavage are the two most commonly employed means of gastric emptying. Induction of emesis is of value only when managing patients who have ingested poison within one hour. Emesis must be considered only when there are no absolute contraindications, and when anticipated definitive treatment will be delayed. Usually, emesis is done in the home setting before the patient is transported to the hospital.
Mechanical emesis can be done if toxicity is expected and medical facilities are inaccesible. The caregiver should make sure there are no contraindications to this procedure. Ideally, emesis need not be done in the hospital, unless no equipment is available for gastric evacuation and there is no other recourse.

Mechanical Emesis
Instruct the patient to take 1-2 glasses of warm water, then apply pressure on the posterior pharynx with a blunt instrument.
Apium graveolens (kinchay)
Have the patient take one tablespoon of the juice of pounded kinchay followed by a glass of water.

Contraindications to Emesis

Depressed sensorium
Impaired gag reflex
Late pregnancy
Presence of cardiac disease and aneurysm
Ingestion of caustics, hydrocarbons, convulsants, arrhythmogenic agents

Gastric lavage is performed by inserting a nasogastric tube (Fr. 16 for adults or an appropriately sized tube for pediatric patients). Patient is put on Trendelenburg position with head turned to the left while inserting the nasogastric tube. Patient is then placed on left lateral decubitus position. Lavage is done with 50-60 mL (adult) or 10-20 mL (pediatric) lukewarm or tepid water. Repeat until the return flow is clear. Contraindications to this procedure are co-ingestion of caustics and presence of frank convulsions. The risk of aspiration should be anticipated when this procedure is performed. Protection of the airway must be considered.

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