Poisoning
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Toxicology is the science dealing with poisons, their properties, effects, detection, and treatment of poisoning. The general principles of treatment are to stop the source of poisoning, limit absorption, and provide supportive care which may include the ABC cocktail of naloxone, thiamine, and dextrose. Specific therapy involves use of antidotes, while other measures include forced alkaline or acid diuresis and hemodialysis. Management of poisoning addresses decontamination of the gut, respiratory and circulatory failure, fluid and electrolyte imbalances, metabolic acidosis, convulsions, and use of antidotes. Antidotes include physical, chemical, and pharmacological types aimed at neutralizing specific toxic
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Poisoning
- 1. Poisoning
- 2. • Toxicology is the science that deals with the study of poisons, their source, properties, actions, detection and treatment of poisoning.
- 3. General principles of treatment • Stop the source of poison • Limit the absorption of poison • Supportive therapy – ABC and coma cock tail – Naloxone 2 mg – Thiaine 100 mg – Dextrose 50% 50 mL • Specific therapy with antidotes • Other measures
- 4. Other measures are – Forced alkaline diuresis : Frusemide, Sodium bicarbonate and IV fluids – Forced acid diuresis : Frusemide, Ascorbic acid and IV fluids – Hemodialysis
- 5. General management • • • • Gut decontamination Management of respiratory failure Management of circulatory failure Management of fluid and electrolyte imbalance • Metabolic acidosis • Convulsions • Antidotes
- 6. Gut decontamination • Emesis : Ipecac syrup 20-30 ml or Strong salt solution or freshly prepared mustard powder solution • Do not induce emesis : Corrosive agent or petroleum product or unconscious patient • Stomach wash • Activated charcoal / Medicoal • Purgatives: MgSO4 20-30 g or Sod. Sulphate 20-30 g
- 7. Management of respiratory failure • Oxygen • Mechanical ventilation • Sitting position
- 8. Management of circulatory failure • Plasma expanders : Dextran or whole blood • Vasopressors : Dopamine 2-10 mcgr/kg or phenylephrine 5-20 mcgr/kg or methoxamine or mephenteramine
- 9. Management of fluid and electrolyte imbalance • • • • Hyponatremia : Normal saline Hypernatremia : Frusemide Hypokalemia : KCl 4-6 mEq/L Hyperkalemia : Frusemide or thiazide or 10% calcium gluconate • Hypocalcemia : 10% calcium gluconate
- 10. Metabolic acidosis • Sodium bicarbonate 1-2 mEq/L IV for 30 minutes
- 11. Convulsions • Diazepam 10 mg slow IV • Phenytoin 10 mg/kg IV • Phenobarbitone 10 mg/kg
- 12. Antidotes • Physical antidote : Activated charcoal adsorbs alkaloids • Chemical antidote : acetic acid reacts with alkalis, chelating agents bind heavy metals like lead, arsenic, copper, mercury, etc. • Pharmacological antidotes
- 13. Pharmacological antidotes Toxic agent Antidote Paracetamol N-Acetyl cysteine Morphine and other opioids Naloxone Heparin Protamine sulphate Cyanide Sodium nitrate + Sodium thiosulphate Organophosphates Atropine, Pralidoxime Atropine Physostigmine Copper D-Penicillamine Iron Desferrioxamine Arsenic Dimercaprol Lead Calcium disodium edetate Insulin Glucose Methanol Ethanol Carbon monoxide Oxygen Warfarin Vit K1 oxide
- 14. Thank you