PRINCIPLES%20OF%20ACUTE%20POISONINGS

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PRINCIPLES OF ACUTE POISONINGS TREATMENT
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Most frequent reasons to acute poisonings
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Etiologies of acute liver failure in the USA
(1,033 adults, 1998-2007), acetaminophen
overdose (45) was the most common etiology
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Age distribution of acute poisonings
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Causes of acute poisoning community-acquired

• Drugs
• Chemical substances,
• also of plant origin
• Alcohol and its surrogates
• Pesticides
• 8 of all poisonings - children
• (6 months of age)

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Food poisonings

• Some common bacterial food poisonings
• Salmonella
• Botulism
• Staphylococcal
• Clostridium
• Bacillus cereus
• Diarrhoea and vomiting is common in this
  infection

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Side effects (SE) of drugs

• Takes 5th place among causes of mortality on the
  Earth after heart-vascular diseases, malignant
  tumors, lungs diseases, traumas
• Among stationary patients frequency of SE after
  introduction of drugs makes 2-40

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SE of drugs

• 150 000 200 000 people in U.S.A. die from side
  effects of drugs annually
• 76,6 billion are spared in U.S.A. annually to
  treat complications attached to drugs usage

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Medical mistakes in clinics

• Doctors
• - overdosing
• - administration of drugs to patients with
  allergy
• - mixing up names of the drugs
• Medical nurses
• - introduction of other drug by a mistake
• - violation of drug introduction regime
• - mistake in medical form
• - mixing up names of the drugs

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Factors that influence on toxicity of the poison

• Physical and chemical properties
• Dose
• Concentration
• Speed of introduction
• Way of penetration into organism
• Age
• Condition of the organism
• Accumulation of the poison
• Tolerance to the poison

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Comparing of dose-effect cures of the drugs with
different limits of security
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Therapeutic diapason
Drug B
Drugs ? and B
Toxic diapason
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Drug A
0
0,1
1
100
10
1000
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Comparing of dose-effect curves of hypno-sedative
drugs A and B
Respiratory arrest
Drug A
Anesthesia
Drug B
Sedation
0,1
1
100
10
1000
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Stages of acute poisoning

• TOXICOGENIC the poison circulates in organism,
  there are obvious manifestations of its toxic
  action or its metabolites action on
  corresponding structures (receptors)
• SOMATOGENIC the poison has been excreted from
  the organism but there are manifestations of
  damaging of organs and systems (kidney, liver
  insufficiency, lung edema, etc.)

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PRINCIPLES OF ACUTE POISONINGS TREATMENT

• Clearing of gastro-intestinal tract, skin, mucous
  membranes from the poison
• Absorption, destroying or neutralization of the
  poison using specific antagonists
• Elimination of the desorbed poison from the blood
  and tissues
• Pathogenetic, symptomatic treatment and
  reanimation

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Provoking vomiting

• mechanical method
• hypertonic solution (10 ) of sodium chloride
• Apomorphine hydrochloride (0,2-0,5 ml s.c.)
• Contraindications
• - Coma (unconsciouseness)
• - elderly patients
• - lung emphysema, tuberculosis
• - pregnancy
• - poisoning with cauterizing substances
• - poisoning with volatile liquids
• - poisoning with antiemetic drugs
• - convulsive episode in anamnesis

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STOMACH LAVAGE

• Fabre stomach lavage performed in time even by
  an inexperienced person is much more effective
  than the most modern methods of treatment, if
  they are used late
• - after 4-5 hours in case of poisoning with
  spasmolytic drugs, soporific, salicylates
• - after 12 hours and more in case of
  poisoning with morphine derivates, noxirone
• - after 15 min.-1 hour in case of poisoning
  with cauterizing substances
• - after 1-2 days in case of poisoning with
  mushrooms

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Gastric (stomach) lavage
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LAXATIVES

• If the poison is unknown, only salt laxatives
  should be used (!!!) -
• magnesium (sodium) sulfate - 20-30 g
• Ricine oil is contraindicated in case of
  poisoning with fat-soluble substances
  (phosphorus, POS, oil-products, benzole
  derivatives etc.)
• Vaseline oil decreases absorptive ability of
  intestines

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ANTIDOTES

• Greek antidoton anti poison
• are used if poison is correctly specifically
  identified
• - physical absorb the poison (activated
  charcoal, other enterosorbents)
• - chemical destroy the poison, transform it
  into non toxic substance, form complex substances
  with it (acids alkalis, ?D??, unithiol,
  protamine sulfate)
• - physiological act as antagonists relatively
  to the poison on the level of specific receptors
  (naloxon, atropine)

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Activated charcoaluniversal antagonist of
physical action

• 1 g adsorbs 1800 mg of mercury dichloride,
  950 mg of strychnine, 800 mg of morphine, 700 mg
  of atropine or nicotine, 550 mg of salicylic
  acid, it is highly effective in case of poisoning
  with alkaloids
• Single dose - 20-100 g
• not effective in case of poisonings with
  acids, alkalis, phenols, less effective in case
  of poisoning with hydrocyanic acid (HCN)

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CHEMICAL ANTIDOTES

• Tannin - 0,5 solution for poisoning with heavy
  metals salts and alkaloids (except morphine,
  physostygmine, nicotine, atropine and cocaine)
• Potassium permanganate - 0,01-0,02 - food
  poisonings, alkaloids (morphine, strychnine,
  nicotine, chinine, physostygmine)
• Copper sulfate poisoning with phosphorus
• Sodium chloride poisoning with silver salts
  (AgNO3)
• Iodine (15 drops per 100 ml of water)
  precipitates silver, lead, mercury compounds,
  strychnine, chinine
• Unithiol (dimercaprol, BAL, i.m.) poisoning
  with heavy metals salts, cardiac glycosides
• Deferoxamine poisoning with iron preparations
• EDTA (trilon B) binding lead, copper,
  magnesium, radioactive elements - plutonium,
  uranium, thorium, yttrium compounds

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- 0,5 solution for poisoning with heavy metals
salts and alkaloids (except morphine,
physostygmine, nicotine, atropine and cocaine)
Tannin
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Potassium permanganate

• 0,01-0,02 - food poisonings, alkaloids
  (morphine, strychnine, nicotine, chinine,
  physostygmine)

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Iodine

• (15 drops per 100 ml of water) precipitates
  silver, lead, mercury compounds, strychnine,
  quinine

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Unithiol (dimercaprol, BAL, i.m.)

• poisonings with salts of heavy metals, cardiac
  glycosides

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PHYSIOLOGICAL ANTAGONISTSdo not change
physical-chemical condition of the poison

• Naloxon poisoning with opiates
• Atropine poisoning with M-cholinomimetics and
  POS
• Proserine poisoning with atropine, curare-like
  drugs
• Analeptics poisoning with soporific drugs,
  narcotics
• Flumazenil (anexate) poisoning with
  tranquilizers
• Potassium chloride poisoning with cardiac
  glycosides
• Oxygen poisoning with carbon monoxide (CO)
• Ethanol poisoning with methanol, ethylenglycol

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MEASURES TO ELIMINATE THE POISON out of THE
ORGANISM

• substitutive blood infusion (10-15 l)
• hemosorption (plasma-, lymph-sorption)
• hemodialysis (artificial kidney)
• peritoneal dialysis
• enterosorption
• forced diuresis
• lung hyperventilation
• hyperbaric oxygenation

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Hemodialysis, hemosorption

• Effective, if the substance has a small volume of
  distribution theophylline, carbamazepin, lithium
  carbonate, salicylates, valproic acid,
  barbiturates
• Not effective, if the substance has a big volume
  of distribution rifampicin, lidocain, sybazon,
  anaprilin, dyltiazem, digoxin

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FORCED DIURESIS

• In case of poisoning with substances weak
  acids (salicylates, barbiturates, nalidixic acid,
  antibacterial and antidiabetic sulfonamides,
  indometacin, indirect anticoagulants, clofibrate)
  alkalizing organism liquids with NaHCO3

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FORCED DIURESIS

• In case of poisoning with substances weak
  alkalis
• (chinin, amphetamine, amitryptiline, caffeine,
  theophyllin, novocain)
• changing pH of medium to acid side with vitamin
  ?, ammonium chloride

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