History
A detailed history, including the duration of the disease, characteristics and frequency of bowel movements, and associated abdominal and systemic symptoms, may provide a clue to the underlying cause. The presence of a common source, types of specific food, travel history, and use of antibiotics always should be investigated.
The presenting complaints, typical features and pathogenesis of various causative agents, and diagnosis and treatment information can be found in Table 1 in the Causes section.
The following are some of the salient features of food poisoning:
-
Acute diarrhea in food poisoning usually lasts less than 2 weeks. Diarrhea lasting 2-4 weeks is classified as persistent. Chronic diarrhea is defined by duration of more than 4 weeks.
-
The presence of fever suggests an invasive disease. However, sometimes fever and diarrhea may result from infection outside the GI tract, as in malaria.
-
A stool with blood or mucus indicates invasion of the intestinal or colonic mucosa.
-
When vomiting is the major presenting symptom, suspect Staphylococcus aureus, B cereus, or Norovirus. [1]
-
Reactive arthritis can be seen with Salmonella, Shigella, Campylobacter, and Yersinia infections.
-
A profuse rice-water stool suggests cholera or a similar process.
-
Abdominal pain is most severe in inflammatory processes. Painful abdominal cramps suggest underlying electrolyte loss, as in severe cholera.
-
A history of bloating should raise the suspicion of giardiasis.
-
Yersinia enterocolitis may mimic the symptoms of appendicitis.
-
Proctitis syndrome, seen with shigellosis, is characterized by frequent painful bowel movements containing blood, pus, and mucus. Tenesmus and rectal discomfort are prominent features.
-
Consumption of undercooked meat/poultry is suspicious for Salmonella, Campylobacter, Shiga toxin E coli, and C perfringens.
-
Consumption of raw seafood is suspicious for Norwalk-like virus, Vibrio organism, or hepatitis A.
-
Consumption of homemade canned foods is associated with C botulinum.
-
Consumption of unpasteurized soft cheeses is associated with Listeria, Salmonella, Campylobacter, Shiga toxin E coli, and Yersinia.
-
Consumption of deli meats notoriously is responsible for listeriosis.
-
Consumption of unpasteurized milk or juice is suspicious for Campylobacter, Salmonella, Shiga toxin E coli, and Yersinia.
-
Salmonella has been associated with consumption of raw eggs.
Physical
The physical examination should focus on assessing the severity of dehydration and include the following evaluation:
-
A dry mouth, decreased axillary sweat, and decreased urine output indicate mild dehydration, whereas orthostasis, tachycardia, and hypotension indicate more severe volume depletion.
-
A rectal examination always should be performed to directly visualize the stool, to test occult blood, and to palpate the rectal mucosa for any lesions.
-
Rose spot macules on the upper abdomen and hepatosplenomegaly may be seen in Salmonella typhi infection.
-
Erythema nodosum and exudative pharyngitis are suggestive of Yersinia infection.
-
Patients with Vibrio vulnificus or Vibrio alginolyticus may present with cellulitis and otitis media.
Causes
The CDC estimates that 97% of all cases of food poisoning result from improper food handling; 79% of cases result from food prepared in commercial or institutional establishments and 21% of cases result from food prepared at home. [7]
The most common causes are as follows: (1) leaving prepared food at temperatures that allow bacterial growth, (2) inadequate cooking or reheating, (3) cross-contamination, and (4) infection in food handlers. Cross-contamination may occur when raw contaminated food comes in contact with other foods, especially cooked foods, through direct contact or indirect contact on food preparation surfaces.
Bacteria are responsible for approximately 75% of the outbreaks of food poisoning and for 80% of the cases with a known cause in the United States. [5] As many as 1 in 10 Americans has diarrhea due to food-borne infection each year.
Table 1.Causes of Food Poisoning. (Open Table in a new window)
Causative Agents |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
Staphylococci |
Improperly stored foods with high salt or sugar content favors growth of staphylococci. Intense vomiting and watery diarrhea start 1-4 h after ingestion and last as long as 24-48 h |
Enterotoxin acts on receptors in the gut that transmit impulses to the medullary centers |
Symptomatic treatment |
|
B cereus |
Contaminated fried rice (emetic) Meatballs (diarrheal) Emetic: Duration is 9 h, vomiting and cramps Diarrheal: Lasts for 24 h Mainly vomiting after 1-6 h and mainly diarrhea after 8-16 h after ingestion; lasts as long as 1 d |
Emetic enterotoxin (short incubation and duration) - Poorly understood Diarrheal enterotoxin (long incubation and duration) - Increasing intestinal secretion by activation of adenylate cyclase in intestinal epithelium |
Symptomatic treatment |
|
C perfringens |
Inadequately cooked meat, poultry, or legumes Acute onset of abdominal cramps with diarrhea starts 8-24 h after ingestion. Vomiting is rare. It lasts less than 1 d. Enteritis necroticans associated with C perfringens type C in improperly cooked pork (40% mortality) |
Enterotoxin produced in the gut, and food causes hypersecretion in the small intestine |
Culture of clostridia in food and stool Symptomatic treatment |
|
C botulinum |
Canned foods (eg, smoked fish, mushrooms, vegetables, honey) Descending weakness and paralysis start 1-4 d after ingestion, followed by constipation. Mortality is high |
Toxin absorbed from the gut blocks the release of acetylcholine in the neuromuscular junction |
Toxin present in food, serum, and stool. Respiratory support Intravenous trivalent antitoxin from CDC |
|
Listeria monocytogenes |
Raw and pasteurized milk, soft cheeses, raw vegetables, shrimp Systemic disease associated with bacteremia Intestinal symptoms precede systemic disease Can seed meninges, heart valves, and other organs Highest mortality among bacterial food poisonings |
Highly motile, heat-resistant, gram-positive organism |
CSF or blood culture Must treat with antibiotics if bacteremic |
|
Enterotoxic E coli (eg, traveler's diarrhea) |
Contaminated water and food (eg, salad, cheese, meat) Acute-onset watery diarrhea starts 24-48 h after ingestion Concomitant vomiting and abdominal cramps may be present. It lasts for 1-2 d |
Enterotoxin causes hypersecretion in small and large intestine via guanylate cyclase activation |
Supportive treatment No antibiotics |
|
Enterohemorrhagic E coli (eg, E coli O157:H7) |
Improperly cooked hamburger meat and previously spinach Most common isolate pathogen in bloody diarrhea starts 3-4 d after ingestion Usually progresses from watery to bloody diarrhea. It lasts for 3-8 d May be complicated by hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura |
Cytotoxin results in endothelial damage and leads to platelet aggregation and microvascular fibrin thrombi |
Diagnosis with stool culture Supportive treatment No antibiotics |
|
Enteroinvasive E coli |
Contaminated imported cheese Usually watery diarrhea (some may present with dysentery) |
Enterotoxin produces secretion Shigalike toxin facilitates invasion |
Supportive treatment No antibiotics |
|
Enteroaggregative E coli |
Implicated in traveler's diarrhea in developing countries Can cause bloody diarrhea |
Bacteria clump on the cell surfaces |
Ciprofloxacin may shorten duration and eradicate the organism |
|
V cholera |
Contaminated water and food Large amount of nonbloody diarrhea starts 8-24 h after ingestion. It lasts for 3-5 d |
Enterotoxin causes hypersecretion in small intestine Infective dose usually is 107 -109 organisms |
Positive stool culture finding Prompt replacement of fluids and electrolytes (oral rehydration solution) Tetracycline (or fluoroquinolones) shortens the duration of symptoms and excretion of Vibrio |
|
V parahaemolyticus |
Raw and improperly cooked seafood (ie, mollusks and crustaceans) Explosive watery diarrhea starts 8-24 h after ingestion It lasts for 3-5 d |
Enterotoxin causes hypersecretion in small intestine Hemolytic toxin is lethal Infective dose is usually 107 -109 organisms |
Positive stool culture Prompt replacement of fluids and electrolytes Sensitive to tetracycline, but unclear role for antibiotics |
|
V vulnificus |
Wound infection in salt water or consumption of raw oysters Can be lethal in patients with liver disease (50% mortality) |
Polysaccharide capsule Growth correlates with availability of iron (especially transferrin saturation >70%) |
Culture of characteristic bullous lesions or blood Immediate antibiotics if suspected (eg, doxycycline and ceftriaxone) |
|
C jejuni |
Domestic animals, cattle, chickens Fecal-oral transmission in humans Foul-smelling watery diarrhea followed by bloody diarrhea Abdominal pain and fever also may be present; it starts 1-3 d after exposure and recovery is in 5-8 d |
Uncertain about endotoxin production and invasion |
Culture in special media at 42°C Erythromycin for invasive disease (fever) |
|
Shigella |
Potato, egg salad, lettuce, vegetables, milk, ice cream, and water Abrupt onset of bloody diarrhea, cramps, tenesmus, and fever starts 12-30 h after ingestion. Usually self-limited in 3-7 d |
Organisms invade epithelial cells and produce toxins Infective dose is 102 -103 organisms Enterotoxin-mediated diarrhea followed by invasion (dysentery/colitis) |
Polymorphonuclear leukocytes (PMNs), blood, and mucus in stool Positive stool culture Oral rehydration is mainstay Trimethoprim-sulfamethoxazole (TMP-SMX) or ampicillin for severe cases No opiates |
|
Salmonella |
Beef, poultry, eggs, and dairy products Abrupt onset of moderate-to-large amount of diarrhea with low-grade fever; in some cases, bloody diarrhea Abdominal pain and vomiting also present, beginning 6-48 h after exposure and lasts 7-12 d |
Invasion but no toxin production |
Positive stool culture finding Antibiotic for systemic infection |
|
Yersinia |
Pets; transmission in humans by fecal-oral route or contaminated milk or ice cream Acute abdominal pain, diarrhea, and fever (enterocolitis) Incubation period not known Polyarthritis and erythema nodosum in children May mimic appendicitis |
Gastroenteritis and mesenteric adenitis Direct invasion and enterotoxin |
Polymorphonuclear leukocytes and blood in stool Positive stool culture finding No evidence that antibiotics alter the course but may be used in severe infections |
|
Aeromonas |
Untreated well or spring water Diarrhea may be bloody May be chronic up to 42 d in the United States |
Enterotoxin, hemolysin, and cytotoxin |
Positive stool culture Fluoroquinolones or TMP/SMX for chronic diarrhea |
|
Parasitic Food Poisoning |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
E histolytica |
Contaminated food and water 90% asymptomatic 10% dysentery Minority may develop liver abscesses |
Invasion of the mucosa by the parasites |
Criterion standard is colonoscopy with biopsy Ova and parasites may be seen in the stool but has low sensitivity Luminal amebicides (eg, paromomycin) Tissue amebicides (eg, metronidazole) |
|
G lamblia |
Contaminated ground water Fecal-oral transmission in humans Mild diarrhea with nausea and abdominal cramps starts 2-3 d after ingestion; lasts for 1 wk May become chronic |
Unknown Highest concentration in the distal duodenum and proximal jejunum |
Initial diagnostic test is stool enzyme-linked immunosorbent assay Duodenal aspiration or small bowel biopsy Cyst in the stool Metronidazole |
|
Seafood/Shellfish Poisoning |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
Paralytic shellfish poisoning |
Temperate coastal areas Source - Bivalve mollusks Onset usually is 30-60 min Initial symptoms include perioral and intraoral paresthesia Other symptoms include paresthesia of the extremities, headache, ataxia, vertigo, cranial nerve palsies, and paralysis of respiratory muscles, resulting in respiratory arrest |
Fish acquires toxin-producing dinoflagellates |
General observation for 4-6 h Maintain patent airway. Administer oxygen, and assist ventilation if necessary For recent ingestion, charcoal 50-60 g may be helpful |
|
Neurotoxic shellfish poisoning |
Coastal Florida Source - Mollusks Illness is milder than in paralytic shellfish poisoning |
Fish acquires toxin-producing dinoflagellates |
Symptomatic |
|
Ciguatera |
Hawaii, Florida, and Caribbean Source - Carnivorous reef fish Vomiting, diarrhea, and cramps start 1-6 h after ingestion and last from days to months Diarrhea may be accompanied by a variety of neurologic symptoms including paresthesia, reversal of hot and cold sensation, vertigo, headache, and autonomic disturbances such as hypotension and bradycardia Chronic symptoms (eg, fatigue, headache) may be aggravated by caffeine or alcohol |
Fish acquires toxin-producing dinoflagellates Toxin increases intestinal secretion by changing intracellular calcium concentration |
Symptomatic Anecdotal reports of successful treatment of neurologic symptoms with mannitol 1 g/kg IV |
|
Tetrodotoxin poisoning |
Japan Source - Puffer fish Onset of symptoms usually is 30-40 min but may be as short as 10 min; it includes lethargy, paresthesia, emesis, ataxia, weakness, and dysphagia; ascending paralysis occurs in severe cases; mortality is high. |
Neurotoxin is concentrated in the skin and viscera of puffer fish. |
Symptomatic |
|
Scombroid |
Source - Tuna, mahi-mahi, kingfish Allergic symptoms such as skin flush, urticaria, bronchospasm, and hypotension usually start within 15-90 min |
Improper preservation of large fish results in bacterial degradation of histidine to histamine |
Antihistamines (diphenhydramine 25-50 mg IV) H2 blockers (cimetidine 300 mg IV) Severe reactions may require subcutaneous epinephrine (0.3-0.5 mL of 1:1000 solution) |
|
Heavy Metal Poisoning |
Source |
Symptoms |
Treatment |
|
Mercury |
Ingestion of inorganic mercuric salts |
Causes metallic taste, salivation, thirst, discoloration and edema of oral mucous membranes, abdominal pain, vomiting, bloody diarrhea, and acute renal failure |
Consult a toxicologist Remove ingested salts by emesis and lavage, and administer activated charcoal and a cathartic Dimercaprol is useful in acute ingestion |
|
Lead |
Toxicity results from chronic repeated exposure It is rare after single ingestion |
Common symptoms include colicky abdominal pain, constipation, headache, and irritability Diagnosis is based on lead level (>10 mcg/dL) |
Other than activated charcoal and cathartic, severe toxicity should be treated with antidotes (edetate calcium disodium [EDTA] and dimercaprol). |
|
Arsenic |
Ingestion of pesticide and industrial chemicals |
Symptoms usually appear within 1 h after ingestion but may be delayed as long as 12 h Abdominal pain, watery diarrhea, vomiting, skeletal muscle cramps, profound dehydration, and shock may occur |
Gastric lavage and activated charcoal Dimercaprol injection 10% solution in oil (3-5 mg/kg IM q4-6h for 2 d) and oral penicillamine (100 mg/kg/d divided qid for 1 wk) |
|
Tables
Causative Agents |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
Staphylococci |
Improperly stored foods with high salt or sugar content favors growth of staphylococci. Intense vomiting and watery diarrhea start 1-4 h after ingestion and last as long as 24-48 h |
Enterotoxin acts on receptors in the gut that transmit impulses to the medullary centers |
Symptomatic treatment |
|
B cereus |
Contaminated fried rice (emetic) Meatballs (diarrheal) Emetic: Duration is 9 h, vomiting and cramps Diarrheal: Lasts for 24 h Mainly vomiting after 1-6 h and mainly diarrhea after 8-16 h after ingestion; lasts as long as 1 d |
Emetic enterotoxin (short incubation and duration) - Poorly understood Diarrheal enterotoxin (long incubation and duration) - Increasing intestinal secretion by activation of adenylate cyclase in intestinal epithelium |
Symptomatic treatment |
|
C perfringens |
Inadequately cooked meat, poultry, or legumes Acute onset of abdominal cramps with diarrhea starts 8-24 h after ingestion. Vomiting is rare. It lasts less than 1 d. Enteritis necroticans associated with C perfringens type C in improperly cooked pork (40% mortality) |
Enterotoxin produced in the gut, and food causes hypersecretion in the small intestine |
Culture of clostridia in food and stool Symptomatic treatment |
|
C botulinum |
Canned foods (eg, smoked fish, mushrooms, vegetables, honey) Descending weakness and paralysis start 1-4 d after ingestion, followed by constipation. Mortality is high |
Toxin absorbed from the gut blocks the release of acetylcholine in the neuromuscular junction |
Toxin present in food, serum, and stool. Respiratory support Intravenous trivalent antitoxin from CDC |
|
Listeria monocytogenes |
Raw and pasteurized milk, soft cheeses, raw vegetables, shrimp Systemic disease associated with bacteremia Intestinal symptoms precede systemic disease Can seed meninges, heart valves, and other organs Highest mortality among bacterial food poisonings |
Highly motile, heat-resistant, gram-positive organism |
CSF or blood culture Must treat with antibiotics if bacteremic |
|
Enterotoxic E coli (eg, traveler's diarrhea) |
Contaminated water and food (eg, salad, cheese, meat) Acute-onset watery diarrhea starts 24-48 h after ingestion Concomitant vomiting and abdominal cramps may be present. It lasts for 1-2 d |
Enterotoxin causes hypersecretion in small and large intestine via guanylate cyclase activation |
Supportive treatment No antibiotics |
|
Enterohemorrhagic E coli (eg, E coli O157:H7) |
Improperly cooked hamburger meat and previously spinach Most common isolate pathogen in bloody diarrhea starts 3-4 d after ingestion Usually progresses from watery to bloody diarrhea. It lasts for 3-8 d May be complicated by hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura |
Cytotoxin results in endothelial damage and leads to platelet aggregation and microvascular fibrin thrombi |
Diagnosis with stool culture Supportive treatment No antibiotics |
|
Enteroinvasive E coli |
Contaminated imported cheese Usually watery diarrhea (some may present with dysentery) |
Enterotoxin produces secretion Shigalike toxin facilitates invasion |
Supportive treatment No antibiotics |
|
Enteroaggregative E coli |
Implicated in traveler's diarrhea in developing countries Can cause bloody diarrhea |
Bacteria clump on the cell surfaces |
Ciprofloxacin may shorten duration and eradicate the organism |
|
V cholera |
Contaminated water and food Large amount of nonbloody diarrhea starts 8-24 h after ingestion. It lasts for 3-5 d |
Enterotoxin causes hypersecretion in small intestine Infective dose usually is 107 -109 organisms |
Positive stool culture finding Prompt replacement of fluids and electrolytes (oral rehydration solution) Tetracycline (or fluoroquinolones) shortens the duration of symptoms and excretion of Vibrio |
|
V parahaemolyticus |
Raw and improperly cooked seafood (ie, mollusks and crustaceans) Explosive watery diarrhea starts 8-24 h after ingestion It lasts for 3-5 d |
Enterotoxin causes hypersecretion in small intestine Hemolytic toxin is lethal Infective dose is usually 107 -109 organisms |
Positive stool culture Prompt replacement of fluids and electrolytes Sensitive to tetracycline, but unclear role for antibiotics |
|
V vulnificus |
Wound infection in salt water or consumption of raw oysters Can be lethal in patients with liver disease (50% mortality) |
Polysaccharide capsule Growth correlates with availability of iron (especially transferrin saturation >70%) |
Culture of characteristic bullous lesions or blood Immediate antibiotics if suspected (eg, doxycycline and ceftriaxone) |
|
C jejuni |
Domestic animals, cattle, chickens Fecal-oral transmission in humans Foul-smelling watery diarrhea followed by bloody diarrhea Abdominal pain and fever also may be present; it starts 1-3 d after exposure and recovery is in 5-8 d |
Uncertain about endotoxin production and invasion |
Culture in special media at 42°C Erythromycin for invasive disease (fever) |
|
Shigella |
Potato, egg salad, lettuce, vegetables, milk, ice cream, and water Abrupt onset of bloody diarrhea, cramps, tenesmus, and fever starts 12-30 h after ingestion. Usually self-limited in 3-7 d |
Organisms invade epithelial cells and produce toxins Infective dose is 102 -103 organisms Enterotoxin-mediated diarrhea followed by invasion (dysentery/colitis) |
Polymorphonuclear leukocytes (PMNs), blood, and mucus in stool Positive stool culture Oral rehydration is mainstay Trimethoprim-sulfamethoxazole (TMP-SMX) or ampicillin for severe cases No opiates |
|
Salmonella |
Beef, poultry, eggs, and dairy products Abrupt onset of moderate-to-large amount of diarrhea with low-grade fever; in some cases, bloody diarrhea Abdominal pain and vomiting also present, beginning 6-48 h after exposure and lasts 7-12 d |
Invasion but no toxin production |
Positive stool culture finding Antibiotic for systemic infection |
|
Yersinia |
Pets; transmission in humans by fecal-oral route or contaminated milk or ice cream Acute abdominal pain, diarrhea, and fever (enterocolitis) Incubation period not known Polyarthritis and erythema nodosum in children May mimic appendicitis |
Gastroenteritis and mesenteric adenitis Direct invasion and enterotoxin |
Polymorphonuclear leukocytes and blood in stool Positive stool culture finding No evidence that antibiotics alter the course but may be used in severe infections |
|
Aeromonas |
Untreated well or spring water Diarrhea may be bloody May be chronic up to 42 d in the United States |
Enterotoxin, hemolysin, and cytotoxin |
Positive stool culture Fluoroquinolones or TMP/SMX for chronic diarrhea |
|
Parasitic Food Poisoning |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
E histolytica |
Contaminated food and water 90% asymptomatic 10% dysentery Minority may develop liver abscesses |
Invasion of the mucosa by the parasites |
Criterion standard is colonoscopy with biopsy Ova and parasites may be seen in the stool but has low sensitivity Luminal amebicides (eg, paromomycin) Tissue amebicides (eg, metronidazole) |
|
G lamblia |
Contaminated ground water Fecal-oral transmission in humans Mild diarrhea with nausea and abdominal cramps starts 2-3 d after ingestion; lasts for 1 wk May become chronic |
Unknown Highest concentration in the distal duodenum and proximal jejunum |
Initial diagnostic test is stool enzyme-linked immunosorbent assay Duodenal aspiration or small bowel biopsy Cyst in the stool Metronidazole |
|
Seafood/Shellfish Poisoning |
Source and Clinical Features |
Pathogenesis |
Diagnosis and Treatment |
|
Paralytic shellfish poisoning |
Temperate coastal areas Source - Bivalve mollusks Onset usually is 30-60 min Initial symptoms include perioral and intraoral paresthesia Other symptoms include paresthesia of the extremities, headache, ataxia, vertigo, cranial nerve palsies, and paralysis of respiratory muscles, resulting in respiratory arrest |
Fish acquires toxin-producing dinoflagellates |
General observation for 4-6 h Maintain patent airway. Administer oxygen, and assist ventilation if necessary For recent ingestion, charcoal 50-60 g may be helpful |
|
Neurotoxic shellfish poisoning |
Coastal Florida Source - Mollusks Illness is milder than in paralytic shellfish poisoning |
Fish acquires toxin-producing dinoflagellates |
Symptomatic |
|
Ciguatera |
Hawaii, Florida, and Caribbean Source - Carnivorous reef fish Vomiting, diarrhea, and cramps start 1-6 h after ingestion and last from days to months Diarrhea may be accompanied by a variety of neurologic symptoms including paresthesia, reversal of hot and cold sensation, vertigo, headache, and autonomic disturbances such as hypotension and bradycardia Chronic symptoms (eg, fatigue, headache) may be aggravated by caffeine or alcohol |
Fish acquires toxin-producing dinoflagellates Toxin increases intestinal secretion by changing intracellular calcium concentration |
Symptomatic Anecdotal reports of successful treatment of neurologic symptoms with mannitol 1 g/kg IV |
|
Tetrodotoxin poisoning |
Japan Source - Puffer fish Onset of symptoms usually is 30-40 min but may be as short as 10 min; it includes lethargy, paresthesia, emesis, ataxia, weakness, and dysphagia; ascending paralysis occurs in severe cases; mortality is high. |
Neurotoxin is concentrated in the skin and viscera of puffer fish. |
Symptomatic |
|
Scombroid |
Source - Tuna, mahi-mahi, kingfish Allergic symptoms such as skin flush, urticaria, bronchospasm, and hypotension usually start within 15-90 min |
Improper preservation of large fish results in bacterial degradation of histidine to histamine |
Antihistamines (diphenhydramine 25-50 mg IV) H2 blockers (cimetidine 300 mg IV) Severe reactions may require subcutaneous epinephrine (0.3-0.5 mL of 1:1000 solution) |
|
Heavy Metal Poisoning |
Source |
Symptoms |
Treatment |
|
Mercury |
Ingestion of inorganic mercuric salts |
Causes metallic taste, salivation, thirst, discoloration and edema of oral mucous membranes, abdominal pain, vomiting, bloody diarrhea, and acute renal failure |
Consult a toxicologist Remove ingested salts by emesis and lavage, and administer activated charcoal and a cathartic Dimercaprol is useful in acute ingestion |
|
Lead |
Toxicity results from chronic repeated exposure It is rare after single ingestion |
Common symptoms include colicky abdominal pain, constipation, headache, and irritability Diagnosis is based on lead level (>10 mcg/dL) |
Other than activated charcoal and cathartic, severe toxicity should be treated with antidotes (edetate calcium disodium [EDTA] and dimercaprol). |
|
Arsenic |
Ingestion of pesticide and industrial chemicals |
Symptoms usually appear within 1 h after ingestion but may be delayed as long as 12 h Abdominal pain, watery diarrhea, vomiting, skeletal muscle cramps, profound dehydration, and shock may occur |
Gastric lavage and activated charcoal Dimercaprol injection 10% solution in oil (3-5 mg/kg IM q4-6h for 2 d) and oral penicillamine (100 mg/kg/d divided qid for 1 wk) |
|
