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EBMG

Treatment of Poisoning in the Elderly

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

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.

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.

Ethanol

Anticholinergics

Antidepressants, antipsychotics, sedatives

Cardiovascular drugs

Oral antidiabetics

Laxatives (containing magnesium or phosphate)

NSAIDs, opioids, salicylates

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