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EBMG

Treatment of Poisoning in the Elderly

Essentials

  • For general principles of assessing and treating poisoning, see Treatment of Poisoning.
  • Elderly patients are susceptible to poisoning because pharmacokinetics and dynamics change with age.
    • Impaired renal function
    • Reduced muscle bulk and relative amount of water in the body
    • Increased share of body fat
    • Changed function of drug target organs
  • Normal drug doses may have significant adverse effects, and symptoms of poisoning may be delayed.
  • For the most common agents causing poisoning in the elderly, see Table T1.
  • Use of various natural products is common, and these may interact with medication.
  • Weakening eyesight, hearing and mental capacity may complicate correct taking of medication.
  • In the elderly, too, poisoning may result from use of intoxicants or represent a suicide attempt. A breathalyser test should be done as a basic examination on admission.

Symptoms

  • Symptoms of poisoning may be abnormal.
    • Falling due to the use of a sedative
    • Delirium, changed mood, memory problems, psychosis

Treatment

  • The treatment of acute poisoning follows the same principles as in younger patients; see Treatment of Poisoning.
  • In the case of mild overdose that has developed slowly, the drug dose may be adjusted and the results of concentration tests can be waited for, as necessary.
    • Typically seen in drugs with a narrow therapeutic range, such as valproic acid or digoxin
  • In the case of lithium, salicylate or metformin poisoning, the possibility of dialysis should be considered at an early stage.

Further measures

  • Home carers may help administer medications if the patient is incapable of taking them independently (see also Assessment of Functional Capacity in the Elderly).
  • As coping at home becomes more difficult, the patient should be placed in 24-h care.

The most common agents causing poisoning in the elderly

Ethanol
Anticholinergics
Anticoagulants
Antidepressants, antipsychotics, sedatives
Cardiovascular drugs
Oral antidiabetics
Laxatives (containing magnesium or phosphate)
NSAIDs, opioids, salicylates

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