PARACETAMOL POISONING:

1
PARACETAMOL POISONING

• Hepatic damage more than 150mg per kg
• Clinical feature
• Nausea ,
• vomiting ,
• abdominal discomfort
• In untreated patients developing liver damage ,
  vomiting continues beyond 12 hrs and there is
  tenderness over the liver , jaundice ,hepatic
  encephalopathy , loin pain , haematuria ,
  proteinuria suggest renal failure.
• Investigation LFTs, liver enzyme
  ,INR(international normalised ratio)
• LFT Alanine transaminase (ALT), also called
  Serum Glutamic Pyruvate Transaminase (SGPT) or
  Alanine aminotransferase (ALAT) 
• Aspartate transaminase (AST) also called Serum
  Glutamic Oxaloacetic Transaminase (SGOT) or
  aspartate aminotransferase (ASAT)
•  Alkaline phosphatase (ALP)
• Bilirubin (direct and total) 

2
Management

• Paracetamol antidotes
• Acetylcysteine is given by iv infusion in 5
  dextrose .
• Initial dose 150mg per kg body weight in 200 ml
  dextrose over 15 mins ,
• Than 50 mg per kg in 500 ml over 4 hrs ,
• Then 100 mg per kg in 1L over 16 hrs
• Methionine if acetylecysteine is not available
• 2.5g every 4 hrs to a total of 10 g.

3
IRON POISONING

• Serious toxicity more than 60 mgper kg body
  weight,
• Lethal dose 150-300 mg per kg.
• C / F
• Nausea ,
• vomiting ,
• diarrhoea ,
• abdominal pain
• Severe poisoning
• haematemesis ,
• drowsiness ,
• convulsion ,
• coma
• metabolic acidosis and shock

4
Management

• Check serum iron ,FBC ,glucose
• Gastric lavage if more than 20 mg iron per kg
  body weight
• Use supportive measures if required
• In serious
• Desferrioxamine
• iv infusion (15 mg per kg per hr , max 80 mg per
  kg in 24 hr)

5
Salicylate poisoning(Aspirin)

• Mild toxicity 150mg per kg body weight
• Severe and fatal dose 500 mg per kg body
  weight

6
NSAIDS
7
Clinical features

• Acid-base status -
• Stimulate the respiratory center, leading to
  hyperventilation and respiratory alkalosis
• Interfere with the Krebs cycle, limit production
  of ATP, and increase lactate production, leading
  to ketosis and metabolic acidosis
• Respiratory system effects -
• Causes stimulation of respiration
• level of 35 mg/dL or higher causes increases in
  both rate (tachypnea) and depth (hyperpnea)
• Glucose metabolism -
• Hypoglycemia (increased cellular metabolic
  activity)

8
Cont..

• Fluid and electrolyte effects -
• dehydration because of increased GI tract losses
  (vomiting) and insensible fluid losses (hyperpnea
  and hyperthermia).
• Renal clearance of salicylate is decreased by
  dehydration.
• CNS effects -
• Salicylates are neurotoxic, which manifests as
  tinnitus, and ingestion can lead to hearing loss
  at doses of 20-45 mg/dL or higher.
• CNS toxicity is related to the amount of drug
  bound to CNS tissue.
• Other s disorientation, seizures, cerebral
  edema, hyperthermia, coma and death.

9
Cont..

• GI tract effects -
• Nausea and vomiting are the most common effects.
• Hepatic effects -
• Hepatitis
• Reye syndrome (characterized by nausea, vomiting,
  hypoglycemia, elevated levels of liver enzymes
  and ammonia, fatty infiltration of the liver,
  increased intracranial pressure, and coma)

10
Cont..

• Hematologic effects -
• Hypoprothrombinemia and platelet dysfunction are
  the most common effects.
• Bleeding (either by inhibition of vitamin
  Kdependent enzymes or by the formation of
  thromboxane A2).
• Musculoskeletal effects -
• Rhabdomyolysis can occur because of dissipation
  of heat and energy resulting from oxidative
  phosphorylation uncoupling.

11
Management

• Gastric lavage
• Mild poisoning
• plasma salicylate less than 350 mg per L than
  increase oral fluids
• Moderate
• more than 350 mg per L than IV fluids to correct
  dehydration , sodium bicarbonate 1.26
  alkalinises the urine
• Severe haemodialysis

12
KEROSENE OIL POISONING

• C / F age between 1 and 3 years of age ,
• common symptoms
• chemical pneumonitis ,
• fever ,
• cough ,
• breathlessness ,
• abdominal distention
• Rarely
• Convulsion , Coma ,cyanosis
• Radiological changes right basal infiltrates.
• Emphysema ,pleural effusion and pneumatoceles
  have also been observed.

13
Management

• Supportive and symptomatic
• Gastric lavage if amount ingested is massive
  (within 30 mins of ingestion)
• Oxygen if respiratory involvement
• Antibiotic
• Observation for at least 24 hrs is essential even
  in an asymptomatic child