TO XICO LOG Y

DR. REINO PALACPAC, MD.

OBJECTIVE

1. DEFINE TOXICOLOGY & RELATED TERMS

2. DETERMINE THE CLASSIFICATION OF TOXICOLOGIC AGENTS
3. IDENTIFY TOXICOLOGIC AGENTS & ITS CLINICAL MANIFESTATIONS,
PHARMACOKINETICS & PHARMACODYNAMICS
4. TO BE ABLE TO MANAGE CLINICALLY THE EFFECTS OF TOXICOLOGIC AGENTS
OCCUPATIONAL & ENVIRONMENTAL

DEFINITION OF TERMS
TOXICOLOGY DELETERIOUS EFFECTS OF CHEMICAL AGENTS ON ALL LIVING
SYSTEMS
POISONS, TOXIC SUBSTANCE, TOXIC CHEMICAL, TOXICANT
A SUBSTANCE OR CHEMICAL THAT CAUSES INJURY, ILLNESS , HARM,
INCAPACITATION OR DEATH
 HAZARD ABILITY OF THE CHEMICAL AGENT TO CAUSE INJURY IN A GIVEN
SITUATION OR SETTING

RISK EXPECTED FREQUENCY OF THE OCCURRENCE OF AN UNDESIRABLE

EFFECT ARISING FROM EXPOSURE TO THE CHEMICAL OR PHYSICAL AGENTS

ROUTE OF EXPOSURE SKIN, MUCUS, INHALATION, ORAL INGESTION

DURATION OF EXPOSURE LENGTH OF TIME
 BIO ACCUMULATION CHEMICAL ACCUMULATES WITHIN TISSUES IF THE
INTAKE OF A CONTAMINANT BY AN ORGANISM EXCEEDS THE LATTERS ABILITY
TO METABOLIZE IT OR EXCRETE IT

BIOMAGNIFICATION UNDETECTABLE IN WATER, MAGNIFIED AS IT PASSES

THRU THE FOOD CHAIN

ECOTOXICOLOGY TOXIC EFFECTS OF CHEMICALS ON POPULATIONS &

COMMUNITIES OF LIVING ORGANISMS WITHIN A DEFINED ECOSYSTEM
OCCUPATIONAL TOXICOLOGY

WORKPLACE
IDENTIFY AGENTS OF CONCERN
DEFINE CONDITIONS LEADING TO THEIR SAFE USE
PREVENT ABSORPTION OF HARMFUL AMOUNT
THRESHOLD LIMIT VALUES (TLVS)
OCCUPATIONAL TOXICOLOGY

WORKPLACE
IDENTIFY AGENTS OF CONCERN
DEFINE CONDITIONS LEADING TO THEIR SAFE USE
PREVENT ABSORPTION OF HARMFUL AMOUNT
THRESHOLD LIMIT VALUES (TLVS)
ENVIRONMENTAL TOXICOLOGY

POTENTIALLY DELETERIOUS IMPACT OF CHEMICALS PRESENT AS POLLUTANTS

OF THE ENVIRONMENT ON LIVING ORGANISM

SURROUNDINGS - AIR, SOIL, WATER

ACCEPTABLE DAILY INTAKE ( ADI )
APPRECIABLE RISK?
AIR CONCENTRATIONS (PPM)
TLV-TWA (TIME WEIGHTED AVERAGE)
8 HOURS WORKDAY TO WHICH WORKERS MAY BE REPEATEDLY EXPOSED
WITHOUT ADVERSE EFFECT

TLV-STEL (SHORT TERM EXPOSURE LIMIT)

IS THE MAXIMUM CONCENTRATION THAT SHOULD NOT BE EXCEEDED AT ANY
TIME DURING 15 MIN EXPOSURE PERIOD

TLV-C (CEILING)
IS THE CONCENTRATION THAT SHOULD NOT BE EXCEEDED EVEN
INSTANTANEOUSLY
ENVIRONMENTAL TOXIC CHEMICALS

POLLUTANTS
AIR -SOIL -WATER

AGRICULTURAL CHEMICALS
INSECTICIDES/PESTICIDES -HERBICIDES

SOLVENTS
HALOGENATED ALIPHATIC HYDROCARBONS
AROMATIC HYDROCARBONS
AIR POLLUTANTS

CARBON MONOSIDE (CO). 52%

SULFUR DIOXIDE (SO2) 14%
HYDROCARBONS. 14%
PARTICULATE MATTER (SMOKE) 4%
NITROGEN OXIDES (NO2). 14%
OTHERS.. 2%
SOIL/WATER POLLUTANTS

DIOXINS
POLY CHLORINATE BIPHENYLS (PCBS)
METALS
INSECTICIDES/PESTICIDES

BOTANICALS
ACETYL CHOLINE INHIBITORS
CHLORINATED HYDROCARBONS
HERBICIDES

PARAQUAT
PHENOXYACETIC ACIDS
SPECIFIC CHEMICALS

CARBON MONOXIDE
SULFUR DIOXIDE
NITROGEN OXIDE
OZONE
CARBON MONOXIDE
ODORLESS,COLORLESS,TASTELESS GAS,NON IRRITATING, BY PRODUCT OF INCOMPLETE COMBUSTION
TLV: 25PPM
COMBINES WITH THE OXYGEN-BINDING SITES OF HEMOGLOBIN- AFFINITY FOR HGB 220X THAT OF
OXYGEN

CARBOXYHEMOGLOBIN (THUS NO O2 GOES TO TISSUE)

TISSUE HYPOXIA HEADACHE,CONFUSION,LOSS OF VISUAL
ACUITY,TACHYCARDIA,TACHYPNEA,SYNCOPE COMA,CONVULSION,SHOCK,RESPY FAILURE, DEATH

RX: REMOVAL OF SOURCE,BREATHING PURE OXYGEN,HYPERBARIC O2 ( 2-3X ATMOSPHERIC

PRESSURE )
SULFUR DIOXIDE
COLORLESS,IRRITATING GAS
COMBUSTION OF FOSSIL FUELS
TLV-TWA: 2PPM
SULFUROUS ACID - MUCOUS MEMBRANES, CONJUCTIVAL & BRONCHIAL IRRITATION
5-10 PPM BRONCHOSPASM
RX: REMOVAL AND RELIEF SULFUROUS ACID IS FORMED FROM SULFUR OXIDE UPON
CONTACT W/ MOIST MEMBRANE CAUSING SEVERE IRRITATION
TX: NON-SPECIFIC, BRONCHODILATORS, WASH EYES & SKIN W/ WATER
NITROGEN OXIDE
BROWNISH IRRITANT GAS
BY PRODUCT OF FIRES OR FRESH SILAGE IN FARMS
INSIDE A SILO, IT CAN LEAD TO SILO-FILLERS DISEASE
S/S:
IRRITANT TO EYES/NOSE
COUGH,FROTHY SPUTUM
DYSPNEA,CHEST PAIN,DEEP LUNG IRRITATION CAUSING FIBROTIC DESTRUCTION OF
TERMINAL BRONCHIOLES (BRONCHIOLITIS OBLITERANS), EMPHYSEMA, PULMO EDEMA

TX:
BRONCHODILATORS
SEDATIVE
ANTIBIOTICS
OZONE
A BLUISH IRRITANT GAS
PRESENT NORMALLY IN ATMOSPHERE & ABSORBS ULTRAVIOLET LIGHT
OCCUR AROUND HIGH VOLTAGE ELECTRICAL EQUIPMENT & AIR & WATER
PURIFICATION DEVICES BAD OZONE

IRRITANT TO MUCOUS MEMBRANE

UPPER & LOWER RESPY TRACT IRRITATION
PULM EDEMA,DRYNESS OF THROAT
CHANGES IN VISUAL ACUITY
SUBSTERNAL CHEST PAIN
CHRONIC BRONCHITIS, BRONCHIOLITIS FIBROSIS, EMPHYSEMA
TX:
NO SPECIFIC TX
SYMPTOMATIC TX
SOLVENTS

HALOGENATED ALIPATHIC HYDROCARBONS

AROMATIC HYDROCARBONS
TRICHLORO ETHYLENE
TETRA CHLORO ETHYLENE
HALOGENATED ALIPATHIC HYDROCARBONS
INDUSTRIAL SOLVENTS,DEGREASING AGENTS, DRY CLEANING AGENTS
WATER POLLUTANTS IN GROUND WATER
CARBON TETRACHLORIDE, CHLOROFORM, TRICHLOROETHYLENE, TETRACHLOROETHYLENE, FLUORINATED FORMS
CARCINOGENIC(RENAL,PROSTATE,TESTICULAR)
CNS DEPRESSANT NAUSEA, VERTIGO, LOCOMOTOR DISTURBANCE, HEADACHE, COMA , IMPAIRED MEMORY,
PERIPHERAL NEUROPATHY

NEPHROTOXIC ALL
HEPATOTOXIC CARBON TETRA CHLORIDE
CARDIOTOXIC - ALL
TX: NON SYMPTOMATIC, TREAT WHATEVER ORGAN IS AFFECTED
AROMATIC HYDROCARBONS
BENZENE, IN GASOLINE
CNS DEPRESSANT EUPHORIA, ATAXIA, COMA, DROWSINESS, NAUSEA,
VERTIGO, HEADACHE
HEMATOTOXIC LEUKEMIA, APLASTIC ANEMIA, PANCYTOPENIA,
THROMBOCYTOPENIA

TOLUENE, NON-MYELOGENIC
CNS DEPRESSANT, EYE/SKIN IRRITANT
XYLENE
SUBSTITUTE FOR BENZENE, NON MYELOGENIC
CNS DEPRESSANT, SKIN IRRITANT
TX: SYMPTOMATIC/SUPPORTIVE
 TRICHLORO ETHYLENE/ TETRA
CHLORO ETHYLENE
CHLORINATED HYDRO CARBON USED AS INDUSTRIAL SOLVENT
PESTICIDE/INSECTICIDE/HERBICIDE
PESTICIDE/INSECTICIDE/HERBICIDE
PESTICIDE/ INSECTISIDE

ORGANOCHLORINE PESTICIDE
ORGANOPHOSPHOROUS PESTICIDE
CARBAMATE PESTICIDE
ORGANOCHLORINE PESTICIDE
DDT (CHLOROPHENOTHANE)
MOSQUITO KILLER-FUMIGATION, POORLY ABSORBED IN SKIN
TOXIC IF INHALED OR INGESTED
OTHERS - BENZENE HEXACHLORIDES , CYCLODIENES-ALDREIN CHLORDANE,
DIELDRIN,HEPTACHLOR (READILY ABSORBED IN SKIN), TOXAPHENES

MECHANISM
INTERFERE W/ INACTIVATION OF THE SODIUM CHANNEL AND CAUSE
REPETITIVE FIRING IN MOST NEURONS
TREMORS OR SEIZURE/CONVULSION

CARCINOGENIC, BREAST CA?, BRAIN CA, TESTICULAR CA, NON HODGKINS

LYMPHOMA

TX: NO SPECIFIC TX, SYMPTOMATIC TX

ORGANO
KILLS INSECTS
PHOSPHOROUS
DIRECTLY OR USED AS PLANT
PESTICIDE
SYSTEMIC(ABSORBED FIRST BY PLANTS &
WHEN INSECTS FEED ON THE PLANT, THEY DIE)
CHEMICAL BASE (WAR GASES) SOMAN, SARIN (NERVE GAS)- USED IN JAPAN
RAILWAY,TERRORIST ATTACK & SYRIA, TABUN
ABSORBED IN SKIN, INHALATION, INGESTION
COMPOUNDS AZINPHOSMETHYL, CHLORVINPHOS, DIAZINON, DICHLORVOS,
FENITHROTHION, MALATHION, PARATHION, TRICHLORFON
EFFECT
INHIBITS ACETYL CHOLINESTERASE
RESULTS TO ACCUMULATION OF ACETYL CHOLINE & INCREASE CHOLINERGIC ACTIVITY
MAY ALSO CAUSE DEMYELINATION OF NERVES RESULTING TO PARALYSIS,
POLYNEUROPATHY(TINGLING SENSATION W/ MOTOR WEAKNESS, ATAXIA)
RESPIRATORY MUSCLE PARALYSIS - DEATH
TX: NO SPECIFIC TX, ATROPINE
SARIN NERVE GAS
CARBAMATE PESTICIDE
ALSO INHIBIT ACETYL CHOLINESTERASE
SAME EFFECT AS W/ ORGANO PHOSPHATES, SAME TX AS W/
ORGANOPHOSPHATES

SHORT DURATION
PRALIDOXIME IS NOT RECOMMENDED
ALDICARB, AMINOCARB, CARBARYL
BOTANICAL PESTICIDE

NATURAL SOURCES
NICOTINE
ROTENONE
PYRETHRUM
NICOTINE PESTICIDE
DRIED LEAVES OF NICOTIANA TOBACUM & N.MISTICA
RAPIDLY ABSORBED IN MUCOSA
THE FREE ALKALOID IS ABSORBED IN SKIN,BUT THE SALT REACTS W/
ACETYLCHOLINE RECEPTOR OF POSTSYNAPTIC MEMBRANE (SYMPATHETIC &
PARASYMPATHETIC GANGLIA, NEUROMUSCULAR JUNCTION)

RESULT DEPOLARIZATION RAPIDLY FOLLOWED BY BLOCKADE OF

TRANSMISSION
EXCITATION (CONVULSION), FOLLOWED BY PARALYSIS
ROTENONE PESTICIDE
OBTAINED FROM
DERRIS ELLIPTICA,
D. MELLACENSIS (PLANT/VINE)
ORAL INGESTION CAUSES
GIT IRRITATION, CONJUCTIVITIS
DERMATITIS, PHARYNGITIS,
RHINITIS
TX:
SYMPTOMATIC
PYRETHRUM PESTICIDE
PYRETHRIA I, PYRETHRIA II
CINEUM I, CINEUM II
JASMOLIN I, JASMOLIN II
INHALATION OR INGESTION;
NOT SKIN
TOXICITY
CNS EXCITATION, CONVULSION,
TETANIC PARALYSIS
CONTACT DERMATITIS
TX: SYMPTOMATIC
HERBICIDE DESTROY PLANTS

CHLORPHENOXY HERBICIDE
GLYPHOSATE HERBICIDE
BIPYRIDYL HERBICIDE
CHLOROPHENOXY HERBICIDE
WEED DESTRUCTION/EXFOLIANT
CONTAINS DIOXIN USED IN AGENT ORANGE IN VIETNAM WAR CAUSING SEVERE AGRICULTURAL
DAMAGE & SOCIAL DISRUPTION

TOXICITY
COMA
MUSCLE HYPOTONIA
HEPATOXIC
NEPHROTOXIC
CARCINOGENIC NON-HODGKINS LYMPHOMA,SARCOMA
BIRTH DEFECTS
TX: SYMPTOMATIC
GLYPHOSATE HERBICIDE

GLYCIN
MOST WIDELY USED HERBICIDE
DAMAGE ANY PLANT
TO AVOID THIS, GENETICALLY MODIFIED PLANTS LIKE SOYBEAN, CORN, COTTON THAT
ARE RESISTANT WERE DEVELOPED

TOXICITY
EYE & SKIN IRRITANT
NO SPECIFIC TREATMENT
BIPYRIDYL HERBICIDE

PARAQUAT
TOXICITY INGESTION, INHALATION
HGIC LUNG EDEMA, ALVEOLITIS, LUNG FIBROSIS, HEMATEMESIS, BLOODY
STOOL, DEATH AFTER SEVERAL WEEKS

HEPATOTOXIC, NEPHROTOXIC, CARDIOTOXIC

TX - GASTRIC LAVAGE, CATHARTIC/CLEANSING, ADSORBENT - CHARCOAL
ENVIRONMENTAL POLLUTANTS

POLYCHLORINATED BIPHENYL (PCB)

ENDOCRINE DISRUPTORS
ASBESTOS
POLYCHLORINATED BIPHENYLS
(PCB)
USED AS HEAT TRANSFER FLUID, LUBRICATING OIL, PLASTICIZERS,WAX EXTENDER, FLAME
RETARDANT

MANUFACTURE IN U.S. STOPPED IN 1997

RESISTANT TO BIO DEGRADATION
ACCUMULATE IN FOOD CHAIN
EXPOSURE MAY LAST FOR SEVERAL MONTHS
IN JAPAN 1968 COOKING OIL CONTAMINATION (YUSHOS DISEASE)
EFFECT ON FETAL DEVELOPMENT (CHILDHOOD INTELLECTUAL DYSFUNCTION)
DERMA PROBLEMS - CHLOR ACNE, FOLLICULITIS, ERYTHEMA, DRYNESS, RASH,
HYPERKERATOSIS, HYPERPIGMENTATION

HEPATOTOXIC
CARCINOGENIC MELANOMA, BREAST PANCREAS, THYROID,SARCOMA,LUNG
ENDOCRINE DYSRUPTORS
ESTROGEN LIKE
ANTI ANDROGENIC
THYROID FXN DISRUPTION
MIMIC, ENHANCE, DISRUPT, INHIBIT
SAMPLES
PHYTO ESTROGENS
MYCO ESTROGENS
DDT
PCB
BROMINATED FLAME RETARDANT
UNDER INVESTIGATION
ASBESTOS
PROGRESSIVE LUNG DISEASE (ASBESTOSIS)
LUNG CANCER
MESOTHELIOMA OF PLEURA OR PERITONEUM
OTHER CA
COLON
LARYNGEAL
STOMACH
LYMPHOMA
BANNED IN COUNTRIES
ONLY CANADA & ZIMBABWE CONTINUE TO USED IT
METALS
ARSENIC
LEAD
MERCURY
BERYLLIUM
CADMIUM
MANGANESE
URANIUM
ARSENIC

MINERAL
USES
IN CAR BATTERIES, ELECTRONIC, PESTICIDE, HERBICIDE,INSECTICIDE
BEFORE TREATMENT OF SYPHYLIS, CANCER, LEUKEMIA, PSORIASIS
CHEMICAL WARFARE CAUSING BLISTERS & LUNG IRRITATION
POISONING
MULTI ORGAN FAILURE FROM NECROTIC CELL DEATH
LEAD

POISONING (PLUMBISM)
COMMONLY IN PAINT MATERIALS
TOXICITY
NEUROTOXIC, ANEMIA, SEIZURE, COMA, DEATH
LEAD
MERCURY
IN MEDICAL SUPPLIES
THERMOMETER
BP APPARATUS
MERCURY POISONING (ERYTHISM), HYDRARGYRIA
DAMAGE TO BRAIN, KIDNEY, LUNGS
BAD EFFECT ON VISION, HEARING, SPEECH, NEUROPATHY, PINK
DISCOLORATION OF SKIN
MERCURY POISONING
BERYLLIUM
A LIGHT ALKALINE METAL
INCORPORATED IN ALLOYS & CERAMICS
NON-SPARK QUALITY
USED IN DENTAL APPLIANCE
NUCLEAR WEAPONS
BERYLLIUM-COPPER ALLOY IN COMPUTER & IN ENCASEMENT OF NUCLEAR
WEAPON HARDENING OF MISSILE CERAMICS NOSE CONES,SPACE SHUTTLE HEAT
SHIELD TILES

TOXICITY BY INHALATION, CARCINOGEN

CHRONIC GRANULOMATOUS PULMONARY FIBROSIS, CANCER
AUTO IMMUNE SKIN DISEASE
BERYLLIUM
CADMIUM

IN MANUFACTURE OF NICKEL CADMIUM BATTERY,

SOLDING/WELDING, TELEVISION, PLATING OPERATION,
SEMI CONDUCTOR, PLASTIC STABILIZER

TOXICITY INHALATION, INGESTION

CANCER, KIDNEY DAMAGE
CADMIUM FUME FEVER
CHILLS, FEVER, COUGH, MALAISE
MANGANESE

USED IN WELDING MATERIALS, FUEL ADDITIVE

PSYCHIATRIC & MOTOR DISTURBANCE
PARKINSONS
URANIUM

HAS NUCLEAR PROPERTIES

USED IN NUCLEAR WEAPONS OR FUEL
TOXICITY
BIRTH DEFECTS
CANCER
MULTI ORGAN FAILURE
CHELATORS METAL
CHELATORS BIND W/ METALS & PREVENT FURTHER ABSORPTION & PROMOTES EXCRETION
DIMERCAPROL (BRITISH ANTI LEWISITE) LEAD ARSENIC, MERCURY
SUCCIMER - LEAD, ARSENIC, MERCURY
EDETATE CALCIUM (EDTA) - LEAD
UNITHOL (DIMERCAPTOPROPANESULFONIC ACID)- MERCURY
PENICILLAMINE COPPER , LEAD
DEFEROXAMINE - IRON
PRUSSIAN BLUE(HEXACYANOFERRATE)
TOXICOLOGY
MANAGEMENT OF THE POISONED PATIENT
MOST DEATHS DUE TO POISONING ARE DUE TO INTENTIONAL SUICIDAL OVERDOSE
SOME ARE DUE TO ACCIDENTAL INGESTION BY A CHILD BUT THE INCIDENCE WAS
MARKEDLY REDUCED DUE EFFECTIVE SAFETY PACKAGING & EDUCATION

PRIORITY IN MANAGEMENT
RESPIRATORY FAILURE
HYPOTENSION
SEIZURE
THERMO REGULATORY DISTURBANCE
ELIMINATION OF DRUGS/TOXIN
 TOXICOKINETICS
ABSORPTION
DISTRIBUTION
EXCRETION
METABOLISM
TOXIC DOSES OF THERAPEUTIC AGENTS
TOXICODYNAMICS
INJURIOUS EFFECTS OF SUBSTANCES ON BODY FUNCTION
TOXIC MEDICINES
VD VOLUME OF DISTRIBUTION
AMOUNT OF DRUG DISTRIBUTED IN THE BODY
A LARGE VD IMPLIES THAT THE DRUG IS NOT READY ACCESSIBLE TO MEASURES AIMED AT
PURIFYING THE BLOOD SUCH AS HEMODIALYSIS

DRUGS W/ LARGE VD (> 5 L/KG)

ANTIDEPRESSANT
ANTIPSYCHOTIC
ANTIMALARIAL
OPIODS
PROPRANOLOL
VERAPAMIL
 DRUGS W/ LOW VD (< 1 L/KG)
SALICYLATE
ETHANOL
PHENOBARBITAL
LITHIUM
VALPROIC ACID
PHENYTOIN
CLEARANCE
VOLUME OF PLASMA CLEARED OF THE DRUG PER UNIT OF TISSUE
BY KIDNEY OR LIVER
FOR DETOXIFICATION
APPROACH TO THE POISONED
PATIENT
CAUSE OF DEATH IN THE POISONED PATIENT
WE MUST UNDERSTAND THIS TO TREAT PATIENT & PREVENT DEATH
CNS TOXICITY
DEPRESSANT
OBTUNTED
COMATOSE
LOOSE THEIR AIRWAY PROTECTIVE REFLEXES & RESPIRATORY DRIVE
AIRWAY OBSTRUCTION DUE TO FLACCID TONGUE OR ASPIRATION OF GASTRIC
CONTUENT DUE TO ABSENT SWALLOWING
OVERDOSE OF NARCOTICS,SEDATIVES HYPNOTICS(BARBITURATES,ALCOHOL)
 CVS TOXICITY
HYPOTENSION DUE TO DEPRESSED CARDIAC CONTRACTILITY
HYPOVOLEMIA DUE TO VOMITING OR DIARRHEA OR FLUID SEQUESTRATION
PERIPHERAL VASCULAR COLLAPSE DUE TO BLOCKADE OF ALPHA ADRENERGIC
VASCULAR TONE OR ARRYTHMIA
HYPOTHERMIA OR HYPERTHERMIA CAN CAUSE HYPOTENSION
LETHAL ARRYTHMIA OR VENTRICULAR TACHYCARDIA & FIBRILLATION DUE TO
OVERDOSE OF CARDIO ACTIVE DRUGS
EPHEDRINE, AMPHETAMINE,COCAINE,DIGITALIS,THEOPHYLLINE
 DRUGS NOT CONSIDERED AS CARDIO ACTIVE BUT DUE TO OVERDOSE MAY
CAUSE CVS PROBLEM
TRICYCLIC ANTIDEPRESSANT
ANTIHISTAMINE
OPIOIDS
 CELLULAR HYPOXIA MAY OCCUR DESPITE ADEQUATE VENTILATION & O2
ADMINISTRATION IF POISONING W/
CYANIDE
HYDROGEN SULFIDE
CARBON MONOXIDE
THEY MAY NOT BE CYANOTIC BUT SIGNS OF HYPOXIA ARE THE FOLLOWING
TACHYCARDIA
HYPOTENSION
LACTIC ACIDOSIS
ISCHEMIA ON ECG
 SEIZURE, RIGIDITY
MAY CAUSE PULMONARY ASPIRATION,HYPOXIA,BRAIN DAMAGE
HYPERTHERMIA MAY RESULT FROM SUSTAINED MUSCULAR HYPERACTIVITY &
LEAD TO BREAKDOWN OF MUSCLES,MYOGLOBINURIA & RENAL FAILURE, LACTIC
ACIDOSIS & HYPERKALEMIA
DRUGS ANTIDEPRESSANT, INH, DIPHENHYDRAMINE, COCAINE, AMPHETAMINE
 PULMONARY DAMAGE
PARAQUAT DAMAGES LUNG TISSUE CAUSING FIBROSIS SEVERAL DAYS AFTER
INGESTION

MASSIVE HEPATIC NECROSIS

AFTER ACETAMENOPHEN POISONING OR CERTAIN MUSHROOM POISONING
RESULTING TO HEPATIC ENCEPHALOPATHY & DEATH 48-72 HRS AFTER INGESTION

TRAUMA MAY LEAD TO DEATH

ALCOHOL INTOXICATION
SEDATIVE HYPNOTIC INTOXICATION
HALLUCINATION
PHENCYCLIDINE (PCP) ANGEL DUST
LYSERGIC ACID DIETHYL AMIDE (LSD)
INITIAL MANAGEMENT
ABCD
AIRWAY
CLEAR OF VOMITUS
ORAL AIRWAY OR ENDOTRACHEAL INTUBATION
LATERAL LEFT DOWN POSITION TO MOVE DOWN THE FLACCID TONGUE OUT OF
THE OBSTRUCTED AIRWAY

BREATHING
MEASURED FOR ADEQUACY BY PULSE OXYMETER OR ARTERIAL BLOOD GAS
 CIRCULATION
PULSE RATE, BLOOD PRESSURE, URINARY OUTPUT
EVALUATION OF PERIPHERAL PERFUSION BY OXYMETER OR NAILBED COLOR
BLOOD EXAM INCLUDING BLOOD SUGAR
DRUGS
DEXTROSE CHALLENGE FOR ALL COMATOSE PATIENT OR W/ ALTERED MENTAL
STATUS(D50-50)IV
ALCOHOLIC PATIENT-GIVE THIAMINE(VIT.B1) IM OR IV TO PREVENT WERNICKES
SYNDROME
NALOXONE .4-2MG IV FOR RESPY DEPRESSION CAUSED BY OPIODS.(LARGER
DOSE REQUIRED FOR PROPOXYPHERE OR CODEINE OVERDOSE)
FLUMAZENIL FOR BENZODRAZEPINE
SHOULD NOT USED IF SUSPECT OVERDOSE W/ TRICYDIC ANTIDEPRESSANT OR
W/ SEIZURE DISORDER SINCE THIS DRUG CAN TRIGGER CONVULSION
HISTORY & P.E.
AFTER THE ABCD, A MORE THOROUGH HX/PE SHOULD BE DONE
R/O OTHER CAUSES OF COMA LIKE TRAUMA,MENINGITIS,METABOLIC
DISORDER(DM)
IDENTITY TOXIC SUBSTANCE

HISTORY
AMOUNT & TYPE OF DRUG
SURROUNDING WHERE PATIENT WAS FOUND
SYRINGES,BOTTLES,HOUSEHOLD PRODUCTS,MEDICATIONS,WRAPPERS
P.E. LOOK FOR CLUES
VITAL SIGNS
EYES
MOUTH SKIN
ABDOMEN
CNS
VITAL SIGN BP,PULSE,RESPIRATION,TEMP

HYPERTENSION & TACHYCARDIA

NOTED W/ AMPHETAMINE,COCAINE,ANTI MUSCARINIC/ANTI CHOLINERGIC
HYPOTENSION & BRADYCARDIA
CALCIUM CHANNEL BLOCKER,B-BLOCKER,CLONIDINE,SEDATIVE HYPNOTIC
HYPOTENSION W/ TACHYCARDIA
TRICYCLIC ANTIDEPRESSANT, TRAZODONE, QUITIAPINE, VASODILATORS, B-
ANTAGONIST
 RAPID RESPIRATION
SALICYLATE
CARBON MONOXIDE POISONING
TOXINS PRODUCING METABOLIC ACIDOSIS OR CELLULAR HYPOXIA
HYPER THERMIA
SYMPTHOMIMETICS
ANTI CHOLINERGIC
SALICYLATES
DRUGS CAUSING SEIZURE OR RIGIDITY
HYPO THERMIA
CNS DEPRESSANT
 EYES
MIOSIS OIPIODS, CLONIDINE,PHENOTHIAZINE,CHOLINESTERASE INHIBITORS
(ORGANOPHOSPHATE INSECTICIDES),DEEP COMA DUE TO SEDATIVE DRUGS
MYDRIASIS(PUPILLO DILATATION)
AMPHETAMINE, COCAINE, LSD, ATROPINE, ANTICHOLINERGICS
HORIZONTAL NYSTAGMUS
PHENYTOIN, ALCOHOL, BARBITURATES, OTHER SEDATIVE
VERTICAL & HORIZONTAL NYSTAGMUS
PHENCYCLIDINE
PTOSIS/OPTHALMOPLEGIA
BOTULISM
 MOUTH
BURNS FROM INGESTION OF CORROSIVE SUBSTANCE
SOOT FROM SMOKE INHALATION
ODORS OF ALCOHOL,HYDROCARBON SOLVENT, AMMONIA,CYANIDE(BITTER
ALMOND)
SKIN
ATROPINE/ANTIMUSCARINIC
FLUSHED,DRY,HOT
EXCESSIVE SWEATING
ORGANOPHOSPHATE, NICOTINE, SYMPATHOMIMETIC
CYANOSIS
HYPOXEMIA OR METHA HEMOGLOBINEMIA
ICTERUS(YELLOWISH)
HEPATIC NECROSIS DUE TO ACETAMENOPHEN OR AMANITA
PHALLOIDES MUSHROOM POISONING
 ABDOMEN
ILEUS
ANTIMUSCARINIC/ANTICHOLINERGIC
OPIOD
SEDATIVES
HYPERACTIVE BOWEL/CRAMPS, DIARRHEA
ORGANOPHOSPHATE
IRON
ARSENIC
THEOPHYLLIN
A. PHALLOIDES & A. MUSCARINIC MUSHROOM
 CNS
FOCAL SEIZURE OR MOTOR DEFICIT SUGGEST INTRACRANIAL HGE FRM TRAUMA OR
TUMOR LESIONS, RATHER THAN FROM INTOXICATION FROM POISON
NYSTAGMUS, DYSARRTHRIA,ATAXIA
PHENYTOIN, CARBAMAZEPINE, ALCOHOL, OTHER SEDATIVE
TWITCHING,MUSCULAR HYPERACTIVITY
ATROPINE, ANTICHOLINERGIC, COCAINE
OTHER SYMPATHOMIMETICS
 MUSCULAR RIGIDITY
HALOPERIDOL, OTHER ANTIPSYCHOTIC
STRYCHINE OR TETANUS
GENERALIZED HYPERTOXICITY & LOWER EXTREMITY CLONUS
SEROTONIA SYNDROME
SEIZURES
ANTIDEPRESSANTS (TRICYCLINE), BUPROPION, COCAINE, AMPETHAMINE
THEOPHYLLINE, INH, DEPHENHYDRAMINE
FLACCID COMA/ABSENT REFLEXES & DEEP COMA
SEDATIVE HYPNOTICS, CNS DEPRESSANTS
MAY BE MISTAKEN FOR BRAIN DEATH
 LABORATORY & IMAGING PROCEDURES
ARTERIAL BLOOD GAS
ELECTROLYTES
RENAL FXN TEST
SERUM OSMOLARITY
ECG
IMAGING XRAY, CT-SCAN, MRI
 ARTERIAL BLOOD GAS
PO2 LOWER HYPOXIA
MEASURES ONLY O2 DISSOLVED IN PLASMA & NOT TOAL BLOOD
OXYGEN(INCLUDING OXYHEMOGLOBIN)
MAYBE NORMAL IN CARBON MONOXIDE POISONING
PCO2 INCREASE HYPERCAPNIA
 ELECTROLYTES
NA, K,CL, HCO2 (BICARBONATE)
HYPERKALEMIA (INCREASE K) CAUSING DRUGS MAY CAUSE ARRYTHMIA
POTASSIUM ITSELF, B-BLOCKERS, DIGITALIS, POTASSIUM SPARING DIURETICS, FLUORIDE
HYPOKALEMIA
BARRIUM
B-ANTAGONIST
CAFFEINE
THEOPHYLLINE
THIAZIDE
LOOP DIURETICS
 RENAL FUNCTION TEST BUN,CREATININE, URINALYSIS
DIRECTLY NEPHROTOXIC DRUGS
OR DUE TO SHORK OR MYOGLOBINURIA
INCREASE SERUM CREATININE KINASE & MYOGLOBIN IN URINE
NOTE IN MUSCLE NECROSIS DUE TO SEIZURE OR MUSCULAR RIGIDITY
OXALATE CRYSTALS IN URINE SUGGEST ETHYLENE GLYCOL POISONING
SERUM OSMOLARITY
DEPENDENT ON SODIUM,GLUCOSE & BLOOD UREA NITROGEN
CHANGES DUE TO
ETHANOL,METHANOL,ETHYLANE GLYCOL,ISOPROPANOL
 ECG
WIDE QRS
ANTIDEPRESSANTS
QUINIDINE
PROLONGED QT
QUINIDINE
ANTIDEPRESSANT
ANTI PSYCHOTIC
LITHIUM
ARSENIC
AV BLOCK, ARTERIAL/VENTRICULAR ARRYTHMIA
DIGOXIN & OTHER CARDIAC GLYCOSIDES
INCREASE ISCHEMIC CHANGES DUE TO CARBON MONOXIDE
 IMAGING
SOME TABLETS LIKE IRON & POTASSIUM ARE RADIO OPAQUE & CAN BE SEEN ON
XRAY
CHEST XRAY MAY SHOW
ASPIRATION PNEUMONIA
HYDRO CARBON PNEUMONIA
PULMONARY EDEMA
CT-SCAN TO R/O HEAD TRAUMA VS DRUG INTOXICATION
TOXICOLOGY SCREENING TEST
BROAD SCREENING NOT IDEAL TAKES A LONG TIME TO GET RESULTS SEVERAL DAYS
SOME HIGHLY TOXIC DRUGS ARE NOT INCLUDED
CALCIUM CHANNEL BLOCKER
B-BLOCKERS
INH
TX IS USUALLY BASED FIRST ON CLINICAL EVALUATION & NOT ON WAITING FOR RESULTS OF TOXICOLOGY
SCREENING

USEFUL FOR ANTIDOTE THERAPHY

QUANTITATIVE DETERMINATION OF ACETAMENOPHEN PRIOR TO GIVING ACETYL CYSTEINE
HEMODIALYSIS FOR
SALICYTE,ETHYLENE GLYCOL,METHANOL,THEOPHYLLINE, CARBAMAZEPINE, LITHIUM,VALPORIC ACID
 DECONTAMINATION
REMOVING TOXINS FROM SKIN, GIT
SKIN DECONTAMINATION
REMOVE CONTAMINATED CLOTHING & SUBMIT FOR LAB ANALYSIS
WASH W/ SOAP & WATER(WEAR GLOVES/MASK)
GIT DECONTAMINATION
INDUCE EMESIS OR GASTRIC LAVAGE IF NECESSARY (W/ IN 1HR)
ACTIVATED CHARCOAL
EMESIS
GIVE IPECAC SYRUP(RARELY USED NOW)
AVOID IF SUBSTANCE INGESTED IS COUROSSIVE,PETROLEUM DISTILLATE,OR RAPID ACTING
CONVULSANT
AVOID FINGERTIP STIMULATION OF LARYNX,SALT WATER,APOMORPHINE
GASTRIC LAVAGE
THRU NGT, USE WARM NSS TO AVOID HYPOTHERMIA
 ACTIVATED CHARCOAL
CAN ABSORB MANY TOXINS EXCEPT
IRON
LITHIUM
POTASSIUM
FINDS POORLY TO
ALCOHOL
CYANIDE
NOT USEFUL FOR CORROSIVE MINERAL ACID & ALKALINE
CATHARTIC/LAXATIVE
HASTEN REMOVAL OF TOXIN BY DIARRHEA
REDUCE ABSORPTION OF TOXIN
USE BALANCED POLY ETHYLENE GLYCOL ELECTROLYTE SOLUTION (GOLYTELY; COLYTE)
GIVEN ORAL 1-2 LITERS/HR FOR SEVERAL HOURS UNTIL DIARRHEA CLEAR
SPECIFIC ANTIDOTES
POISON ANTIDOTE
ACETAMENOPHEN ACETYLCYSTEINE
ANTICHOLINESTERASE ATROPINE, PRALIDOXIME
ORGANOPHOSPHATE
CARBAMATES
MEMBRANE DEPRESSANT CARDIOTOXIC DRUGS SODIUM BICARBONATE
TRICYCLIC ANTI DEPRESSANT
QUINIDINE
FLUORIDE, CALCIUM BLOCKER
CALCIUM
 POISON ANTIDOTE
IRON SALT DEFEROXAMINE
DIGOXIN & OTHERS GLYCOSIDE DIGOXIN ANTIBODIES
THEOPHYLLINE,CAFFEINE,
METAPROTERENOL ESMOLOL

METHANOL,ETHYLANE GLYCOL
ETHANOL, FOMEPIZOLE
BENZODIAZEPINE
B-BLOCKER FLUMAZENIL
GLUCAGON
 POISON ANTIDOTE
CYANIDE HYDROXYCOBALAMINE (VIT B12)
NALOXONE
NARCOTIC,OPIODS OXYGEN
CARBON MONOXIDE PHYSOSTIGMINE
ANTICHOLINERGIC
ELIMINATION OF TOXINS
DIALYSIS
PERITONEAL DIALYSIS
IN EFFICIENT INELIMINATING MOST TOXIN
HEMODIALYSIS
MORE EFFECTIVE
REMOVES
FORMIC ACID IN METHANOL POISONING
OXALIC & GLYCOLIC ACID IN ETHYLENE GLYCOL POISONING
IN SALICYLATE POISONING

FORCED DIURESIS
NOT RECOMMENDED
 URINARY PH MANIPULATION
ALKALINIZATION OF URINE IN SALICYLIC ACID POISONING
IN PHENCYCLIDINE, AMPHETAMINE OVERDOSE- ACIDIFICATION IS NOT ADVICED
SINCE IT MAY WORSEN RHABDOMYOLYSIS
COMMON TOXIC SYNDROMES
ACETHAMENOPHEN
OVERDOSE INGESTION FROM SUICIDE ATTEMPTS
MORE THAN 7000MG (14 TABS) IS POTENTIALLY TOXIC
HEPATOTOXIC
INITIALLY GIT UPSET (NAUSEA/VOMITING)
SUICIDE ATTEMPTS AND ACCIDENTAL POISONING
AFTER 24-36 HRS LIVER INJURY APPEARS
INCREASE AMINOTRANSFERASE
HYPOPROTHROMBINEMIA
FULMINANT LIVER FAILURE-HEPATIC ENCEPHALOPATHY, DEATH
RENAL FAILURE MAY ALSO OCCUR
ANTIDOTE
ACETYL CYSTEINE ACTS AS GLUTATHIONE SUBSTITUTE BINDING THE TOXIC
METABOLITE
SHOULD BE STARTED W/ IN 8-10HRS
AMPHETAMINES & OTHER
STIMULANTS

(CRANK,CRYSTAL), METHYLENE DIOXY METHAMPHETAMINE (MDMA,ECSTASY),

SHABU,COCAINE(CRANK), PSEUDO EPHEDRINE (SULFA FED), EPHEDRINE,
HERBAL MA-HUANG, CAFFEINE, METHYLENE DIOXYPYROVALERONE (MDPV),
METHCATHIONE (BATH SALTS), IVORY WAVE, BOUNCE,BUBBLES,MAD
COW,MEOW MEOW
AMPHETAMINES
EFFECT USUAL DOSE
EUPHORIA, WAKEFULLNESS, SENSE OF POWER OF WELL BEING
HIGHER DOSE-
RESTLESSNESS, AGITATION, ACUTE PSYCHOSIS, HYPERTENSION,TACHYCARDIA
MUSCULAR HYPERACTIVITY, HYPERTHERMIA (BRAIN DAMAGE),RHABDO
MYOLYSIS(RENAL FAILURE

TX NO ANTIDOTE
SEIZURE GIVE BENZODIAZEPINE (LOZAZEPAM/ATIVAN)
HYPERTHERMIA WATER SPONGE BATH
ANTICHOLINERGIC
INHIBITS ACETYLCHOLINE & MUSCARINIC RECEPTOR
ANTIMUSCARNIC AGENTS
PRESENT IN PLANTS/MUSHROOMS
ALSO ANTIHISTAMINES (DIPHENLYDRAMINE)
CAN CAUSE SEIZURE
CLASSIC SYNDROME
RED AD BEET
SKIN FLUSHED
HOT AS HARE (HYPERTHERMIA)
DRY AS BONE (DRY MUCUS MEMBRANE,NO SWEATING)
BLIND AS BAT (BLURRED VISION,CYCLOPLEGIA)
MAD AS HATTER (CONFUSION,DELIRUIM)
ANTICHOLINERGIC
OTHER S/S
TACHYCARDIA
DILATED PUPILS
AGITATED DELIRIUM
COMA
MUSCLE TWITCHING
URINARY RETENTION
TX SUPPORTIVE
SEDATION W/ BENZODIAZEPINE OR ANTIPSYCHOTIC(HALOPERIDOL W/
AGITETED)
PHYSOSTIGMINE-SPECIFIC ANTIDOTE SLOW IV 0.5-1MG
ANTIDEPRESSSANT
TRICYCLIC
AMITRIPTYLINE, DESIPRAMINE, DOXEPINE
MORE THAN 1000 MG IS LETHAL
COMPETETIVE ANTAGONIST AT MUSCARINIC ANTI CHOLINERGIC
TACHYCARDIA
DILATED PUPILS
DRY MOUTH
VASODILATION LOWER BP
CARDIAC DEPRESSANT LOWER CONTACTILLITY RESULT TO ARRYTHMIA,
CONDUCTION BLOCK & VENTRICULAR TACHYCARDIA
TRICYCLIC ANTIDEPRESSANT
TX
SUPPORTIVE
E.T. INTUBATION IF NEEDED & ATTACH TO VENTILATOR
IVF FOR HYPOTENSION, & DOPAMINE
NOR EPINEPHRINE
ANTIDOTE FOR QUINIDINE LIKE, TOXICITY OF WIDE QRS
SODIUM BICARB
TO EXTRACELLULAR NA TO OVERCOME NA CHANNEL
BLOCKADE
OTHER ANTIDEPRESSANT

OLDER-MONOAMINE OXIDASE INHIBITORS

TRACYLCYPROMINE, PHENELZINE
MAY CAUSE SEVERE HYPERTENSION
NEWER
SSRI-SELECTIVE SEROTIN RECEPTAKE INHIBITORS
FLUOXETINE, PAROXITINE,CITALOPRAM, VENLAFOXINE
SAFER THEY MAY ALSO CAUSE SEIZURE
BUPROPION
NOT AN SSRI MAY ALSO CAUSE SEIZURE
ALL MAY CAUSE SEROTONIN SYNDROME
AGITATION, MUSCLE HYPERACTIVITY, HYPERTHERMIA
ANTIPSYCHOTIC

OLDER PHENOTHIAZINES
BUTEROPHENONES
NEWER ATYPICAL DRUGS
DOPAMINE D2 BLOCKERS
CAN CAUSE PARKINSON SYNDROME DYSTOMIA
NEUROLOGIC MALIGNAT SYNDRONE
LEAD PIPE RIGIDITY, HYPERTHERMIA, AUTONOMIC INSTABILITY
ASPIRIN (SALICYLATE)
SUICIDAL AND ACCIDENTAL POISONING
ACUTE INGESTION > 200MG/KG TOXIC EFFECT
HAD CAUSED A LOT OF DEATH IN CHILDREN BEFORE DUE TO ACCIDENTAL
POISONING OR SUICIDAL POISONING

TOXIC 200MG/KG ACUTE POISONING(MORE THAN 100 TABLETS

IN ELDERLY CHRONIC POISONING IN CHRONIC PAIN TREATMENT
S/S
HYPERVENTILATION
RESPIRATORY ALKALOSIS, INITIALLY THEN METABOLIC ACIDOSIS FOLLOWS
HYPERTHERMIA
VOMITING,DEHYDRATION
SEIZURE,COMA,PULMONARY EDEMA, CARDIOVASCULAR COLLAPSE
ASPIRIN
TX
GIT DECONTAMINATION
NGT GASTRIC LAVAGE
ACTIVATED CHARCOAL
BOWEL IRRIGATION W/ COLYTE
IVF
IV SODIUM BICARBONATE TO ALKALIMIZE URINE & PROMOTE
SALICYLATE EXCRETION
HEMODIALYSIS
BETA BLOCKERS
MOST TOXIC PROPHANOLOL
AS LITTLE AS 2-3X THERAPEUTIC DOSE IS TOXIC
INHIBIT BOTH BETA 1&2
BLOCK SODIUM CHANNEL
BRADYCARDIA, HYPOTENSION
SEIZURE, CARDIAC CONDUCTION BLOCK(WIDE QRS)
TX
INCREASE BP & HEART RATE
IVF
B- AGONIST DRUGS
CALCIUM CHANNEL BLOCKER
CHANNEL BLOCKER/ANTAGONIST
REDUCE CO AND BLOOD PRESSURE
EVEN SMALL OVERDOSE CAN CAUSE SERIOUS TOXICITY OR DEATH
DEPRESS SINUS NODE AUTOMATITICITY
SLOW AV NODE CONDUCTION
REDUCE CARDIAC OUTPUT & LOWER BP IS NOTED IN NIFEDIPINE
TX
NGT- GASTRIC LAVAGE
WHOLE BOWEL IRRIGATION
ORAL CHARCOAL
CALCIUM
GLUCAGON
HIGH DOSE INSULIN + GLUCOSE TO AVOID HYPOGLYCEMIA
LIPID INFUSION FOR VERAPAMIL OVERDOSE
CHOLINE ESTERASE INHIBITORS

ORGANOPHOSPHATES
CARBAMATES
INSECTICIDE/PESTICIDE
INTENTIONAL INGESTION
WORK RELATED IN FACTORY PRODUCTION & PACKAGING
OR TERRORIST ATTACK- IN TOKYO JAPAN & SYRIA(NERVE GAS)
CHOLINE ESTEREAS INHIBITORS

S/S
MUSCARINIC RECEPTOR SYIMULATION CAUSE
ABDOMINAL CRAMPS, DIARRHEA , SALIVATION, SWEATING, URINATION
BRONCHIAL SECRETION
NICOTINIC STIMULATION CAUSES GENERALIZED GANGLIONIC ACTIVATION
HYPERTENSION, TACHYCARDIA OR BRADYCARDIA
MUSCLE FASCICULATION & TWITCHING MAY PROGRESS TO WEAKNESS &
RESPY MUSCLE PARALYSIS
CNS
AGITATION,CONFUSION,SEIZURE
DUMBLES
DIARRHEA,URINATION,MIOSIS,MUSCLE
WEAKNESS,BROCHOSPASM,,LACRIMATION, EXCITATION, SEIZURE
CHOLINE ESTERASE INHIBITORS

TX ANTIDONE
ATROPINE COMPETETIVE INHIBITOR AT MUSCARINIC SITE BUT NO EFFECT AT
NICOTINIC SITE
PRALIDOXIME ACTIVE ON BOTH SITE & RESTORE CHOLINESTERASE ACTIVITY
CYANIDE

HIGHLY TOXIC CHEMICAL USED AS RODENTICIDE,IN EXECUTION OF CRIMINALS

OR IN SUICIDE/HOMICIDE

HYDROGEN CYANIDE IS FORMED FROM BURNING PLASTIC, WOOL & OTHER

SYNTHETIC PRODUCTS

CYANIDE IS ALSO PRODUCED AFTER EATING CASSAVA, SEEDS OF APPLE, PEACH

& APRICOT

CYANIDE BINDS TO CYTOCHROME OXIDASE & INHIBIT OXYGEN UTILIZATION W/

IN THA CELL CAUSING CELLULAR HYPOXIA & LACTIC ACIDOSIS
CYANIDE
S/S
SHORTNESS OF BREATH, AGITATION, TACHYCARDIA, SEIZURE, COMA,
HYPOTENSION,SEVERE METABOLIC ACIDOSIS, DEATH
TX
RAPID CHARCOAL ADMINISTRATION
ANTIDOTE
NITRATE AMYLNITRATE, SODIUM NITRITE, SODIUM THIOSULFATE
NITRITES INDUCE METH HEMOGLOBINEMIA W/C BINDS FREE CYANIDE &
CREATE CYANOMETH HEMOGLOBIN
THIOSULFATE IS A CO FACTOR IN CONVERSION OF CYANIDE TO LESS TOXIC
THIOCYANATE
NEW ANTIDOTE
CONCENTRATED HYDROXYCOBALAMINE (CYANOKI-VIT.B12) COMBINE
RAPIDLY W/ CYANIDE TO FORM CYNOCOBALAMIN, ANOTHER FORM OF
VIT.B12 W/C IS NON TOXIC
DIGOXIN, CARDIAC GLYCOSIDE (OLEANDER) CARDENOLIDE

FOUND IN PLANTS IN SKIN OF SOME TOADS

S/S
VOMITING
HYPERKALEMIA ACUTE TOXICITY
HYPOKALEMIA IS NOT CAUSED BY DIGITALIS TOXICITY BUT W/ CHRONIC USE
POTASSIUM LOSING DIURETICS
ARRYTHMIA CAN OCCUR

TX
ATROPINE FOR BRADYCARDIA OR AV BLOCK
DIGOXIN ANTIBODIES IV
IMPROVEMENT IN 30-60 MIN
ETHANOL & SEDATIVE HYPNOTICS
ALCOHOL
BARBITURATES
BENZODIAZEPINE
CARISOPRODOL
OVERDOSE S/S
EUPHORIA
ROWDY DRUNK
STUPOR, COMA(DEAD DRUNK)
DEPRESSION CAN CAUSE TONGUE TO FALL BACK & CAUSE AIRWAY OBSTRUCTION
HYPOTHERMIA
SEDATIVE

TX
SUPPORTIVE
AIRWAY/ET, VENTILATOR
IVF FOR HYPOTENSION
DOPAMINE FOR HYPOTENSION
FLUMAZENIL FOR BENZODIAZEPINE
NO ANTIDOTE TO ETHANOL,BARBITURATES

ETHYLENE GLYCOL & METHANOL
ALCOHOLS
TOXIC ORGANIC ACIDS
S/S
CNS DEPRESSION DRUNK
TOXIC BY PRODUCT
FORMIC ACID FROM METHANOL
HIPPURIC,OXALIC,GLYCOLIC ACIDS FROM ETHYLENE GLYCOL
CAUSE SEVERE METABOLIC ACIDOSIS & COMA
BLINDNESS IN FORMIC ACID
RENAL FAILURE IN OXALIC & GLYCOLIC
TX ANTIDOTE
FORME PIZOLE
A COMPETETIVE DRUG
CAN BLOCK THE TOXIC PRODUCTS BY INHIBITING THE ENZYME ALCOHOL DEHYDROGENESE
ETHANOL CAN BE AN ANTIDOTE BUT IN ITSELF CAN ALSO BE TOXIC
IRON & OTHER METALS

CONTAINED IN MANY PRENATAL & MULTIVITAMIN

AS FEW AS 10 TAB CAN BE LETHAL TO A CHILD
OTHER METAL LEAD MERCURY, ARSENIC
DISCUSSED IN ANOTHER CHAPTER
OPIOIDS

OPIUM, MORPHINE, HEROIN, MEPERIDINE, METHADONE- COMMON DRUGS

ABUSE

DISCUSSED IN ANOTHER CHAPTER

 RATTLESNAKE ENVENOMATION/POISONING
BITES ARE RARELY FATAL
20% OF CASES NON FATAL
60% MORBIDITY DUE TO DESTRUCTIVE DIGESTIVE ENZYMES CAUSING SEVERE PAIN,
SWELLING BLUISING, HEMORRHAGIC BLEB

SYSTEMIC EFFECTS
NAUSEA,VOMITING, MUSCLE FASCICULATION, TINGLING SENSATION, METALLIC TASTE,
SHOCK, COAGULOPATHY, PROLONGED CLOTTING TIME, LOWER PLATELET COUNT

FIELD REMEDIES LIKE INCISION, SUCTION TOURNIQUE, ICEPACK ARE ACTUALLY MORE
DAMAGING THAN USEFUL

LIMIT MOVEMENT IS MORE HELPFUL TO DELAY VENOM ABSORPTION

TX
ANTIVENUM INJECTION
THEOPHYLLINE
THOUGH BETA AGONIST INHALANTS ARE MORE POPULAR,
THEOPHYLLINE TABLET ARE STILL BEING USED

20-30 TABLETS INGESTION CAN BE FATAL

BLOOD LEVEL CAN INCREASE DUE TO DRUG INTERACTION W/
CIMETIDINE
CIPROFLOXACIN
ERYTHROMYCIN
THEOPHYLLINE
S/S DUE TO BETA 2 ADRENERGIC ACTIVATION
TACHYCARDIA
TREMOR
VOMITING
HYPERTENSION
HYPOKALEMIA
HYPERGLYCEMIA
ARRYTHMIA
SEIZURE
THEOPHYLLINE
TX
BETA BLOCKER-PROPANOLOL,ESMOLOL
GIT DECONTAMINATION
ACTIVATED CHARCOAL
WHOLE BOWEL IRRIGATION
PHENOBARBITAL PREFFERED OVER PHENYTOIN FOR SEIZURE
HEMODIALYSIS

END