General Measures in the Management of Acute Pesticide Poisoning

II. Clinical Evaluation

A. History
The type and amount of poison to which the patient was exposed must be identified in order to establish toxicity. About 80% of adults who take poisons are conscious on arrival in the hospital and a clear history can be obtained. However, some patients may be reluctant to admit what they have taken. In such cases, the physician must pay attention to the patient’s signs and symptoms (toxidrome).
Time of exposure must be established. Knowledge of time of intoxication will offer the clinician an idea of the poison’s phase of biotransformation at the time of admission.
The mode of exposure (i.e., oral, inhalational, dermal) should be taken into account. The route of entry should be established in the initial examination since this will guide subsequent management of the patient.
Ask the patient about all known substances which may contribute to the intoxication. If the patient is unable to supply the information, ask the companion or the relatives to search the area where the poisoning took place. Have them look for other substances or containers of substances which may indicate concomitant exposure or ingestion of another toxicant.
Take note of the circumstances prior to poisoning. Illness occurring while spraying in the field may suggest pesticide poisoning. It is also important to note the patient’s emotional stability since this will have bearing on management in the long term.
Inquire whether the patient is currently taking any medication. Ask about existing heart, liver or lung disease. Psychiatric history and history of recent traumatic life events should also be obtained. Ask about intake of other substances which may aggravate the poisoning (e.g., barbiturates, alcohol, salicylates, beta blockers).
Inquire about home remedies or immediate treatments instituted by medical or non-medical personnel. These measures may either improve or complicate the condition of the patient.
Asymptomatic patients with a history of poisoning must be observed. There are several important and potentially fatal acute poisonings where symptoms are delayed for hours or days such as coumatetralyl poisoning.
Information to be Elicited During History Taking
  1. Time of exposure
  2. Mode of exposure
  3. Intake of other substances
  4. Circumstances prior to poisoning
  5. Current medications
  6. Past medical history
  7. Any home remedies taken
 
     
 
     
 
     
 
     
 
     
 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
   

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