Date post: | 08-Mar-2016 |
Category: |
Documents |
Upload: | elen-mustika |
View: | 10 times |
Download: | 0 times |
of 11
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 1
Toxicity of Alcohols and Toxicity of Alcohols and DerivatesDerivates
Joseph I. Joseph I. SigitSigit
PharmacologyPharmacology--Clinical PharmacyClinical Pharmacy
School of Pharmacy ITBSchool of Pharmacy ITB
11Kuliah Toksikologi Klinik tahun 2013
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
IntroductionIntroduction
AlkoholAlkohol yang yang seringsering digunakandigunakan etanoletanol, , metanolmetanol, , isopropanolisopropanol
PrinsipnyaPrinsipnya semakinsemakin panjangpanjang ToksikToksik
KekecualianKekecualian metanolmetanol ToksikToksik
Glycols Glycols cirinyacirinya rasanyarasanya manismanis
DigunakanDigunakan dlmdlm industriindustri obatobat//makananmakanan
22Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
EtanolEtanol
PenggunaanPenggunaan cukupcukup luasluas
MerupakanMerupakan salahsalah satusatu obatobat tertuatertua
EtanolEtanol clear, colorless liquid, clear, colorless liquid, baubau khaskhas
MerupakanMerupakan CNS CNS depresandepresan
EtanolEtanol digunakandigunakan luasluas, , baikbaik sebagaisebagai obatobat, , minumanminuman maupunmaupun pembawapembawa//pelarutpelarutobatobat//makananmakanan
Kadar Kadar alkoholalkohol dalamdalam darahdarah maksimummaksimum dicapaidicapai3030--90 90 menitmenit..
33Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Ethyl AlcoholEthyl Alcohol
CH
H
H
O
H
C
H
H
44Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 2
Dari Dari manamana EtanolEtanol ??
55
Etanol
Fermentasi Sintesis
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB 66
Fermentasi
Biasa digunakan untukmakanan/minuman
Dibuat skala rumahtangga atau industri
Spesies ragi tertentu(misalnyaSaccharomycescerevisiae) mencernagula dan menghasilkanetanol dan karbondioksida karbon dioksida
C6H12O6 2 CH3CH2OH + 2 CO2
Sintesis
Tidak ditujukan untukkonsumsi
Ditujukan untuk bahan bakaratau keperluan pelarut kimialain
Dibuat dalam skala industri
dibuat dari senyawapetrokimia, utamanya adalahmelalui hidrasi etilena, dengan katalis asam fosfat
C2H4(g) + H2O(g) CH3CH2OH(l).
C2H4 + H2SO4 CH3CH2SO4H, selanjutnya reaksi hidrolisis CH3CH2SO4H + H2O CH3CH2OH + H2SO4
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
77Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
C
i
r
r
h
o
s
i
s
d
e
a
t
h
s
/
1
0
0
,
0
0
0
10
20
30
Per capita alcohol consumption liters/yr
10 155
US
Norway
Japan
Sweden
Italy
Austria
France
Switzerland
Luxembourg
Canada
Belgium
Germany
Spain
Portugal
EireNZ
Netherlands
AustraliaUK
Finland
Transnational alcohol consumption & cirrhosis
88Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 3
3 3 golongangolongan minumanminuman berakoholberakohol
GolonganGolongan A; A; kadarkadar etanoletanol 1%1%--5% (5% (birbir))
GolonganGolongan B; B; kadarkadar etanoletanol 5%5%--20% 20% ((minumanminuman angguranggur/wine)/wine)
GolonganGolongan C; C; kadarkadar etanoletanol 20%20%--45% 45% (Whiskey, (Whiskey, VodcaVodca, TKW, Manson House, , TKW, Manson House, JohnyJohny Walker)Walker)
99Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
MasalahMasalah AlkoholismAlkoholism
1010
Screening untuk alcohol consumption pada health
care settings adalah < 50%
-- inaccurate diagnoses
-- inappropriate treatment
-- drug interactions
-- potential surgical complications
-- unexpected withdrawal
-- lost opportunities for prevention
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Mechanism of Ethanol ToxicityMechanism of Ethanol Toxicity
Exact mechanism Exact mechanism not completely not completely understood understood CNSCNS
CNS effect CNS effect sebanding dengan Blood sebanding dengan Blood ConcentrationConcentration
Selain mempengaruhi fisiologi CNS juga Selain mempengaruhi fisiologi CNS juga mempengaruhi behaviormempengaruhi behavior
1111Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Range Toxicity of EthanolRange Toxicity of Ethanol
1212Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 4
1313
Standard drink chart (US)[
AlcoholAmount (ml)
Amount (fl oz)
Serving size
Alcohol (% by
vol.)
Alcohol
80 proof liquor
44 1.5 One shot 400.6 US fl oz (18 ml)
Beer 355 12 One can 50.6 US fl oz (18 ml)
Table wine
148 5 One glass 120.6 US fl oz (18 ml
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB 1414
MaleFemale
Approximate blood alcohol percentage (by vol.)One drink has 0.5 US fl oz (15 ml) alcohol by volume
Drinks
Body weight
40 kg 45 kg 55 kg 64 kg 73 kg 82 kg 91 kg 100 kg 109 kg
90 lb 100 lb 120 lb 140 lb 160 lb 180 lb 200 lb 220 lb 240 lb
10.05
0.040.05
0.030.04
0.030.03
0.020.03
0.020.03
0.020.02
0.020.02
0.020.02
20.10
0.080.09
0.060.08
0.050.07
0.050.06
0.040.05
0.040.05
0.030.04
0.030.04
30.15
0.110.14
0.090.11
0.080.10
0.070.09
0.060.08
0.060.07
0.050.06
0.050.06
40.20
0.150.18
0.120.15
0.110.13
0.090.11
0.080.10
0.080.09
0.070.08
0.060.08
50.25
0.190.23
0.160.19
0.130.16
0.120.14
0.110.13
0.090.11
0.090.10
0.080.09
60.30
0.230.27
0.190.23
0.160.19
0.140.17
0.130.15
0.110.14
0.100.12
0.090.11
70.35
0.260.32
0.220.27
0.190.23
0.160.20
0.150.18
0.130.16
0.120.14
0.110.13
80.40
0.300.36
0.250.30
0.210.26
0.190.23
0.170.20
0.150.18
0.140.17
0.130.15
90.45
0.340.41
0.280.34
0.240.29
0.210.26
0.190.23
0.170.20
0.150.19
0.140.17
100.51
0.380.45
0.310.38
0.270.32
0.230.28
0.210.25
0.190.23
0.170.21
0.160.19
Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Characteristic of Ethanol Acute Characteristic of Ethanol Acute ToxicityToxicity
NapasNapas berbauberbau alkoholalkohol
DehidrasiDehidrasi, , hipotermiahipotermia, dry skin, dry skin
RespirasiRespirasi menurunmenurun diikutidiikuti dengandenganpeningkatanpeningkatan heart rateheart rate
DalamDalam jumlahjumlah besarbesar dapatdapat menjadimenjadi komakoma / / kematiankematian
PeningkatanPeningkatan ketoacidosisketoacidosis, , laktatlaktat, , piruvatpiruvatdandan asetonaseton darahdarah
1515Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Management of Ethanol ToxicityManagement of Ethanol Toxicity
KeracunanKeracunan etanoletanol dapatdapat ditanggulangiditanggulangidengandengan good supportive therapygood supportive therapy
PentingPenting kontrolkontrol respirasirespirasi
Kadar Kadar gulagula darahdarah harusharus dimonitordimonitor
PadaPada keracunankeracunan etanoletanol defisiensidefisiensi nutrisinutrisi dilakukandilakukan perbaikanperbaikan status status nutrisinutrisi
KeracunanKeracunan dosisdosis tinggitinggi hemodialisishemodialisis
1616Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 5
EfekEfek jangkajangka panjangpanjang EtanolEtanol
1717Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Normal Alcoholic
Jernigan & Ostergaard, 1995 - AHRW
Magnetic Resonance Images
1818Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Fetal Alkohol Syndrome Fetal Alkohol Syndrome
Kemungkinan terjadi pada bayi 3:1000 , Kemungkinan terjadi pada bayi 3:1000 , jika ibu mengkonsumsi alkoholjika ibu mengkonsumsi alkohol
TandaTanda--tanda :tanda :
Gangguan SSPGangguan SSP
Abnormalitas kraniofasialAbnormalitas kraniofasial
Defisiensi mentalDefisiensi mental
BB BB (3 ml alkohol / hari)(3 ml alkohol / hari)
Kematian (75 Kematian (75 90 90 ml/hari)ml/hari)1919 Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
FAS ChildFAS Child
2020Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 6
2121Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
MethanolMethanol
AlkoholAlkohol dengandengan strukturstruktur paling paling sederhanasederhana
DigunakanDigunakan dalamdalam industriindustri dandan sebagaisebagaipelarutpelarut/ / pembawapembawa dalamdalam thinner cat, thinner cat, spiritusspiritus dlldll
KejadianKejadian keracunankeracunan terpaparterpapar lewatlewatinhalasiinhalasi dandan kulitkulit ((sedikitsedikit oral)oral)
KeracunanKeracunan metanolmetanol mortality & mortality & morbidity morbidity
2222Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
2323Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kejadian keracunan Kejadian keracunan sebagian besar sebagian besar karena kecelakaan karena kecelakaan krn metanol sulit krn metanol sulit dibedakan dengan etanoldibedakan dengan etanol
Letal dose Letal dose 3030--240 ml240 ml
Pada manusia dalam bobot Pada manusia dalam bobot 1 g / kg 1 g / kg
2424Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 7
Mechanism of Methanol ToxicityMechanism of Methanol Toxicity
Akibat keracunan metanol Akibat keracunan metanol metabolic metabolic acidosis, gangguan penglihatan dan acidosis, gangguan penglihatan dan kebutaan yg permanenkebutaan yg permanen
Ingestion 4 ml Ingestion 4 ml menyebabkan kebutaanmenyebabkan kebutaan
Metbolic acidosis Metbolic acidosis kaitannya dengan kaitannya dengan pembentukkan laktan dan formiat dari pembentukkan laktan dan formiat dari metanolmetanol
2525Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Characteristic of Methanol ToxicityCharacteristic of Methanol Toxicity
KeparahanKeparahan tergantungtergantung jumlahjumlah paparanpaparan
GangguanGangguan padapada CNS CNS menjadimenjadi gejalagejala awalawalkeracunankeracunan metanolmetanol (euphoria, (euphoria, lemahlemah otototot, , convulsiconvulsi sampaisampai coma)coma)
Ocular toxicity Ocular toxicity didahuluididahului dgndgnpenglihatanpenglihatan kaburkabur, , visual acuity, retinal visual acuity, retinal edema, edema, reflex reflex matamata dandan kebutaankebutaan
KeracunanKeracunan metanolmetanol RespirasiRespirasi & HR & HR
2626Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
2727Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Management of Methanol ToxicityManagement of Methanol Toxicity
SetelahSetelah paparanpaparan akutakut segerasegera emesis emesis atauatau GI GI lavagelavage
PenangananPenanganan metabolic acidosis metabolic acidosis infusinfusNa Na bicarbonatbicarbonat pH pH
EtanolEtanol spesificspesific antidotantidot for for metanolmetanol
PelaksanaanPelaksanaan hemodialisishemodialisis dapatdapatmempercepatmempercepat eliminasieliminasi
2828Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 8
IsopropanolIsopropanol
digunakandigunakan sebagaisebagai pembawapembawa untukuntukdisinfectantdisinfectant
Fatal dose Fatal dose 11--8 ounce or 20 ml8 ounce or 20 ml
CiriCiri keracunankeracunan respirasirespirasi , , hipotensihipotensi, , mild acidosis, mild acidosis, acetonemiaacetonemia & & acetonuriaacetonuria..
Treatment Treatment GI decontamination, GI decontamination, maintain BP, maintain BP, menanganimenangani gangguangangguanelektrolitelektrolit / metabolic acidosis/ metabolic acidosis
2929Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Ethylene GlycolEthylene Glycol
digunakandigunakan dalamdalam industriindustri sbgsbg cairancairanhidrolikhidrolik, heat exchangers , heat exchangers jugajuga digunakandigunakansbgsbg komponenkomponen kosmetikkosmetik, , tintatinta dandan bahanbahanfarmasifarmasi lain.lain.
Paling Paling toksiktoksik dietlenedietlene glycol, yang glycol, yang tdktdktoksiktoksik propilenglycolpropilenglycol
DiethyleneDiethylene glycol glycol pernahpernah menyebabkanmenyebabkankematiankematian
Toxic dose ethylene glycol Toxic dose ethylene glycol 100 ml100 ml
3030Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Mechanism of Ethylene Glycol Mechanism of Ethylene Glycol ToxicityToxicity
3131Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Characteristics of Ethylene Glycol Characteristics of Ethylene Glycol ToxicityToxicity
3232Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 9
Management of ToxicityManagement of Toxicity
Principle goal Principle goal to correct metabolic to correct metabolic acidosis with Na bicarbonatacidosis with Na bicarbonat
Elimination Elimination hemodialisishemodialisis
3333Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
AsetonAseton
AsetonAseton adalahadalah suatusuatu bentukbentuk ketonketon daridarietanoletanol
KarakteristiknyaKarakteristiknya : : jernihjernih, , berbauberbau khaskhas, , mudahmudah terbakarterbakar
PenggunaanPenggunaan : : pelarutpelarut organikorganik, , pembersihpembersihkuku, kuku, pelarutpelarut lemlem, , pembersihpembersih alatalat rumahrumahtanggatangga, thinner, , thinner, bahanbahan dasardasar polimerpolimer dlldll. .
3434Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
EfekEfek toksiktoksik ::
RendahRendah
PadaPada pemaparanpemaparan tinggitinggi padapada matamata atauatau kulitkulitdapatdapat iritasiiritasi
ResikoResiko gangguangangguan pernapasanpernapasan
SepertiSeperti etanoletanol : : efekefek depresidepresi SSPSSP
3535Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB 3636Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 10
FormaldehydeFormaldehyde
KeracunanKeracunan kecelakaankecelakaan krnkrn pelepasanpelepasanformaldehidformaldehid keke udaraudara ingestioningestion
EfekEfek urticariaurticaria, , karsinogenkarsinogen & mutagen& mutagen
YgYg seringsering digunakandigunakan formalin formalin pengawetpengawet, , antiseptikantiseptik, , desinfektandesinfektan..
MerupakanMerupakan zatzat kimiakimia ygyg reaktifreaktif
Fatal dose Fatal dose 6060--90 ml 90 ml
3737Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
JikaJika terpaparterpapar Tissue destruction & Tissue destruction & metabolic acidosismetabolic acidosis
FormaldehidFormaldehid mengiritasimengiritasi matamata, , respirasirespirasi, GI tract., GI tract.
GejalaGejala : : keluarkeluar air air matamata, , rhinitaisrhinitais, , gangguangangguan matamata, , batukbatuk & & sesaksesak..
CNS CNS sakitsakit kepalakepala, , anoreksiaanoreksia, insomnia, insomnia
Metabolic acidosis, Metabolic acidosis, dikikutidikikuti dgndgn gangguangangguancardiovascular cardiovascular dandan kesadarankesadaran
KematianKematian disebabkandisebabkan karenakarena circulatory circulatory collapse collapse
3838Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Treatment :Treatment :
maintain BP, correction acidmaintain BP, correction acid--base base imbalance.imbalance.
Pemberian NA bikarbonat utk metabolic Pemberian NA bikarbonat utk metabolic acidosis, simpatomimetik utk acidosis, simpatomimetik utk simtomsimtom
GI Dilution & dialisis GI Dilution & dialisis
3939Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB 4040Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
Kuliah Toksikologi Klinik thn 2013 10/21/2013
Copyright JI SIGIT , School of Pharmacy ITB 11
4141Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB 4242Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB
4343Copyright JI SIGIT School of Pharmacy ITB Copyright JI SIGIT School of Pharmacy ITB