Botulinum Toxin PoisoningModule information
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up

Tables
References
Glossary
What's New
Patient Information
Guidelines and Systematic Reviews
Non-drug Therapy
  • Initiate early involvement of rehabilitation services to prevent complications.
  • Consider other possible adjunctive therapies in botulinum toxin poisoning.


Initiate early involvement of rehabilitation services to prevent complications. C

  • Begin the following rehabilitative initiatives as soon as possible:
    • Range-of-motion exercises
    • Strength-building programs
    • Splinting and positioning as needed
  • Obtain a speech therapy evaluation to:
    • Assess swallowing to avoid aspiration
    • Instruct in techniques to avoid aspiration, such as chin tuck and extra swallows
    • Evaluate the need for thickening agents or tube feedings
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Consider other possible adjunctive therapies in botulinum toxin poisoning. C

  • Perform debridement in wound botulism to remove infected tissue, and consider treatment with appropriate antibiotics, such as tetracycline, metronidazole, or penicillin.
  • Note that plasmapheresis has been used as an adjunct to antitoxin therapy in very few cases and is not recommended.
  • See table Drug Treatment for Botulinum Toxin Poisoning.
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The American College of Physicians is accredited by the Accreditation Council for continuing Medical Education (ACCME) to provide continuing education for physicians. The American College of Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity. Purpose: This activity has been developed for internists to facilitate the highest quality professional work in clinical applications, teaching, consultation, or research. Upon completion of the CME activity, participants should be able to demonstrate an increase in the skills and knowledge required to maintain competence, strengthen their habits of critical inquiry and balanced judgement, and to contribute to better patient care. Disclosures: Larry E. Davis, MD, FACN, FACP received honorarium from Merck & Co., provided expert testimony, received grants from the VA, NIH, and the University of New Mexico, received royalties from Fundamentals of Neurologic Disease. Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.


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