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Toxicology

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Title: Toxicology


1
10
Toxicology
2
Toxicology
  • 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

3
Figure 10-1 In the majority of accidental
childhood poisonings, poisonous materials are
left in easy reach of children.
Cathy Melloan / PhotoEdit, Inc.
4
Prevention
  • Child-resistant packaging
  • Poison Control Centers
  • Medication error prevention
  • Safe storage of toxins in home

5
Figure 10-2 Child-resistant packaging.
6
Poison 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

7
Treatment 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

8
Treatment of Poisoning
  • Cathartic agents shorten transit time of
    chemicals through GI tract work by retaining
    water in bowel to stimulate peristalsis

9
Table 10-1 Poisons and Antidotes
10
Specific Poisons Acetaminophen
  • Acetaminophen (Tylenol) nausea and vomiting
    (early stages) liver injury after 23 days
  • Antidote acetylcysteine given within 810
    hours

11
Specific Poisons Alcohols
  • Ethanol or ethyl alcohol
  • Treatment includes
  • Emesis, gastric lavage
  • Hemodialysis

12
Specific 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

13
Specific Poisons Ethylene Glycol
  • Treatment gastric lavage within 30 minutes 10
    solution of ethanol and hemodialysis

14
Specific 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

15
Specific Poison Methanol
  • Treatment gastric lavage, IV administration of
    10 solution of ethanol hemodialysis

16
Specific 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

17
Specific Poisons Amphetamines
  • Methamphetamine most common also
    pseudoephedrine, ephedrine
  • Signs/symptoms agitation, restlessness, acute
    psychosis, hypertension, tachycardia, brain
    damage, renal failure
  • No specific treatment

18
Mechanism of Action of Cocaine Animation
Click on the screenshot to view an animation
showing the mechanism of action of cocaine.
Back to Directory
19
Specific Poison Antihistamines
  • Signs/symptoms CNS excitement or depression
    drowsiness, stupor, coma
  • Supportive treatment, phenobarbital or diazepam
    to control convulsions

20
Specific Poison Benzodiazepines
  • Signs/symptoms CNS depression occurs within 30
    minutes coma, respiratory depression
  • Treatment activated charcoal, respiratory support

21
Specific Poison Bleaches
  • Signs/symptoms corrosive action in mouth,
    pharynx, esophagus
  • Treatment dilute ingested bleach with milk or
    water

22
Specific 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)

23
Specific 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

24
Specific Poison Cyanide
  • Medical emergency
  • Signs/symptoms odor of bitter almonds
  • Treatment nitrite to produce methemoglobin
    supportive measures such as 100 oxygen

25
Specific 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

26
Electrolyte 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

27
Specific Poison Isoniazid (INH)
  • Signs/symptoms fever, peripheral neuritis,
    jaundice, skin rash, hepatic injury
  • Treatment pyridoxine, gastric lavage, activated
    charcoal, sodium bicarbonate, hemodialysis

28
Specific Poison Lead
  • Signs/symptoms metallic taste, abdominal pain,
    vomiting, CNS depression, respiratory failure
  • Treatment chelating agents, IV EDTA and
    dimercaprol, gastric lavage

29
Specific 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

30
Specific 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

31
Specific Poison Opioids
  • Signs/symptoms euphoria, drowsiness, constricted
    pupils, hypotension, bradycardia, hypothermia,
    coma, respiratory arrest
  • Treatment gastric lavage or emesis, activated
    charcoal, naloxone

32
Specific Poison Organophosphates
  • Signs/symptoms (30 minutes2 hours) nausea,
    vomiting, urinary and fecal incontinence,
    abdominal cramps, increased bronchial secretions,
    wheezing, coughing, salivation, sweating, blurred
    vision

33
Specific Poison Organophosphates
  • Treatment remove clothing, wash skin with soap
    and water activated charcoal supportive
    measures treatment of seizures, ventilatory
    assistance, oxygen

34
Specific Poison Petroleum Distillates
  • Signs/symptoms pulmonary edema, pneumonitis,
    resembles alcohol intoxication, nausea, headache,
    burning sensation in chest
  • Treatment emesis (if alert), oxygen therapy

35
Specific 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

36
Specific 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

37
Bites 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
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