Title: Toxicology
110
Toxicology
2Toxicology
- 10 million people are poisoned in U.S. each year.
- Attempted suicide
- Accidental legal drug overdosage
- Illegal drug overdosage
- Snake, spider bites
- Exposure to toxins in workplace
3Figure 10-1 In the majority of accidental
childhood poisonings, poisonous materials are
left in easy reach of children.
Cathy Melloan / PhotoEdit, Inc.
4Prevention
- Child-resistant packaging
- Poison Control Centers
- Medication error prevention
- Safe storage of toxins in home
5Figure 10-2 Child-resistant packaging.
6Poison Detection
- Some poisons have specific symptoms to assist in
giving an accurate diagnosis - Cyanide unmistakable odor of bitter almonds
- Insecticides GI hyperactivity, salivation,
pupillary constriction - Carbon monoxide cherry-colored flush of skin and
mucous membranes
7Treatment of Poisoning
- Emetics (e.g., ipecac) trigger vomiting
contraindicated in ingestion of corrosives - Absorbents (activated charcoal) bind poison
molecules to charcoal and excreted effective in
cardiac glycoside and methylxanthine poisoning,
heavy metal and corrosive chemical poisoning
8Treatment of Poisoning
- Cathartic agents shorten transit time of
chemicals through GI tract work by retaining
water in bowel to stimulate peristalsis
9Table 10-1 Poisons and Antidotes
10Specific Poisons Acetaminophen
- Acetaminophen (Tylenol) nausea and vomiting
(early stages) liver injury after 23 days - Antidote acetylcysteine given within 810
hours
11Specific Poisons Alcohols
- Ethanol or ethyl alcohol
- Treatment includes
- Emesis, gastric lavage
- Hemodialysis
12Specific Poisons Ethylene Glycol
- Antifreeze, windshield de-icing solutions
- Signs/symptoms within 112 hours nausea,
vomiting, ataxia, seizures, cerebral edema, coma,
death 1214 hours tachypnea, cyanosis,
tachycardia, pulmonary edema, pneumonitis
13Specific Poisons Ethylene Glycol
- Treatment gastric lavage within 30 minutes 10
solution of ethanol and hemodialysis
14Specific Poison Methanol
- Wood alcohol antifreeze, windshield-washer
fluid, solvent in photocopier solutions - Signs/symptoms visual disturbances, bradycardia,
seizures, metabolic acidosis, respiratory
depression, coma blindness, and permanent
retinal damage
15Specific Poison Methanol
- Treatment gastric lavage, IV administration of
10 solution of ethanol hemodialysis
16Specific PoisonHeparin and Warfarin
- Heparin signs/symptoms hemorrhage, ecchymoses,
melena - Heparin treatment slow IV infusion of protamine
sulfate - Warfarin signs/symptoms hemorrhage
- Warfarin treatment phytonadione (vitamin K)
blood products with clotting factors
17Specific Poisons Amphetamines
- Methamphetamine most common also
pseudoephedrine, ephedrine - Signs/symptoms agitation, restlessness, acute
psychosis, hypertension, tachycardia, brain
damage, renal failure - No specific treatment
18Mechanism of Action of Cocaine Animation
Click on the screenshot to view an animation
showing the mechanism of action of cocaine.
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19Specific Poison Antihistamines
- Signs/symptoms CNS excitement or depression
drowsiness, stupor, coma - Supportive treatment, phenobarbital or diazepam
to control convulsions
20Specific Poison Benzodiazepines
- Signs/symptoms CNS depression occurs within 30
minutes coma, respiratory depression - Treatment activated charcoal, respiratory support
21Specific Poison Bleaches
- Signs/symptoms corrosive action in mouth,
pharynx, esophagus - Treatment dilute ingested bleach with milk or
water
22Specific Poison Carbon Monoxide
- Signs/symptoms cherry color in skin and mucous
membranes, coma, death - Treatment pure oxygen, ventilation support,
diuretics and steroids (to treat resultant
cerebral edema)
23Specific Poison Corrosives
- Ingestion almost always with suicidal intent
- Signs/symptoms irritation severe pain
bleeding severe burns in mouth, esophagus,
stomach profound shock - Treatment immediate dilution with water or milk
emesis or gastric lavage contraindicated
24Specific Poison Cyanide
- Medical emergency
- Signs/symptoms odor of bitter almonds
- Treatment nitrite to produce methemoglobin
supportive measures such as 100 oxygen
25Specific Poison Digoxin
- Signs/symptoms anorexia, nausea, vomiting,
lethargy, abdominal cramping, diarrhea, vertigo,
fatigue, muscle weakness, blurred vision,
seizures, diplopia, electrolyte imbalance,
bradycardia - Treatment ipecac, activated charcoal, lavage
26Electrolyte Imbalances
- Magnesium treatment is IV of 10 mL of a 10
solution of calcium gluconate - Potassium treatment is calcium administration,
sodium bicarbonate or glucose/insulin - Iron treatment is whole bowel irrigation,
deferoxamine
27Specific Poison Isoniazid (INH)
- Signs/symptoms fever, peripheral neuritis,
jaundice, skin rash, hepatic injury - Treatment pyridoxine, gastric lavage, activated
charcoal, sodium bicarbonate, hemodialysis
28Specific Poison Lead
- Signs/symptoms metallic taste, abdominal pain,
vomiting, CNS depression, respiratory failure - Treatment chelating agents, IV EDTA and
dimercaprol, gastric lavage
29Specific Poison Lithium
- Signs/symptoms tremor, diarrhea, polydipsia,
anorexia, polyuria, vomiting, blurred vision,
hypothyroidism, hyperglycemia, weight gain - Treatment gastric lavage within 1 hour,
activated charcoal, whole bowel irrigation,
sodium polystyrene sulfonate, volume resuscitation
30Specific Poison Mercury
- Signs/symptoms burning sensation in throat,
metallic taste, discoloration and edema of mouth,
vomiting, bloody diarrhea, shock - Treatment gastric lavage, activated charcoal, IM
dimercaprol
31Specific Poison Opioids
- Signs/symptoms euphoria, drowsiness, constricted
pupils, hypotension, bradycardia, hypothermia,
coma, respiratory arrest - Treatment gastric lavage or emesis, activated
charcoal, naloxone
32Specific Poison Organophosphates
- Signs/symptoms (30 minutes2 hours) nausea,
vomiting, urinary and fecal incontinence,
abdominal cramps, increased bronchial secretions,
wheezing, coughing, salivation, sweating, blurred
vision
33Specific Poison Organophosphates
- Treatment remove clothing, wash skin with soap
and water activated charcoal supportive
measures treatment of seizures, ventilatory
assistance, oxygen
34Specific Poison Petroleum Distillates
- Signs/symptoms pulmonary edema, pneumonitis,
resembles alcohol intoxication, nausea, headache,
burning sensation in chest - Treatment emesis (if alert), oxygen therapy
35Specific Poison Salicylates
- Signs/symptoms vertigo, hearing impairment,
nausea, vomiting, diarrhea, sweating, drowsiness,
fever, headache, convulsions, hallucinations,
cardiovascular collapse, coma - Treatment emesis, gastric lavage, activated
charcoal, osmotic cathartic, artificial
ventilation
36Specific Poison Theophylline
- Signs/symptoms hypokalemia, hyperglycemia,
hypercalcemia, hypophosphatemia, acidosis
nausea, vomiting, abdominal pain, tachycardia
seizures, hypotension, dysrhythmias - Treatment endotracheal intubation and gastric
lavage, activated charcoal, benzodiazepines and
phenobarbital to treat seizures hemoperfusion or
hemodialysis
37Bites and Stings
- Scorpion treatment is antivenom, calcium
gluconate, and phenobarbital - Spiders antivenom, IV calcium gluconate,
antibiotics, tetanus immunization, oxygen,
antihistamines, adrenalin, muscle relaxants - Snake bites reduce venom absorption incision
and suction ice should not be applied to bite