Management of Drug Overdose and Poisoning - Ministry of Health

453 Pages·2000·0.58 MB·English

These guidelines have been withdrawn
MOH clinical practice guidelines are considered withdrawn five years after
publication unless otherwise specified in individual guidelines. Users should
keep in mind that evidence-based guidelines are only as current as the
evidence that supports them and new evidence can supersede
recommendations made in the guidelines.
CLINICAL PRACTICE GUIDELINES
Management of
Drug Overdose
and Poisoning
Ministry National
Pharmaceutical May 2000
of Health
Administration
MOH Clinical Practice Guidelines 2/2000
Published by
Ministry of Health, Singapore
2000
This publication is meant as a general guide to the management of drug overdose and poisoning and not as an authoritative
reference on the subject. Because of the dynamic nature of information on poisoning, readers are advised that decisions
regarding drug therapy must be based on the independent judgement of the clinician, changing information about a drug/
chemical and changing medical practices. While care has been taken to ensure the accuracy of the information presented at
the time of publishing, the Ministry of Health, the authors, and the publishing editors will not be liable for any errors or
omissions, or any untoward effect arising from the use or misuse of this book.
Management of
Drug Overdose &
Poisoning
I
Message
Clinical toxicology has advanced considerably in the last 10 years since
the publication of the first handbook on the management of poisoning by
the Ministry of Health. The pattern of poisoning has also changed as people
are now exposed to other new drugs and chemicals. New antidotes and
therapies have been developed for the management of such poisoning,
and are now available to health professionals.
The publication of this new edition on the management of drug overdose
and poisoning is most timely. The workgroup has put in great efforts to
produce this comprehensive handbook, which will serve as a quick and
easy reference for health professionals in the management of poisoning.
I would like to congratulate the workgroup members and all contributors
for their achievement. I trust that the handbook will meet the information
requirements of our healthcare workers.
Dr Chen Ai Ju
Director of Medical Services
Ministry of Health
II
Preface
The first handbook on management of poisoning was published by the
Ministry of Health ten years ago. The objective then was to provide a quick
and reliable reference for the complex management of drug overdoses/
poisoning. Since then, great strides have been made in scientific technology,
medicine, agriculture and pest control which have led to the development of
many new products with associated toxic effects. Therefore, it has become
necessary to revise and update the information pertaining to toxicology.
This new edition of the handbook provides comprehensive advice for the
management of drug overdose and poisoning. It is organised into 4 main
sections, each identified by coloured tags in the right margins. Section A gives
an overview of principles in the management of poisoning including the
medico-legal and socio-psychiatric aspects. Section B provides information
on diagnosis and treatment of overdoses of 11 classes of therapeutic agents.
Section C focuses on household, industrial and metallic poisoning; and Section
D is on agricultural poisoning. To make the handbook a practical and useful
guide, a comprehensive index with extensive cross referencing is provided.
The revision and publishing of the handbook has been a challenging and
rewarding task. We hope it will be well utilised by the health professionals.
We would like to record our grateful thanks to the workgroup members for
their time and contribution to the various chapters.
Mrs Tan Shook Fong
Chief Pharmacist/Director
National Pharmaceutical Administration
Ministry of Health
May 2000
III
Workgroup Members
Chairmen
Mrs Tan Shook Fong Dr V Anantharaman
Chief Pharmacist/Director Head (Emergency Medicine)
National Pharmaceutical Administration Singapore General Hosptial
Secretary
Ms Chan Cheng Leng
Head (Information & Research)
National Pharmaceutical Administration
Members
A/Prof Lee How Sung Mr Toh Kaik Bing
Department of Pharmacology Head (New Drug Unit)
National University of Singapore National Pharmaceutical Administra-
tion
Dr Tan Colin Clinical Professor Chao Tzee Cheng
Medical Graduate Special Forensic Advisor
National Pharmaceutical Administration Institute of Science & Forensic Medicine
Dr Bloodworth Chen Bosco Dr Lo Danny
Head (Food Laboratory) Head (Toxicology)
Institute of Science & Forensic Medicine Institute of Science & Forensic Medicine
Mr Tan Kelvin Ms Chua Sheau Bin
Pharmacist Pharmacist
National Pharmaceutical Administration National Pharmaceutical Administra-
tion
Ms N Shymala
Senior Pharmacist
Singapore General Hospital
Acknowledgements
The Committee would like to express its appreciation to the Kwan Im Thong Hood
Cho Temple and the National Medical Research Council (NMRC) for the generous
contribution to the printing of this publication. Special thanks to Dr R Ponampalam
of the Singapore General Hospital for his invaluable feedback and comments.
IV
V
Contents
Message.................................................................................................................I
Preface...................................................................................................................II
Workgroup Members.......................................................................................III
SECTION A - OVERVIEW OF MANAGEMENT
1 Poison Management Systems.........................................................................3
2 Principles of Management of Acute Poisoning..........................................13
3 Decontamination After Poisoning................................................................41
4 Enhancing the Elimination of Toxic Substances from the Body..............55
5 Medico-Legal Aspects of Poisoning.............................................................69
6 Socio-Psychiatric Aspects of Poisons Management...................................71
7 The Toxicology Laboratory...........................................................................75
8 Antidotes & Therapeutic Drugs ...................................................................89
SECTION B - MEDICINAL POISONING
1 Antihistamines..............................................................................................143
2 Anti-Infective Agents
2.1 Anthelmintics...........................................................................................149
2.2 Antibacterial Drugs.................................................................................151
2.3 Antifungal Drugs....................................................................................153
2.4 Antimalarial Drugs.................................................................................155
2.5 Antituberculous Drugs...........................................................................158
2.6 Antiviral Drugs........................................................................................160
3 Autonomic Drugs
3.1 Adrenergic Drugs (Sympathomimetics)..............................................171
3.2 Anticholinergic Drugs............................................................................176
3.3 Cholinergic Drugs (Parasympathomimetics)......................................180
3.4 Skeletal Muscle Relaxants......................................................................181
3.5 Smooth Muscle Relaxants......................................................................183
3.6 Sympatholytic Drugs..............................................................................185
3.7 Sumatriptan .............................................................................................188
VI
4 Cardiovascular Drugs
4.1 Anticoagulants.........................................................................................191
4.2 Antihypertensive Agents.......................................................................193
4.3 Cardiac Drugs..........................................................................................201
4.4 Diuretics ...................................................................................................207
4.5 Fibrinolytics .............................................................................................211
4.6 Nitrites and Nitrates...............................................................................212
5 Central Nervous System Drugs
5.1 Analgesics, Antipyretics and Anti-Inflammatory Agents.................221
5.2 Anticonvulsants/Sedatives ...................................................................232
5.3 Cerebral Stimulants ................................................................................242
5.4 Psychotherapeutic Agents .....................................................................244
6 Gastrointestinal Drugs
6.1 Antacids and Antiflatulents ..................................................................255
6.2 Antidiarrhoeal Drugs .............................................................................257
6.3 Antiemetics ..............................................................................................260
6.4 H Receptor Antagonists........................................................................263
2
6.5 Proton Pump Inhibitors..........................................................................265
7 Gout Preparations
7.1 Allopurinol...............................................................................................267
7.2 Colchicine.................................................................................................269
7.3 Probenecid................................................................................................271
7.4 Sulfinpyrazone ........................................................................................272
8 Hormones and Steroids
8.1 Androgens and Anabolic Steroids........................................................275
8.2 Corticosteroids.........................................................................................277
8.3 Oestrogens................................................................................................288
8.4 Antidiabetic Drugs..................................................................................292
8.5 Pituitary Drugs........................................................................................299
8.6 Thyroid and Antithyroid Drugs............................................................300
9 Oxytocics
9.1 Ergot Alkaloids........................................................................................307
9.2 Oxytocin ...................................................................................................309
10 Skin and Mucous Membrane Agents
10.1 Astringents...........................................................................................311
10.2 Miscellaneous......................................................................................313