Home >> Diseases Of Children >> Intestinal Bacteria to Neoplasms And Parasites Of >> L the Removal of

L the Removal of Poisons from the Body

gm, gr, water, solution, poison, stomach and kidneys

L THE REMOVAL OF POISONS FROM THE BODY Many poisons lead to reflex movements of the body by which they are partly rejected (spitting and vomiting). Our first attempt must be to remove all that is possible mechanically from the mouth and pharynx and to free the stomach from its contents. We must attempt to cause vomiting by irritation of the posterior wall of the pharynx and rapidly follow this with a thorough evacuation of the stomach by the tube. Under some circumstances lavage may also be required. We must take into consideration two facts: in some poisons (lye, acid, corrosive sub limate) we encounter at times deep ulceration of the (esophagus and gastric wall so that perforation by the tube is quite possible; there fore, a soft rubber tube must be used and great care taken. In washing out the stomach we must consider further that the poison must on no account be made soluble. In many cases, therefore, we should not use water for lavage, but in preferanee milk or an albuminous solution (for example, after swallowing corrosive sublimate). In other eases milk is contraindicated on account of its fat content (phosphorous poison ing). Some poisons enter the circulation and are then thrown into the stomach with the gastrie secretion and then absorbed again. Lavage must then be repeated, even if the patient is reached sometime after the drug has been taken (opium, morphine, iodine, ete.). Apomorphine hydrochloride may be used hypodermically to cause vomiting, 0.0008 0.0015 Grn. (-7,-; to Tki gr.) in children under 2 years of age, 0.002-0.005 Gm. fhb) gr.) in children from 2 to 10 years, over this age 0.01 Gm. C, to 1. gr.). To prepare the solution quickly we should have tablets of apoinorphine 0.01 Gm. if, gr.) ready, which can be dissolved in 1 to 5 c.c. 014 16-11 dr.) of water according to the dose which one wishes to give. Emetics which aet on the stomach directly should not be given and even the use of apomorphine may be avoided by causing vomiting mechanically.

-Whatever part of the poison has reached the intestine must be removed as rapidly as possible per rectum. Lavage of the intestines and high elysmata set up peristalsis in the upper parts of the intestine and help to evacuate the small intestine. (A pint to a quart of luke warm salt solution must be introduced with the irrigator to which soap-suds may be added to increase the peristalsis.) If the poison has

entered the body directly from the intestines pdysma of sublimate, carbolic acid, etc.) one should irrigate the bowel with milk or white of egg solution. The use of medicinal purges cannot be avoided at times, the saline purges are the best; for example, Carlsbad salts (I to 3 tea spoonfuls to a tumbler of hot water). Castor oil is contraindicated in phosphorus and cantharicies poisoning.

The skin and kidneys may also help to remove the poison front the body. To increase the secretion of tbe kidneys and sweat glands vve can give large amounts of fluid especially in the shape of milk diluted with carbonic acid waters (one part of milk with three parts of Selters water or Vichy or Wildungen may be given). Where the condition of the stomach does not admit of giving water INT must give repeated rectal injections and give normal salt solution subeutaneously in 0.9 to 1 per eent. solution ithis hypertonie solution is desirable since it causes withdrawal of fluid from the tissues and thereby aids in elimination of the poison). Diuresis must be further excited by remedies stimulating the kidneys, for example, diuretin 1.0-3.0 Gm. (15-45 gr.), water up to 100 c.c. (3 oz.), 1 teaspoonful every one to three hours. Caffeine sodium benzoate, 1 Gm. 115 gr.), water up to 100 ex. (3 oz.), one tea spoonful every one to three hours.

The subcutaneous injection of caffeine is of use (caffeine sodium salieylate 1 Gnt. (15 gr.), water tip to 10 e.c., inject 0.05 to 1 e.e.-1 c.c. =0.1 Gm. eaffeine sodium salieylate=0.05 Gm. eaffeine).

The action of diuretics on the kidneys ean be heightened by stim ulating the action of the heart (camphor, digitalis); this also stimulates the secretion of the skin, which can be excitecl by hot packs, giving hot flaxseed tea, or sometimes by injections of pilocarpine (pilocarpine hydro chlorate 0.05 Gm. aquie ad 10 c.c., half a syringefull, 0.0025 Gm. UT gr.) up to one whole syringe 0.005 Gni. (T1,- g,r.) or two syringes 0.01 Gm. a gr.). We must, make sure of the permeability of the kidneys before giving diuretics. Venescetion followed by- infusion of normal salt solution has proved of service when the poisons have entered the circulation and caused deep unconsciousness.