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  • William W. Forgey, MD

Body System Symptoms and Management - Water and Waste - Reproductive Organs - Diabetes - Poisoning

Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.



WATER AND WASTE


Oral Fluid Replacement Therapy

Replacement of fluid loss is required for three different circumstances: diarrhea, heat stress sweat formation, and insensible moisture loss from breathing and skin respiration (yes, skin must breathe also). The ideal fluid replacement for each of these losses differs in electrolyte and sugar content. In general, diarrhea replacement fluids should not have a sugar content greater than 2.5%, as a higher concentration might cause additional diarrhea. (A higher sugar concentration is not a problem in a person who is not ill.) Sweat replacement solutions should not have a sugar concentration greater than 8.5%; this slows the emptying of the fluid from the stomach. The uptake of water by the body is decreased, as this occurs in the intestines and not the stomach. The ideal electrolyte composition for these circumstances also differs dramatically.


Profound diarrhea from any source may cause severe dehydration and electrolyte imbalance. The non-vomiting patient must receive adequate fluid replacement, equaling his stool loss plus about 2 liters (2 quarts) per day. For a couple of days, an adult can replace these losses by drinking enough plain water. A child or less healthy adult will require electrolyte replacement in addition to the water. The Centers for Disease Control and Prevention (CDC) recommends the oral replacement cocktails for fluid losses caused by profound diarrhea seen in table 3-7. Drink alternately from each glass. Supplement with carbonated beverages, or water and tea made with boiled or carbonated water as desired. Avoid solid foods and milk until recovery.


Throughout the world, the United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) distribute an electrolyte replacement product called Oralyte. It must be reconstituted with adequately purified water.


If the patient is maintaining fluid balance with an effective oral rehydration therapy, such as with the packets as indicated above, the additional glass of carbonated or bicarbonate water is not necessary. Other products that are considered safe for rehydration due to diarrheal losses are NaturaLyte, Pedialyte, Enfalyte, and Pediatric. Gatorade is too high in carbohydrate and too low in sodium, potassium, and base to be considered a safe substitute, even with modification.


Water Purification

Water can be purified adequately for drinking by mechanical, physical, and chemical means.


The clearest water possible should be chosen or attempts made to clarify the water prior to starting any disinfectant process. Water with high particulate counts of clay or organic debris allows high bacterial counts and tends to be more heavily contaminated. In preparing potable, or drinkable, water, we are attempting to lower the germ counts to the point that the body can defend itself against the remaining numbers. We are not trying to produce sterile water; that would generally be impractical.


The use of chlorine-based systems has been effectively used by municipal water supply systems for years. There are two forms of chlorine readily available to the outdoors traveler. One is liquid chlorine laundry bleach, and the other is halazone tablets.


Laundry bleach that is 4 to 6% sodium hypochlorite can make clear water safe to drink if 2 drops are added to 1 quart of water. Avoid brands of bleach that contain soap or surfactant. Mix this water thoroughly and let it stand for 30 minutes before drinking. The resulting blend should have a slight chlorine odor. If not, the original laundry bleach may have lost some of its strength, and you should repeat the dose and let it stand an additional 15 minutes prior to drinking.


Halazone tablets from Abbott Laboratories are also effective. They are quite stable, with a shelf life of 5 years, even when occasionally exposed to temperatures over 100°F (38°C). Recent articles in outdoor literature have stated that halazone has a short shelf life and that it loses 75% of its activity when exposed to air for 2 days. Abbott Labs refutes this and has proven the efficacy of halazone sufficiently to receive FDA approval. A clue to the stability of the tablets is that they turn yellow and have an objectionable odor when they decompose. Check for this before use. Add 5 tablets to a quart of clear water for adequate chlorination.


Chlorine-based systems are very effective against viruses and bacteria. They work best in neutral or slightly acid waters. As the active form of the chlorine, namely hypochlorous acid (HClO), readily reacts with nitrogen-containing compounds such as ammonia, high levels of organic debris decrease its effectiveness. The amount of chlorine bleach or halazone added must be increased if the water is alkaline or contaminated with organic debris.


Iodine is a fairly effective agent against protozoan contamination such as Giardia lamblia and Entamoeba histolytica, both of which tend to be resistant to chlorine. Further, iodine is not as reactive to ammonia or other organic debris, thus working better in cloudy water. It is relatively ineffective against cryptosporidia, which must be destroyed by either filtration or heat (see page 92). Tincture of iodine, as found in the home medicine chest, may be used as the source of the iodine. Using the commonly available 2% solution, 5 drops should be added to clear water or 10 drops to cloudy water, and the resultant mix should be allowed to stand 30 minutes prior to drinking.


An elemental iodine concentration of 3 to 5 ppm (parts per million) is necessary to kill amoeba and their cysts, algae, bacteria and their spores, and enterovirus. Crystals of iodine can also be used to prepare a saturated iodine water solution for use in disinfecting drinking water. In a 1-ounce (30 ml) glass bottle, place 4 to 8 grams of USP-grade iodine crystals. Water added to this bottle will dissolve varying amounts of iodine, based upon the water temperature. This saturated iodine water solution is then added to a quart of water. The amount added to produce a final concentration of 4 ppm will vary according to temperature, as indicated in table 3-8.



This water should be stored for 15 minutes before drinking. If the water is turbid or otherwise contaminated, the amounts of saturated iodine solution indicated in table 3-8 should be doubled and the resultant water stored 20 minutes before using. This product is now commercially available as Polar Pure through many outdoor stores and catalog houses.


Mechanical filtration methods are also useful in preparing drinking water. They normally consist of a screen with sizes down to 6 microns, which are useful in removing tapeworm eggs (25 microns) or Giardia lamblia (7 to 15 microns). These screens enclose an activated charcoal filter element, which removes many disagreeable tastes. As most bacteria have a diameter smaller than 1 micron, bacteria and the even smaller viral species are not removed by filtration using these units. For water to be safe after using one of these devices, it must be pretreated with chlorine or iodine exactly as indicated above prior to passage through the device. While these filters remove clay and organic debris, they will plug easily if the water is very turbid. A concern with the charcoal filter usage is that the filters may become contaminated with bacteria when they are used the next time. Pretreating the water helps prevent this. I have frequently used a charcoal filter system to ensure safe, good-tasting water after chemical treatment.


Another filtration method is perhaps one of the oldest, namely filtering through unglazed ceramic material. This was done in large crocks, a slow filtration method popular in tropical countries many years ago. A modern version of this old system is the development of a pressurized pump method. Made in Switzerland, the Katadyn Pocket filter has a ceramic core enclosed in a tough plastic housing, fitted with an aluminum pump. The built-in pump forces water through the ceramic filter at a rate of approximately 3/4 quart (750 ml) per minute. Turbid water will plug the filter, but a brush is provided to easily restore full flow rates. This filter has a 0.2-micron size, which eliminates all bacteria and larger pathogens. Pretreating of the water is not required. There is evidence that viral particles are also killed by this unit, as the ceramic material is silver-impregnated, which appears to denature viruses as they pass through the filter. The European Union did not approve this claim; as a result, the manufacturer no longer makes this statement in their literature. I have worked with many groups using this device, however, and they have had many favorable comments. These units are not cheap, costing about $370 retail. They weigh 23 ounces. There are several less expensive ceramic units now available, but be sure to pretreat the water chemically when using these systems, as they may be ineffective against viral disease without the silver impregnation.


Using the same technology as kidney dialysis systems, Sawyer Products produces a microtubule filter with a 0.1-micron absolute size (see figure 3-3).



Normally a filter with such a small diameter would be very difficult to pump water through, but the microtubules have an effective large surface area allowing one to suck water or to gravity-feed water through the system easily. I prefer the Sawyer personal water bottle filter, as the oral opening is protected by a closing flap mechanism. In dusty areas, especially those with possible fecal contamination, such as trails in developing countries, this is ideal. Sawyer also makes an attachment using this filter system that screws into common commercial disposable water bottles.


If it not only removes particles but has an absorption mechanism to remove chemicals, a quality water filter eliminates viruses and bacteria, as well as protects against chemical contaminants and waterborne parasites. It may require prefiltering to remove large particles, charcoal or similar filtering to remove chemicals, and a microfilter to remove bacteria. Sawyer also produces a microtubule system with an absolute pore size of 0.02 microns, thus also effective against hepatitis C virus particles.


SteriPEN and similar devices use ultraviolet C rays to kill viral, bacterial, and protozoan cysts. The water should be prefiltered if it is turbid, as shadows from particles in the water potentially shield these germs from destruction. Of course, agitation or swirling the wand in the water helps overcome this problem, and the light must stay on longer. Loss of battery power ends the device’s usefulness.


Another method of water purification has been with us a long time, namely using our old friend fire. Bringing water to a boil will effectively kill pathogens and make water safe to drink.One reads variously to boil water 5, 10, or even 20 minutes, but simply bringing the water temperature to 150°F (65.5°C) is adequate to kill the pathogens discussed above and all others besides. At high altitude the boiling point of water is reduced. For example, at 25,000 feet (7,600 meters) the boiling point of water is 185°F (85°C). Bringing water to a boil is the minimal safe time for preparation. At times fuel or water may be in short supply and this minimal time must be used.


It will never be necessary to boil water longer than 5 minutes, and the shortest time mentioned (just bringing the water to a boil) will suffice for a safe drinking water. This water will not be sterile, but it will be safe to drink.


Water may be obtained by squeezing any freshwater fish and some plants. A solar still can be prepared for reprocessing urine, water from debris, or any moist material, as indicated in figure 3-4. In water-poor areas, catching rainwater may be an essential part of routine survival. Be careful, however, of melting ice; treat all meltwater as indicated above. There is a very strong chance of contamination in ice deposits. Surprisingly, it is possible to survive quite a long time drinking only urine. Seawater is problematic, as the surface water has varying amounts of salt concentrations, depending upon currents, melting ice, and even river influxes, which are sometimes hundreds of miles away.




Human Waste Disposal

This is a matter not only of aesthetics but of primary preventative medicine. Improper waste disposal on the wagon trains heading west in the 1840s and 1850s caused vast epidemics of cholera in the trains that followed. Unbelievable numbers of people were killed. Even in our wilderness areas, it is widely acknowledged that the cleanest-looking streams should still be suspected of human or animal contamination.


Most official campsites in the national park system have toilets. These should always be used. Otherwise, human defecation should be buried at least 200 feet (60 meters) from a lakeshore or stream. Waste should be buried in a shallow pit, as this promotes rapid decomposition. Disinfecting waste by adding undiluted bleach or solid bleach powder is a viable alternative. In very dry and seldom traveled areas, using the smear technique to dispose of feces is advocated. In some ecosystems all solid waste, including feces, must be carried out. General guidelines are available for different ecosystems and various levels of human usage. The Leave No Trace Foundation curriculum is taught by many outdoor groups interested in conservation.


REPRODUCTIVE ORGANS

Venereal Diseases

Venereal infections are totally preventable by abstention; any other technique falls short of being foolproof. Most venereal infections cause symptoms in the male but frequently do not in the female. Either may note increased discomfort with urination, the development of sores or unusual growths around the genitalia, and discharge from the portions of the anatomy used in sex (pharynx, penis, vagina, anus). Some venereal diseases can be very difficult to detect, such as syphilis, hepatitis B, and AIDS. Hepatitis B is rampant in many parts of the world, with high carrier rates in local population groups. It can be prevented with a vaccine.These are no vaccines against the other venereal diseases except human papillomavirus (HPV).


Gonorrhea is common and easy to detect in the male. Symptoms appear between 2 and 8 days from time of contact and basically consist of a copious greenish-yellow discharge. The female will frequently not have symptoms. From the Rx Oral/Topical Medical Module provide doxycycline, 100 mg twice daily for 15 days, to ensure adequate treatment of syphilis, which may have been caught at the same time. Also give Zithromax, 1 gram at once (4 of the 250 mg tablets), to cure chlamydia, which frequently is a coinfection.


Syphilis has an incubation period of 2 to 6 weeks before the characteristic sore appears. The development of a painless ulcer (1/4 to 1/2 inch, or 0.6 to 1.2 centimeters in size), generally with enlarged, nontender lymph nodes in the region, is a hallmark of this disease. A painful ulcer formation is more characteristic of herpes simplex. The lesion may not appear in a syphilis victim, making the early detection of this disease very difficult. A second stage consisting of a generalized skin rash (which usually does not itch, does not produce blisters, and frequently appears on the soles of the feet and palms of the hands) appears about 6 weeks after the lesions mentioned above. The third phase of the disease may develop in several years, during which nearly any organ system in the body may be affected. The overall study of syphilis is so complicated that a great medical instructor (Sir William Osler) once said,“To know syphilis is to know medicine.”Treatment of primary-stage syphilis is 15 days of antibiotics, as mentioned above. Development of a clear, scanty discharge in the male may be due to chlamydia or other nonspecific urethral infections. Symptoms appear 7 to 28 days after contact. Women may have no symptoms. Treat with doxycycline, 100 mg twice daily, for 15 days. Blood tests for syphilis should be performed now (ideally) and again in 3 months. Since 20% of victims with nonspecific urethritis will have a relapse, adequate medical follow-up after the trip is essential.


Herpes lesions can respond to Denavir 1% cream applied frequently during the day until they disappear in 8 to 10 days. Famvir capsules, 250 mg taken 3 times daily for 7 to 10 days, are effective during the acute phase, when the symptoms first manifest.


Upon returning home, members who may have experienced symptoms of a sexually transmitted disease should be seen by their physician for serology tests for syphilis, hepatitis B tests, chlamydia smears, gonorrheal cultures, herpes simplex titers, and possibly HIV studies. Lesions or growths should be examined as possible molluscum contagiosum, and venereal warts should be treated.


Vaginal Discharge and Itching

Vaginal discharge and/or itching are often not indicators for venereal disease. The most common cause is a fungal or monilia (candida) infection. This condition is more common in conditions of high humidity or with the wearing of tight clothes such as pants or pantyhose.


A typical monilia infection has a copious white discharge with curds like cottage cheese. From the Non-Rx Oral Medication Module, one can use the clotrimazole 1% cream. This formulation has been designed for foot and other skin fungal problems, but it will work vaginally as well. From the Rx Oral Medication Module, also use 1 Diflucan 150 mg tablet for treatment.


A frothy, greenish-yellow, irritating discharge may be due to trichomonas infection. This can be spread by sexual encounters. The male infected with this organism generally has no symptoms, or perhaps a slight mucoid discharge early in the morning, noted before urinating. The treatment of choice is Flagyl (metronidazole), 250 mg capsule 3 times a day for 10 days, or 8 capsules given as 1 dose. This drug cannot be taken with alcohol. Sexual abstention is important until medication is finished and a cure is evident clinically. Generic Flagyl is frequently available in third-world countries at pharmacies without a prescription.


A copious yellow-green discharge may indicate gonorrhea. Any irritating discharge that is not thick and white is best treated with Levaquin, 500 mg once daily. If sexual contact may have been the source of the problem, treat for 15 days to also kill any syphilis that may have been contracted simultaneously. A douche of very dilute Hibiclens surgical scrub, or very dilute detergent solution, can be prepared and may be helpful; very dilute is better than too strong. Frequent douching is not required, but it may be done for a few days as required for comfort and hygiene.


Menstrual Problems

On the move, menstrual flow is best contained with a vaginally inserted tampon, but be sure to have experience with the chosen product prior to heading into the backcountry. A resealable plastic bag, with perhaps a paper bag liner, should be carried if it is necessary to pack out discarded pads. Many find the use of a vaginal cup is the best solution. An excellent blog article that provides pre-trip advice is “Girl Talk: How to Handle Your Period in the Backcountry” (blog.rei.com/ hike/girl-talk-part-2-handling-your-period-in-the-backcountry/).


Rolling several Nu-Gauze pads from the Topical Bandaging Module will substitute as an outer sanitary napkin if none is available. Menstrual cramping can generally be controlled with ibuprofen, 200 mg, 1 or 2 tablets every 4 to 6 hours, from the Non-Rx Oral Medication Module. While this medication is generally used as an antiarthritic, its anti-prostaglandin activities make it an ideal medication for the treatment of menstrual pain.


Menorrhagia, either excessive flow or long period of flowage, should be evaluated by a physician to determine if there is an underlying pathology that could or should be corrected. If the problem is simply one of hormone imbalance, this can frequently be corrected by the use of birth control pills with higher amounts of estrogen and lower progestogen content. Consult a physician well in advance of a trip, as it takes a least three cycles of the “correct” hormone dose to comfortably predict adequate management.


Spontaneous Abortion

Bleeding during pregnancy is not unusual—20 to 30% of women bleed or cramp during the first 20 weeks of their pregnancies. This is termed threatened abortion and is treated with bed rest, since this usually decreases the bleeding and cramping. However, 10 to 15% of pregnant women will go on to abort. As long as all products of the abortion pass—a “complete abortion”—the bleeding and pain will stop and the uterus shrinks back to its normal size.


An incomplete abortion—the expulsion of only a portion of the fetus or the rupture of only the membranes—will often require a surgeon’s care to perform a D&C (dilation and curettage). However, urgent evacuation is always mandatory. Watch for signs of sepsis, such as elevated temperature, and start an antibiotic if possible. Give Rocephin, 1 gram IM, followed by 500 mg IM every 12 hours. The best oral antibiotic recommended from your Rx Oral/Topical Medication Module would be Levaquin, 500 mg given daily. Give pain medication as necessary.


Ectopic Pregnancy

In an ectopic pregnancy, spotting and cramping usually begin shortly after the first missed period. If a pregnancy test is positive and the woman has severe lower abdominal pain lasting more than 24 hours, you probably have a surgical emergency on your hands. A rupture of the uterine tube usually occurs at 6 to 8 weeks of pregnancy, while a rupture of a cornual pregnancy occurs at 12 to 16 weeks. The rupture causes massive blood loss with a rapid onset of shock and death when it occurs.


While other causes of spotting during pregnancy are possible, you are in no position to handle any of them off the grid. Evacuate this woman immediately.

If a woman is having spotting and lower abdominal pain, and the pregnancy test is negative, you are in no position to bet her life that she is not pregnant. Ectopic pregnancies have lower blood levels of ß subunit HCG hormone to detect, and the test may, therefore, be falsely negative.


Pregnancy

If you are approaching a potential off-grid situation and a member of your team is in advanced pregnancy, you will need to have the supplies and basic knowledge of delivery. During the second trimester she should receive an additional 340 kcal (kilocalorie) and during the third trimester 450 additional kcal of food per day. She should also have a multivitamin that includes 400 to 600 mcg folic acid, 400 IU vitamin D, 300 mg calcium, 70 mg vitamin C, 3 mg thiamine, 2 mg riboflavin, 20 mg niacin, 6 mg vitamin B-12, 290 mcg iodine (but not more than a total daily amount of 1,100 mcg), and trace amounts of zinc and copper.


Over 94% of deliveries are uncomplicated, but about 10 to 20% of pregnancies end with a spontaneous abortion before the 20th week; this might be much higher as many miscarriages occur so early in pregnancy that the woman might not realize she was even pregnant. Once pregnancy is advanced and obvious (generally beyond the 12th to 16th week), care must be taken to make sure that the woman’s diet is appropriate as mentioned above and that she does not develop hypertension (not usual before week 20). This hypertension is best controlled with reduced sodium intake and the possible use of a diuretic blood pressure medication. Gestational diabetes can occur between weeks 24 and 28, and one should ideally check blood sugars at that time. If the person develops signs of diabetes (frequency of urination matched with thirst), diet and exercise usually manage 80% of these cases, while some women will require insulin. Frequency and burning while urinating small amounts may mean a urinary tract infection. Obstetricians would treat a urinary tract infection usually with nitrofurantoin, 100 mg twice daily, but the Rx Oral/Topical Medication Module suggestion of levofloxacin, 500 mg once daily for 3 days, is safe. Edema in late pregnancy is a serious sign of a condition called preeclampsia (hypertension, protein in urine, and edema). It must be treated as a medical emergency. Return to the grid if possible—otherwise, bed rest, salt restriction, diuretic. On the grid, the baby is frequently delivered early to prevent this condition from progressing, which can otherwise lead to the death of both the mother and child. Seizures from eclampsia are difficult to treat and are rare in places like the United States but relatively common in areas where I volunteer like Haiti. This is a deadly situation without help.


In general, delivery progresses through various stages without danger to mother or child. However, even basic training for the birthing assistant will provide a safer birth and management of the newborn and will identify issues requiring sometimes very basic maneuvers, or some very desperate ones, to save lives in the 10% of situations that require help. There is an ideal chapter on birthing in Buck Tilton’s book Wilderness First Responder (Falcon Guides, 2010) covering basic principles in detail, including immediate care of the newborn.


Survival mode off the grid will require maintaining the mother on her prenatal vitamins and encouraging breastfeeding exclusively for 6 months, then continue combined with solid food for 2 years.


Painful Testicle

If pain is severe, provide support by having the victim lie on the insulated ground with a cloth draped over both thighs, forming a sling or cradle on which the painful scrotum may rest. If ambulatory, provide support to prevent movement of the scrotum. Cold packs would help initially, and providing adequate pain and nausea medication as available is certainly appropriate. An antibiotic is not required unless a fever ensues.


Spontaneous pain in the scrotum, with enlargement of a testicle, can be due to an infection of the testicle (orchitis) or more commonly to an infection of the sperm-collecting system called the epididymis (epididymitis). Treatment of choice would be to provide an antibiotic such as doxycycline, 100 mg, 1 tablet twice daily, or Levaquin, 500 mg once daily. Pain medication should be provided as necessary.


The problem may not be due to an infection at all. It is possible for the testicle to become twisted, due to a slight congenital defect, with severe pain resulting. This testicular torsion, as it is called, is a surgical emergency. It can be almost impossible to distinguish from orchitis. In a suspected case of torsion, it is helpful to try to reduce the torsion. Since the testicle always seems to rotate “inward,” one need only rotate the affected testicle “outward.”This will often result in immediate relief of the pain. If you cannot achieve this, or if you are dealing with orchitis, no harm is done; but if it is a torsion, you have saved the testicle and the trip. A person with severe testicular pain should be evacuated as soon as possible, as infection or torsion can result in sterility of the involved side. An unreduced testicular torsion can become gangrenous, with life-threatening infection resulting.


MANAGING DIABETES

Diabetic children and adults can have an active off-grid life, but learning to control their diabetes must first be worked on with their physicians. The increased caloric requirement of significant exercise may range above an extra 2,000 calories per day, yet insulin dosage requirements may drop as much as 50%. The diabetic, as well as the trip partners, must be able to identify the signs of low blood sugar (hypoglycemia)—staggering gait, slurred speech, moist skin, clumsy movements—and know the proper treatment, for example, oral car.bohydrates or sugar candies and, if the patient becomes unconscious, the use of injectable glucagon. The urine of diabetic outdoor trav.elers should be tested twice daily to confirm control of sugar. This testing should preclude a gradual accumulation of too much blood sugar, which can result in unconsciousness in its advanced stage. This gradual accumulation would have resulted in massive sugar spill in the urine and finally the spill of ketone bodies, providing the patient ample opportunity to increase insulin dosage to prevent hyperglyce.mia (too high of a blood sugar level). Battery-powered, point-of-care blood sugar test devices (glucometers) must be included in the per.sonal property of anyone taking insulin.


Storage of insulin off the grid, where it forgoes recommended refrigeration, is not a major problem as long as the supply is fresh and direct sunlight and excessive heat are avoided. Unopened insu.lin usually has an expiration date of one year. With proper storage this might be extended several years, but there is an unknown finite point when it will not be viable. Biologicals such as insulin will not have long, extended storage times. Syringes, alcohol prep pads, Keto.Diastix urine test strips, insulin, and glucagon are light additions to the Off-Grid Medical Kit. Persons who are insulin dependent will not be able to survive without grid contact. Adults whose diabetes started later in life might do adequately with oral medications, but they need to have an ideal body mass index and eat no more calo.ries than they are expending. I recommend persons with diabetes who experience elevating blood sugars should readily accept start.ing insulin. Lifestyle changes, weight loss, and healthy diet choices might allow control to be reestablished and diabetes medications reduced, or even stopped altogether. It is all a matter of results. Ele.vated blood sugars require more aggressive medication management. But just because you start insulin does not mean you will always have to be on it. Start it sooner than later, and try to modify your life so you can live without insulin. If the grid collapses, you may have to get by without it.




POISONING

Plant or Food Poisoning

The ideal treatment after poison plant ingestion is to give the patient activated charcoal. If that isn’t possible, induce vomiting by gagging the throat with a finger or spoon. This latter technique may well be the only method available while in the bush.



Petroleum Products Poisoning

The danger from accidentally drinking various petroleum products— for example, while siphoning gas from one container to another—is the possibility of accidentally inhaling or aspirating this liquid into the lungs. That will kill. The substances are not toxic enough in the gastrointestinal (GI) tract to warrant the danger of inducing vomit.ing. Do not worry about swallowing several mouthfuls of any petro.leum product. If the person vomits, there is nothing you can do about it, except position him so that there is less chance of aspiration into the lungs—sitting while bending forward is probably ideal. The more volatile the substance, the more the danger of aspiration. In other words, kerosene is less dangerous than Coleman fuel.


If organic phosphorous pesticides are dissolved in the fuel, you have a more complex problem. These substances are potentially toxic and must be removed. In the emergency room this would be accom.plished by gastric lavage, or stomach pumping. In the bush, if you cannot evacuate the person within 12 hours, you will have to take a chance of inducing vomiting, with possible lethal aspiration—to eliminate the poison. Treat by inducing gagging as described above under Plant or Food Poisoning. After vomiting, administer a slurry of activated charcoal, if available. This helps bind non-regurgitated toxins. Charcoal powder, to which you add water to form a slurry, is available at pharmacies. In the field you might consider tearing apart a charcoal water filter and crushing the charcoal granules. Or you can make the slurry from the blackened, partially burnt portions of logs from a campfire.



Ciguatera Poisoning

Ciguatera poisoning is caused by a toxin released by a small ocean organism called a dinoflagellate. As various species of fish eat this small plant, they acquire the toxin. Larger fish that in turn prey on the smaller fish acquire larger and larger amounts of the toxin, thus resulting in more severe cases of ciguatera toxin poisoning in humans if these larger fish are consumed. Over 400 species of fish from the tropical reefs of Florida, the West Indies, and the Pacific have been implicated, but most often it has been barracuda, grouper, and amber.jack that are contaminated. No deep-sea fish, such as tuna, dolphin, or wahoo, have been found contaminated.


There is no way to detect contamination—no change in flavor, texture, or color of the fish flesh. Worse yet, no method of preserving, cooking, or treating fish can destroy this toxin. One must rely on local knowledge to avoid potentially polluted species.


Symptoms usually start with numbness and tingling of the lips and tongue, and then progress to dry mouth, abdominal cramping, vomiting, and diarrhea that lasts 6 to 17 hours. Muscle and joint pain, muscle weakness, facial pain, and unusual sensory phenomena such as reversal of hot and cold sensations develop. Occasionally low blood pressure, respiratory depression, and coma can result. Neuro.logical symptoms are made worse by alcohol and exercise. Start rescue breathing if necessary (see page 17). This type of poisoning does not result in death.


See also Scombroid Poisoning (below) and Paralytic Shellfish Poisoning (page 86).


Scombroid Poisoning

The flesh of dark-meat fish, such as tuna, mackerel, albacore, bonito, amberjack, and mahi-mahi (dolphin), contain large amounts of histi.dine. Improper storage after catching these fish allows bacterial enzy.matic changes to this meat, releasing large amounts of histamine and other toxic by-products that are not destroyed by cooking.


Symptoms of scombroid poisoning include flushing, dizziness, headache, burning of the mouth and throat, nausea, vomiting, and diarrhea. Severe poisoning can cause significant respiratory distress.


Diphenhydramine has been reported to cause an increase in symp.toms at times, which is surprising since it is an excellent antihistamine. Ranitidine (Zantac) 150 mg, from the Non-Rx Oral Medication Module, may block the effects of scombroid poisoning; give two 150 mg tablets every 12 hours. While normally a prescription product at 300 mg dosage used to control stomach acid formation, ranitidine’s mode of action is known as a histamine-2 receptor blocker.


Puffer Fish Poisoning

Incorrectly prepared puffer fish (fugu) contain tetrodotoxin, which can be lethal as it leads to respiratory failure and cardiac collapse. Symptoms may be slow in onset. Provide CPR as necessary (see page 17). Probably more people are killed by ingesting poisonous marine creatures than are killed by any other type of encounter, such as trauma from biting, stinging, or shocking.


Paralytic Shellfish Poisoning

Mussels, clams, oysters, and scallops may ingest the poison saxitoxin from dinoflagellates found in “red tide,” which occurs from June to October along the New England and Pacific coasts. Numbness around the mouth may occur between 5 and 30 minutes after eating. Other symptoms are similar to ciguatera poisoning (page 85). These include gastrointestinal illness, loss of coordination, and paralysis progressing to complete respiratory paralysis with 12 hours in 8% of cases. No specific treatments or antidotes are available, but purging of stomach contents should be encouraged. Artificial support of respira.tion is potentially lifesaving.







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