General ToxicologyGeneral Toxicology

NMT11

1 General toxicology

General ToxicologyGeneral ToxicologyGeneral ToxicologyGeneral Toxicology

1111)))) Classification of Poisons?Classification of Poisons?Classification of Poisons?Classification of Poisons? 2222)))) Factors affecting action?Factors affecting action?Factors affecting action?Factors affecting action? 3333)))) Fate.Fate.Fate.Fate. 4444)))) Diagnosis.Diagnosis.Diagnosis.Diagnosis. 5555)))) Treatment.Treatment.Treatment.Treatment.

ClassificationClassificationClassificationClassification

� Origin (Source)

� Onset (Mode of exposure)

� Organ

� One Site or > 1 site (Site of action)

Origin & SourceOrigin & SourceOrigin & SourceOrigin & Source::::

1111.... PlantsPlantsPlantsPlants 2222.... MineralsMineralsMineralsMinerals (Metals)(Metals)(Metals)(Metals)

3333.... AnimalAnimalAnimalAnimal 4444.... SyntheticSyntheticSyntheticSynthetic

1. Opium

Morphine

Heroine

2. Atropine

3. Strychnine

4. Digitalis

-Lead

-Mercury

-Arsenic

-Antimony

-Ph

-Fe

-Snake.

-Scorpion.

-Sea

Marine animal’s venom

A �Analgesics

B � Barbiturates

(Hypnotics)

C� Cyclic

Antidepressant

(Psychotropics)

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Organ Specificity:Organ Specificity:Organ Specificity:Organ Specificity:

1- Arsenic Liver (Hepatotoxic).

, Paracetamol

2- Digitalis Heart

Cardiotoxic.

3- Aconite Heart. �� ا��

4- Mercury Micturation (Nephrotoxic).

, Phenol (Kidney)

5- Neuro Toxins Convulsants & Depressants.

6- Ocular Toxins Methanol & Nicotine.

7- Dermal Toxins Corrosives & AS & Hg.

8- Respiratory Toxins Kerosene & Fumes.

Site Site Site Site of Actionof Actionof Actionof Action: : : :

Local� Immediate & Far � Act after Mixed Severe Destructive Absorbtion (Double Action) effect Strong Remote Local irritant Action & systemic effect

Mild - Flowers � e.g. Atropine. - Metals

Corrosives - Factories� Synthetic Drugs -Mild Corrosives

Oxalic acid Phenol

Acids Alkalis (Carbolic acid)

Mode Mode Mode Mode ofofofof Exposure:Exposure:Exposure:Exposure: 1- Acute � Single High Dose of the Poison.

2- Chronic � Repeated Small Dose of the Poison.

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Factors Factors Factors Factors aaaaffecting ffecting ffecting ffecting action of the paction of the paction of the paction of the poisonoisonoisonoison

PoisonPoisonPoisonPoison

3333 S S S S Patient Patient Patient Patient 5555 PharmaPharmaPharmaPharma

1- Quantity (Dose)

2- Quality (Form). 3Qs

3- Quickest

(Route Of Administration)

1- Quantity (Dose)

� X Severity

� Vomiting � less effect.

� Fatal Dose � Smallest

amount� Death

2- Quality (Form)

� Gas > Liquid > Solid

Powders > Lumps

� Solubility

� Concentration

3- Quickest route

(route of administration)

IV > Inh. > IM > s.c (skin) >

through mucous membrane >

intradermal (skin).

“3S”

1- Small Or Old (Age)

Children can tolerate Atropine.

2- Strong Or Not (Healthy)

Liver Kidney Detoxification &

Execretion

Toxicity

3- Stomach

(MCQ) Empty Or Full.

ا�آ� ا�ا��

)�� ( )��( Fatty Meals

Rapid Absorption

e.g.

Achlorohydria + Ph +Mercury -As -Alcohol

e.g.: HCL

KCN HCN

Non Toxic Toxic

Toxicity Of KCN

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”arma5 ph“

1)Allergy small non-toxic

abnormal exaggerated

response

irinspA

enicillin Puffer S spirinA

y crasdiosyn2) I

Crazy

response

e.g. Morphine (Abnormal response

due to genetic factor)

3) Tolerance (in addicts)

Toxicity

Dose Produce same effect

4) Interaction

i) Synergism� � ص�آ�س و ا

Barbiturates + Ethanol

ii) Antagonism→رد��ي وا� ا

Ethanol + methanol

5) Cummulation

E.g. Digitalis

Lead

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5 General Toxicology

Fate of the poison:Fate of the poison:Fate of the poison:Fate of the poison: ADMEADMEADMEADME

AAAAbsorption DDDDistribution MMMMetabolism EEEExcretion

1- Ingested

a)GIT

Stomach

Circulation

b) Vomiting

c) Stool

____

later

• Liver

Non-toxic

Toxic

Paracetamol

Parathion

Methanol

(1) Kidney:

- Urine

- Saliva

- Sweat

(2) GIT:

� Stomach

- Morphine

- Antimony

� Descending colon

- Arsenic

� Caecum

- Mercury

(3) Bile to Duodenum:

- Barbiturates

- Digitalis

- TCA

“Entero-hepatic

circulation”

2- Inhaled

Lung

Circulation

3- Injected

IV IM Skin

Muscle skin

Circulation

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SchemeSchemeSchemeScheme

1111.... Condition of poisoningCondition of poisoningCondition of poisoningCondition of poisoning

Accidental Suicidal Homicidal

Children Anything

Workers except stuff with Therapeutic characteristic smell Addicts

ن �رع ا�� ا��ب ا��ت � ا��م Cyanide Alcohol Opium Nicotine - Organo - Phenol

(bitter (bars) (perfumes) (Cigarettes) phosphorous

almond - Kerosene ز��

oil)

2222.... Fatal Fatal Fatal Fatal dosedosedosedose

3333.... Fatal periodFatal periodFatal periodFatal period

4444.... ActionActionActionAction

5555.... Clinical pictureClinical pictureClinical pictureClinical picture

6666.... TTTTtttttttt

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7777.... PostPostPostPost----mortum picturemortum picturemortum picturemortum picture

±±±± 8888.... Source [classification]Source [classification]Source [classification]Source [classification] ±±±± 9999....Kinetics [ADME]Kinetics [ADME]Kinetics [ADME]Kinetics [ADME] 10101010.... Diagnosis Diagnosis Diagnosis Diagnosis (((([investigation[investigation[investigation[investigation) ) ) ) Talk about (1) Circumstantial evidence

(2) C/P

(3) PM picture

(4) Investigations (living and dead)

11. D.D.

Investigations

Living ارج�Dead ا �� ا

(1) Blood

(2) Urine

(3) stool

(4) Vomitus

+ (5) Hair/nail

(1)Stomach

(2)Intestine

(3)Blood

(4)Kidney

(5)Liver

(6) Brain

(7) H / N / B / T Metals ال ��

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General toxicologGeneral toxicologGeneral toxicologGeneral toxicologyyyy

6) CNS “3Cs”

• Coma

• Cyanosis

• Central asphyxia

ActionActionActionAction Clinical pictureClinical pictureClinical pictureClinical picture 1) GIT • Nausea

• Vomiting

• Colic

• Diarrhea

2) Heart • Pulse Arrest

• Blood pressure

3) Sensory nerve

then

• Tingling

• Numbness

• Hypersensation then

• Hyperthesia Anaesethea

•

4) Motor nerve(N-M junction)

then

• Twitches

• Tremors

• Fasciculations then

• Convulsions Paralysis

5) CNS C H A I R

Restlessness

Irritability

Anxiety

Hypertension

Convulsions

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7) Renal failure

Oliguria + A B C then

Anuria

Albumin Blood Casts

8) Hepatic failure

1- Pain + tenderness in Rt

hypochondrium.

2- Jaundice + Bleeding

3- Bilirubin + SGOT + SGPT

4- Albumin + Prothrombin time

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SUS

SES

PostPostPostPost----Mortem PictureMortem PictureMortem PictureMortem Picture B P

P

“SUS” Stomach

Smell Ulcer Seeds or tablets

+

“SES” Skin

Smell Eschars Site of injection (needle)

+ Edema

+ “B”rain If there is CNS affection

Congestion

+

Internal

+ “P”assages Respiratory Death from asphyxia

External signs of asphyxia (from forensic)

+

“P”ost-Mortem changes Hypostasis

(Look at the colour change)

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Treatment:Treatment:Treatment:Treatment:

1111---- Prevention of further exposure.Prevention of further exposure.Prevention of further exposure.Prevention of further exposure. 2222---- Supportive or symptomatic treatment.Supportive or symptomatic treatment.Supportive or symptomatic treatment.Supportive or symptomatic treatment.

3333---- Elimination of poison from GIT.Elimination of poison from GIT.Elimination of poison from GIT.Elimination of poison from GIT. 4444---- Destruction of poisonDestruction of poisonDestruction of poisonDestruction of poison in GIT &in GIT &in GIT &in GIT & absorption (local antidotes).absorption (local antidotes).absorption (local antidotes).absorption (local antidotes).

5555---- Excretion of the absorbed poison.Excretion of the absorbed poison.Excretion of the absorbed poison.Excretion of the absorbed poison. 6666---- Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).

TreatmentTreatmentTreatmentTreatment

1111---- Prevention of further exposure:Prevention of further exposure:Prevention of further exposure:Prevention of further exposure: Masks, gloves • Factory (Industrial exposure) Periodic-Medical Examination Removal of patients • Clinic i.e. Hospitalization Addicts

Suicidal & Homicidal

• House Accidental poisoning among children

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2222---- Supportive & Symptomatic treatment:Supportive & Symptomatic treatment:Supportive & Symptomatic treatment:Supportive & Symptomatic treatment: • Respiratory depression.

• CVS.

• Coma.

3333---- Elimination of poison from Elimination of poison from Elimination of poison from Elimination of poison from GIT:GIT:GIT:GIT: (ECG)

Emesis Cathartics Gastric lavage

4444---- Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption: (Local antidotes)

5555---- Excretion of the absorbed poison:Excretion of the absorbed poison:Excretion of the absorbed poison:Excretion of the absorbed poison: Blood Diuresis + Dialysis + Haemoperfusion

6666----Counteraction of the absorbed poison:Counteraction of the absorbed poison:Counteraction of the absorbed poison:Counteraction of the absorbed poison: Blood Physiological antidote

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3333---- Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)

1111))))Emetics:Emetics:Emetics:Emetics: aaaa---- Def:Def:Def:Def: Vomiting (3hrs) bbbb---- Types:Types:Types:Types: A-Mechanical B-Chemical

Gag Reflex Local Central Mixed (Stomach) (C.T.Z)

a- NaCl b- Mustard Powder

(obsolete cause death)

Apomorphine

• Hypernatreuria Contra CNS • Convulsions 6mg → Adults • Hypertension 1-2 mg→ children

Syrup of Epicac

1-Source: Plant (safe) 2-A.P: Emetine + Cephaline

3-Dose: 30ml/30 min 15ml/30min for children 4-Action

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3333---- ContraindicationsContraindicationsContraindicationsContraindications::::

Poisons Patients

1- Corrosives & Kerosene fear of fear of chemical perforation pneumonitis

Because it is volatile

Stomach Esophagus

Where vomitus is going back through the esophagous to the mouth.

1- Comatosed Asphyxia Aspiration pneumonia 2- Convulsions: Vomiting can stimulate

convulsions. 3- Cardiac. 4- GIT Esophageal varices

Recent gastric operation 5- Cough reflex e.g. old 6- Pregnant.

7- Elderly patients.

2222---- Cathartics: Cathartics: Cathartics: Cathartics: “Purgatives”“Purgatives”“Purgatives”“Purgatives”

aaaa---- ActionActionActionAction: Faster passage of poison through GIT absorption bbbb---- Types Types Types Types (Osmotic) �� ز�� Castor oil MgSO4 (30 g in 300 ml H2O & 250 mg/kg)

(Osmotic Purgative) 10% solution in children Avoid in fat soluble poison

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3- Gastric lavage: aaaa---- DefDefDefDef. Evacuation / W bbbb---- IndicationIndicationIndicationIndication 3 hrs post

Most effective

Easily absorbed drugs • Hysterical • Comatosed • Uncooperative c- Procedure (Refere to book) 1- Nurse Remove denture, give gag

plaster 2- Patient 3- Doctor

___________________________________

Ensure Patient

___________________

Close with forceps

to avoid any residues to get aspired

General Toxicology

Evacuation / Washing / Tube

s post-ingestion & emesis failed

Exception: can be done after 12 hrs in 1) Secreted e.g. Morphine+Antimony

Most effective 2) Slow Barbiturate 3) Sticky Aspirin

• Hysterical • Comatosed • Uncooperative

efere to book) H2O, Head (lt) to stop stomach movments

Nurse Remove denture, give gag

Tube 50 cm

1.5 cmplaster paraffin 1.5m

Swallow Introduction

___________________________________ 1- Cough

Ensure Patient 2- Dyspnea 3- Cyanosed 1- Ear

Doctor 2- Hands 3- Eye

_______________________________________ 1- Funnel

H2O to avoid any residues 3- Forceps Closes the tube during

to get aspired avoid aspiration of any residue of in into air passages

hrs in: ecreted e.g. Morphine+Antimony

Barbiturate

to stop stomach movments

cm

___________________________________

Dyspnea

____________________

Closes the tube during withdrawal to avoid aspiration of any residue of in the tube

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dddd---- ContraindicationContraindicationContraindicationContraindication:::: I- Absolute CI: 1- Corrosives Perforation by tube because friable tissue

II- Relative CI : 2- Kerosene (volatile) insert cuffed endotracheal tube 3- Coma due to fear from aspiration pneumonia 4- Convulsions Inhalation anesthesia (Ether) to avoid ↑ freq. & severity of convulsions

eeee---- Complications (Hazards)Complications (Hazards)Complications (Hazards)Complications (Hazards)::::

1- Oesophagus Perforation & bleeding

2- Trachea Asphyxia

3- Lung Aspiration pneumonia

4- Heart Cardiac arrest

5- Psychic trauma

6- Gaging

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3333---- Destruction of the poison in GITDestruction of the poison in GITDestruction of the poison in GITDestruction of the poison in GIT::::

Local antidotesLocal antidotesLocal antidotesLocal antidotes

A – PHISCO-MECHANICAL: 1-Demulcent e.g. olive oil –egg white –milk � corrosives 2-Dissolvents e.g. 10% alcohol or glycerine �phenol (followed by rapid gastric lavage ) 3- Cotton 4-Charcoal (adsorbent)

aaaa----originoriginoriginorigin : plant bbbb----usesusesusesuses:::: plants metal

enterohepatic *rew: bile to duodenum cccc----dosedosedosedose: 50 gm / 500 ml H2O every 4 hrs

dddd----precautions :precautions :precautions :precautions : do not give it before syrup of epicac � it will be adsorbed

eeee---- action :action :action :action : absorb the poison and it is not absorbed � raw charcoal

B-CHEMICAL:

By Chemical Reaction

1111---- NNNNeutralization eutralization eutralization eutralization Acid + weak alkali exothermic Obsolete � because react. Alkalis + weak acid co2 production

2D 2C

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2222---- oxidationoxidationoxidationoxidation H2O2 or KMNO4

-Plants O2 �� -Organophosphorus O2 و� -Cyanide �� و را

3333---- precipitationsprecipitationsprecipitationsprecipitations �� ي��

a) Tannic acid ا��ح

1) Plants ) ا�� ( 2) Antimony ) ��) ا�! ��

b) Fe (OH)3 "��ا� Arsenic (Napolion)

c) MgSO4 Carbolic acid

4444 ) ) ) ) RRRReduction eduction eduction eduction

a) Ferric vitamin C ferrous Citrus fruit after meal

b) Mercuric Na formaldehyde mercurous . sulfoxylate

4444---- ELIMINATION OF POISON : ELIMINATION OF POISON : ELIMINATION OF POISON : ELIMINATION OF POISON :

1 – LIVER Detoxification ( Biotransformation ) 2- LUNGS Resp. stimulant 3- GIT Purgative 4- KIDNEY Diuresis

5- BLOOD Blood

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KIDNEYKIDNEYKIDNEYKIDNEY Types

Diuresis Contraindication

TypesTypesTypesTypes

1)Saline Diuresis #$%

Na thio-sulphate %)�دن

Heavy Metal Poisoning

2)Osmotic Diuresis

Mannitol 10% 10gm IV infusion

3) Forced Diuresis

1111))))PrinciplePrinciplePrinciplePrinciple 2222))))TypesTypesTypesTypes

3333))))SubstSubstSubstSubstanceanceanceance

4444))))PoisonPoisonPoisonPoison 5555))))PrecautionsPrecautionsPrecautionsPrecautions

Change PH of urine Ionization ↓Absorption

↑Excretion (Ion trap Phenomena)

1)Alkaline (PH>7)

*NaHco3 *Na lactate

Acid *Salicylic acid *Babituric Acid

Fluid balance & electrolyte balance should be monitored

2)Acid (PH 5)

*NH4Cl *Vit C (Ascoribic Acid)

*Amphetamine *Quinine

Contraindications of Contraindications of Contraindications of Contraindications of renal diuresis:renal diuresis:renal diuresis:renal diuresis:---- 1) Poison +,-.

Not renal

2) Renal failure - /% +,-.

3) H2o Shock

4) K Heart Failur

BLOODBLOODBLOODBLOOD a)Dialysis

b)Haemoperfusion

c)Plasma phoresis

d)Exchange blood transfusion

e)Chelators

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IIII----DialysisDialysisDialysisDialysis ****IndicationIndicationIndicationIndication 1)x x Diuresis

2)Renal failure

3)Coma

****PrecautionPrecautionPrecautionPrecaution Dialysable drugs only!!

A) PeritonealA) PeritonealA) PeritonealA) Peritoneal

B) Haemo (Artificial B) Haemo (Artificial B) Haemo (Artificial B) Haemo (Artificial Kidney)Kidney)Kidney)Kidney)

*Procedure*Procedure*Procedure*Procedure

1) Evaluate bladder 2) Catheter

dialyisate fluid similar to plasma ѐ dextrose, hepraine ѐ procaine

3) 2 L after 1h 4) Syphonage

*Uses*Uses*Uses*Uses

ا��ت

Methanol & Ethylene

glycol

*Procedure*Procedure*Procedure*Procedure Blood + poison Peritoneal membrane cellophane

Blood - Poison *Disadvantages:*Disadvantages:*Disadvantages:*Disadvantages:

4 HIGH

“ Ineffective” 1)High ptn blood

2)High Vol of

Distribution

3)High Lipid Bulk,

passes the tissues

4)High Molecular

weight

1111) ) ) ) DDDDialysis ialysis ialysis ialysis :::: - Haemoperfusion → passage of anticoagulated blood via charcoal or resin

columns . severe intoxication

1) ) ) ) IIIIndicationndicationndicationndication high → barbiturates

hypothermia , hypotension , etc → coma

2) PPPProcedurerocedurerocedurerocedure → adsorbs the poison

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3) ) ) ) EEEEffective forffective forffective forffective for: : : : removal of lipid soluble & ptn bound poisons e.g. barbiturates , salicylates & meprobamates .

- Exchange bl. Transfusion → 1) xxx dialysis

→ 2) ↓ VD → highly conc. In blood

- Plasma pheresis → removal of the plasma ( vol. of distribution from the

blood replace it with another sub )

2222) ) ) ) chelators chelators chelators chelators : : : :

----Def.Def.Def.Def. → + metals → non – toxic comp. → soluble & ↓ urine

----Types :Types :Types :Types : 1) BAL

2) DMSA

(5) 3) EDTA

4) Penicillamine

5) Desferol

1111))))BALBALBALBAL → AAAAnti nti nti nti –––– llllewsite ewsite ewsite ewsite = ( = ( = ( = ( 2222 ---- 3333 Dimercaprol Dimercaprol Dimercaprol Dimercaprol ) ) ) ) ↓ BBBBritish ritish ritish ritish

2SH 3 Routes of admin Disadvantage

Uses : Uses : Uses : Uses :

Lead Mercury Arsenic Antimony Gold Bismuth

NMT 11


2SH

2222 Analogues Analogues Analogues Analogues ( DMSA & DMPS )

Routes of admin. :Routes of admin. :Routes of admin. :Routes of admin. : IM , eye drops & skin ointment

NEVER IV →→ embolism Hr days

Dose :Dose :Dose :Dose : 2.5 mg ⁄ kg 2.5mg/kg/6 2

2.5mg/kg/12 7 then Hr days

Disadvantages of BAL : Disadvantages of BAL : Disadvantages of BAL : Disadvantages of BAL : 1) plumbism ( pb ) : limited value in ttt as it chelates only lead in blood but not in bone & tissues .

2) pyrexia (anti-histaminics ) → antihistaminics given to avoid allergic reaction .

3) bean ( G-6-PD ↓↓↓ ) → haemolysis

4) BAL- Fe complex ( iron ) → more toxic than Fe

N.B. Answer for BAL + DMSAAnswer for BAL + DMSAAnswer for BAL + DMSAAnswer for BAL + DMSA

2222---- DMSA DDMSA DDMSA DDMSA Dimercaptoimercaptoimercaptoimercapto----succinic acid (succimer )succinic acid (succimer )succinic acid (succimer )succinic acid (succimer )

Less toxic analogue 10mg /kg/8 5 10 mg/ kg/ 12 2 Of BAL Hr day Hr weeks a) Plumbism : from bone, blood&tissues

b) Less toxic analogue of BAL Better than BALBetter than BALBetter than BALBetter than BAL C) G-6-PD DEF. : NO HAEMOLYSIS

d) Fe

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e) Orally : without chelating with essential menirals (Ca, Mg , Fe, Cu, Zn ) f) Lead : ALAD enz. ( A- aminolevulinic acid dehydrogenase ) EDTA like

3333---- DDDD----penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : source source source source ::::penicillin Dose :Dose :Dose :Dose : 1 capsule/6h/10 days (as Antib) -copper & zinc toxicity -chronic toxicity of lead & mercury -Contain 1 SH group ( mono-thiol )

4444---- DDDDesferol : (or desferoxamine ) esferol : (or desferoxamine ) esferol : (or desferoxamine ) esferol : (or desferoxamine ) - Fe toxicity - Acts on iron in storage areas ( ferritin & haemosidrin )

# # # # DoseDoseDoseDose des fer ol

"� 4hr د �� آ�ر� 2 4 1 2

2ampoules 1ampoule 4hrs twice

1st : 2 ampoules 2nd : 1ampoule every 4 hrs 2 times

still red (wine color ) normal→ stop ttt. means that he still has iron Continue ttt as before BUT don not exceed 12 ampoules / day = 6 gm / day Urine : normal → stop ttt

UrineUrineUrineUrine

NMT 11


5555---- EDTA : ( Ethymine EDTA : ( Ethymine EDTA : ( Ethymine EDTA : ( Ethymine –––– diamine tetraacetic acid )diamine tetraacetic acid )diamine tetraacetic acid )diamine tetraacetic acid )

Ca → ,�0 ا�$�

Lead→ ),67ل 34 %�ا �-(,�0 ا�!�ء اآ�-→ ,9وب 34 ا� /- Glucose Dose :Dose :Dose :Dose : 1 2 5-2 1gm Twice / day 5 days Stop ttt 2 days then continue (to give chance for pb )

TypesTypesTypesTypes 3 1) di-sodium EDTA (has Ca ) �lead toxicity

2) di-sodium EDTA (non- Ca ) � digitalis toxicity 3) di-cobalt EDTA ( kilocyanor ) � cyanide toxicity

1111---- DiDiDiDi---- sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) + Ca to spare body calcium , prevent chelation of Ca , prevent hypocalcaemia & tetany . -If you Chelate any metal that has greater affinity for EDTa than Ca

e.g this is the case for lead which can replace Ca in complex forming poorly dissociable chelate that is rapidly excreted in urine .

2222---- DiDiDiDi----sodium EDTA (Non sodium EDTA (Non sodium EDTA (Non sodium EDTA (Non –––– Ca ) Ca ) Ca ) Ca ) Given in digitalis toxicity because ppl with digitalis toxicity has hypercalcaemia

3333---- DiDiDiDi----sodium EDTAsodium EDTAsodium EDTAsodium EDTA::::

In cyanide toxicity

NMT 11


5555---- CCCCounteraction of the absorbed poisonounteraction of the absorbed poisonounteraction of the absorbed poisonounteraction of the absorbed poison:

**** physiological / systemic antidote **** physiological / systemic antidote **** physiological / systemic antidote **** physiological / systemic antidote

1) Chemical inactivator 2) Antagonistic antidote 3) Competitive antidote 4) Chelators ( as before ) + include it in answer

1111) ) ) ) CCCChemical inactivators hemical inactivators hemical inactivators hemical inactivators

e.g. N C B12

Na→Na thiosulfate → for metals→non toxic compounds Ca → oxalic acid → inactivation Ba→ Hydroxycobalamine + cyanide toxicity → vit B12 (cyanocobalamine )

2222) ) ) ) AAAAntagonistic antidote: ntagonistic antidote: ntagonistic antidote: ntagonistic antidote: Antagonise the pharmacological action of physiological mechanism . e.g.

Atropine Organophosphorus Mephenisine Strychnine (Muscle relaxant)

3333) ) ) ) CCCCompetitive ompetitive ompetitive ompetitive antidote:antidote:antidote:antidote: antidote → compete with the poison for the

receptor or compete with the receptor for poison

NMT 11


Examples : 3 M

a) Morphine: compete with the poison for receptors :

e.g. naloxone , nalorphine , levalorphine …. Compete with Morphine on the opiate receptor b) Metals : compete with the receptor for the poison e.g. BAL & Resp. enz.compete for the Metals c) Mobeedat ( organophosphorus ) : oximes compete with the receptor → choline esterase enz. For the organophosphorus → preventing its binding to the enz..

*********

SSSSupportive & symptomatic ttt :upportive & symptomatic ttt :upportive & symptomatic ttt :upportive & symptomatic ttt :

* S* S* S* Supportive ttt : upportive ttt : upportive ttt : upportive ttt : 1) Respiratory depression 2) CVS → shock or collapse 3) CNS → coma 4) Acute hepatic failure 5) Kidney failure

1111) ) ) ) RespiratoryRespiratoryRespiratoryRespiratory depression:depression:depression:depression: 3333AAAA

Air passages Suction tube ( remove secretions ,vomitus, FB ) Endotracheal tube Tracheostomy tube (in laryngeal obstruction & edema of

Epiglottis)

Air → Carbogen maintain respiration

95% O2- 5% CO2 ( stim. Respiration)

Artificial respiration

NMT 11


2222) ) ) ) CVSCVSCVSCVS → SHOCK OR COLLAPSE SHOCK OR COLLAPSE SHOCK OR COLLAPSE SHOCK OR COLLAPSE

1) elevate the leg with head downwards

2) vital signs affection : * Respiratory → ↓ → give O2

* Temp. → ↓ → ttt by warming

*B.P. → ↓ → dopamine / dobutamine → ↑ BP → plasma expanders e.g. glucose , manitol , …etc .

* Pulse → Digitalis → Defibrillator

→ Anti-arrythmic drugs

3333) ) ) ) CNSCNSCNSCNS � ComatozedComatozedComatozedComatozed

a) Change the posture ( avoid bed sores & avoid pneumonia) 2C

b) Catheterization (prevents urine retention & calculate amount of fluid coming out to balance fluid level)

c) Take care with respiratory affection (as before)

d) Care of cardiovascular (as before)

4444----KidneyKidneyKidneyKidney Dialysis & Haemoperfusion failureDialysis & Haemoperfusion failureDialysis & Haemoperfusion failureDialysis & Haemoperfusion failure

*R.F. Due to :*R.F. Due to :*R.F. Due to :*R.F. Due to :----

Direct Cause of R.FDirect Cause of R.FDirect Cause of R.FDirect Cause of R.F Indirect Cause of R.FIndirect Cause of R.FIndirect Cause of R.FIndirect Cause of R.F 1-Mercury → Mictureiton ↓Blood →Shock

2-Phosphorus ↓H2o dehydration or electrolyte imbalance

5555----Liver Failure:Liver Failure:Liver Failure:Liver Failure:---- Causes Causes Causes Causes a) Arsenic (Napolion)

b) Paracetamol

NMT 11


ttt: ttt: ttt: ttt: Special diet ↓ Protein ↑Glucose +Vitamins → Vit K + Electrolytes e.g. Ca-Gluconate -Glutathione Because ↓ albumin → No carrier for Ca

****Symptomatic ttt:Symptomatic ttt:Symptomatic ttt:Symptomatic ttt:----

1111)))) Cerebral EdemaCerebral EdemaCerebral EdemaCerebral Edema 2222)))) ConvulsionsConvulsionsConvulsionsConvulsions 3333)))) Pulmonary EdemaPulmonary EdemaPulmonary EdemaPulmonary Edema

1111----Cerebral EdemaCerebral EdemaCerebral EdemaCerebral Edema Osmotic Diuresis (By mannitol)

+ Cortisol (Add it to any symptomatic ttt of edema)

2222----Pulmonary edemaPulmonary edemaPulmonary edemaPulmonary edema Osmotic Diuresis

( Mannitol )+ Cortisone + Suction → Open passages by bronchodil.

+ O2 under pressure

3333----Convulsions:Convulsions:Convulsions:Convulsions:---- Strychnine Most common Cause ttt of convulsions ttt of Strychnine

NMT 11


Mephensin + Mg So4 (slow I.V)

S E M S E M S E M S E M Ether inhalation (Anaesthesia) ا;:$�6ي #$% Succinyl-Choline (Ms.relaxant) -IM → acts as Ms relaxant

-Oral →Acts as purgative 10mg (slow IV)

+ 2B (Any Convulsions) * Barium→ Diazepam “Valium” *Barbiturate

Date post:	28-Dec-2021
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