If you or someone you are caring for has been poisoned, call the national Poisons Information Centre on 131 126.

More than 160 000 people (or 1 in every 145) are poisoned every year in Australia (Healthdirect 2020).

Furthermore, between 2010 and 2012, accidental poisoning was identified as the 15th most common cause of premature mortality (AIHW 2015).

So, do you know what to do if one of your patients/residents is poisoned?

What is Poisoning?

Poisoning occurs when an individual ingests, inhales, injects or absorbs (through the skin) a substance that is harmful to human health (i.e. a poison) (ANZCOR 2011).

Poisoning may cause illness, injury or even death (Healthdirect 2020). This may occur soon after exposure, or in some cases, long-term exposure can cause the effects of the poison to develop over several years (WHO 2014).

Poisons range from substances that are always harmful upon exposure, to those that are only harmful in higher concentrations, to those that are only harmful when ingested - as long as they have the potential to cause harm in some way, they are a poison (Mayo Clinic 2020).

Poisons include:

• Medicines (over-the-counter or prescription)
• Herbal medicines or supplements
• Substances of abuse including alcohol
• Chemicals (e.g. household cleaning products, pesticides)
• Cosmetics (e.g. nail polish)
• Poorly prepared or contaminated food
• Medicines for animals
• Carbon monoxide
• Toxins (poisons from living organisms)
• Venoms (toxins that are injected via an organism).

(Healthdirect 2020; ANZCOR 2011; NHS 2018)

Poisonous v Venomous: What’s the Difference?

Poison and venom are similar terms that both describe harmful substances, however, they are not interchangeable.

• Poisons enter the body via ingestion, inhalation or absorption. Poisonous animals may excrete toxins passively rather than actively attacking.
• Venom is actively injected into the body via a bite or sting, where it enters through a wound. Venom has evolved to serve animals’ specific purposes.

(Australian Academy of Science 2017)

Most Common Causes of Poisoning

• Medicines (e.g. paracetamol, ibuprofen, antidepressants, heart medications and sedatives), which account for 20% of poisonings
• Bleach and household cleaning products, which account for 10% of poisonings
• Soap and toiletries, which account for 4% of poisonings
• Animal bites and stings (e.g. spiders, snakes)
• Pesticides and household chemicals
• Batteries (all types, including button batteries)
• Workplace products (e.g. solvents, paints, glues)
• Plants, mushrooms, trees, flowers and berries.

(Healthdirect 2020)

Who is at Risk of Being Poisoned?

People of all ages may become poisoned, however, children aged between one and three account for 65% of cases (Healthy WA 2013).

Despite this, most victims of poison-related deaths are adults (AIHW 2015).

Children are at increased risk of poisoning due to:

• Age-related physiological factors (thinner skin and faster respiratory rate)
• Natural curiosity and exploration (e.g. opening containers, mimicking adults, putting objects in their mouth)
• Inability to tell the difference between safe and unsafe substances.

(Healthdirect 2020; Better Health Channel 2019)

Risk Factors for Poisoning

• Medication errors
• Substances being left unattended and easily accessible
• Poisonous plants and mushrooms in the garden
• Changes to routine (e.g. visitors, moving house, holidays).

(Better Health Channel 2019)

Symptoms of Poisoning

Symptoms will depend on a number of factors, including the type of poison, the amount of exposure and the patient/resident’s age, size and overall health (Healthdirect 2020).

Potential symptoms include:

• Skin-related symptoms (pain, itchiness, redness, blisters)
• Sweating
• Nausea and vomiting
• Drooling
• Headache
• Impaired vision
• Breathing difficulties
• Restlessness and agitation
• Numbness, tingling or twitching of the tongue and mouth
• Abdominal pain
• Throat pain
• Burn injuries in the mouth or throat
• Confusion
• Drowsiness
• Palpitations
• Loss of consciousness
• Seizures
• Respiratory arrest
• Cardiac arrest.

(Healthdirect 2020; ANZCOR 2011; NHS 2018)

While poisoning may be easily recognised due to the circumstances of the event, in some cases, however, an individual may be unaware that they have been poisoned and attribute their symptoms to something else (ANZCOR 2011).

Acute Management of Poisoning

1. Avoid Poisoning Yourself or Others

There may be a risk of becoming poisoned yourself during the first aid and treatment of the patient/resident (for example, if their clothing is contaminated).

In order to reduce the risk of harming yourself:

• Identify the suspected poison and handle it safely
• Don appropriate PPE if required
• Be aware that if multiple people are affected by the poison there is a high risk of environmental contamination.

(ANZCOR 2011)

2. Decontamination

Decontamination involves separating the patient/resident from the poison, depending on how they have been exposed to the poison:

For Ingested Poison:

1. Provide a sip of water to help wash out the patient/resident’s mouth.
2. DO NOT make the patient/resident vomit.
3. If it is safe to do so, pick up and remove the bottle/packet that the poison is in.
4. Call the Poisons Information Centre on 131 126.

For Inhaled Poison:

1. Move the patient/resident to fresh air. Ensure you don’t put yourself at risk of harm in doing so.
2. Avoid breathing in fumes. Breathing apparatus may be required depending on the poison.
3. Open doors and windows wide if safe to do so.
4. Call the Poisons Information Centre on 131 126.

For Poison in the Eye:

1. Flood the affected eye with saline or cold water for 15 minutes, holding the eyelids open. Use water from a running tap or a cup/jug.
2. Call the Poisons Information Centre on 131 126.

For Poison on the Skin:

1. Remove any contaminated clothes. Avoid contact with the poison when doing so.
2. Flood the affected area with cold running water.
3. Use soap and water to gently wash the affected area. Rinse thoroughly.
4. Call the Poisons Information Centre on 131 126.

(ANZCOR 2011; Healthdirect 2020)

3. Resuscitation and Supportive Care

1. Commence CPR if the patient/resident is unconscious or breathing abnormally (Read: Adult Basic Life Support (BLS) Using DRSABCD). Remove any contamination from around the patient/resident’s mouth before performing CPR.
2. Ensure an ambulance has been called.

(ANZCOR 2011)

4. Management of Specific Poisons

If possible, determine:

• What the poison is
• How much of the poison the patient/client was exposed to
• When the patient/client was exposed to the poison.

You may need to call the national Poisons Information Centre on 131 126 for specific advice.

While waiting for help, monitor the patient/resident’s airway, breathing and circulation and follow the Basic Life Support guidelines (note the linked article applies to adults only).

(ANZCOR 2011)

Preventing Poisoning

Strategies include:

• Storing dangerous substances such as cleaning chemicals securely
• Ensuring that dangerous substance can only be accessed by those who need to use them
• Labelling cleaning products, chemicals and medicines and keeping them in their original packaging
• Ensuring rooms are well-ventilated
• Ensuring medicines are properly stored
• Always following medicine instructions
• Always following the 13 Rights of Medication Administration
• Administering medicines in a well-lit environment
• Checking for poisonous trees and plants
• Properly disposing of waste and unwanted medicines
• Wearing PPE when required
• Avoiding eating and drinking near poisons.

(Healthdirect 2020; ANZCOR 2011)

Additional Resources

• Poisons Information Centre
• Poisonous Plants List | Victorian Poisons Information Centre
• Adult Basic Life Support (BLS) Using DRSABCD | Ausmed Article

References

• Australian Academy of Science 2017, Poison vs. Venom, Australian Academy of Science, viewed 11 March 2021, https://www.science.org.au/curious/people-medicine/poison-vs-venom
• Australian and New Zealand Committee on Resuscitation 2016, ANZCOR Guideline 9.5.1 - Emergency Management of a Victim Who Has Been Poisoned, ANZCOR, viewed 11 March 2021, https://www.nzrc.org.nz/assets/Guidelines/First-Aid/guideline-9-5-1-july11.pdf
• Australian Institute of Health and Welfare 2015, Accidental Poisoning, AIHW, viewed 11 March 2021, https://www.aihw.gov.au/getmedia/5931d8e5-72d9-43a9-b616-b5bd2e45059b/phe201-poisoning.pdf.aspx
• Better Health Channel 2019, Poisoning and Child Safety, Better Health Channel, viewed 11 March 2021, https://www.betterhealth.vic.gov.au/health/HealthyLiving/poisoning-and-child-safety
• Healthdirect 2020, Poisoning, Healthdirect, viewed 11 March 2021, https://www.healthdirect.gov.au/poisoning
• Healthy WA 2013, Poisoning – First Aid, Western Australia Department of Health, viewed 11 March 2021, https://healthywa.wa.gov.au/Articles/N_R/Poisoning-first-aid
• Mayo Clinic 2020, Poisoning: First Aid, Mayo Clinic, viewed 11 March 2021, https://www.mayoclinic.org/first-aid/first-aid-poisoning/basics/art-20056657
• National Health Service 2018, Poisoning, NHS, viewed 11 March 2021, https://www.nhs.uk/conditions/poisoning/
• World Health Organization 2014, Environmental Health in Emergencies: Poisoning, WHO, viewed 11 March 2021, https://www.who.int/environmental_health_emergencies/poisoning/en/