Diagnosis of poisoning
History:
- Patient history: Onset of symptoms, medications taken, exposure to toxic substances, previous poisoning episodes
- Family and friends: Information about patient's habits, access to substances
- Workplace and school: Potential exposure to hazardous materials
- Environmental factors: Household cleaning products, pesticides, carbon monoxide detectors, smoke alarms
Physical examination:
- General: Respiratory distress, hypotension, altered mental status, seizures
- Head and neck: Eyelid edema, miosis, mydriasis, nystagmus
- Chest: Auscultation for wheezing, rales, or diminished breath sounds
- Cardiovascular: Arrhythmias, hypotension, tachycardia
- Skin: Redness, papules, blisters, burns
- Neurological: Tremor, weakness, seizures, altered mental status
Laboratory tests:
- Serum toxicant levels:
- Quantitative analysis to determine substance concentration
- Interpretation based on therapeutic and toxic levels
- Urine drug screen:
- Qualitative analysis to detect presence of illicit drugs or prescription medications
- Blood gas analysis:
- pH, pCO2, pO2, bicarbonate
- Electrolytes and renal function:
- Sodium, potassium, chloride, bicarbonate, creatinine
- Liver function tests:
- AST, ALT, alkaline phosphatase, bilirubin
- Hematologic tests:
- Hemoglobin, hematocrit, white blood cell count
Imaging studies:
- Chest X-ray: Pulmonary edema, aspiration pneumonia
- Computed tomography (CT) scan: Head injury, cerebrovascular accident
- Magnetic resonance imaging (MRI) scan: Brain injury, spinal cord injury
Additional diagnostic procedures:
- Gastric lavage: Removal of ingested toxins via nasogastric tube
- Activated charcoal administration: To adsorb toxins in the gastrointestinal tract
- Hemodialysis or peritoneal dialysis: Removal of toxins from the bloodstream
- Specific antidotes: For specific poisons, such as naloxone for opioid overdose
Differential diagnosis:
- Infectious diseases (e.g., meningitis, encephalitis)
- Metabolic disorders (e.g., diabetic ketoacidosis, hypoglycemia)
- Psychiatric disorders (e.g., psychosis, delirium)
- Trauma (e.g., head injury, spinal cord injury)