clinical toxicology

Question 1

why developing antidote is challenging?

Answer 1

• it is unable to perform controlled human studies to evaluate efficacy
• difficult to extrapolate between human and animals

Question 2

steps to treat poisoned patients?

Answer 2

1. treatment of the poisoned patient
2. prevent further poison absorption
3. enhance the poison elimination
4. administration of antidote
5. administration of supportive care

Question 3

elaborate treatment of poisoned patient

Answer 3

1. clinical stabilization of the patient
2. clinical history in the poisoned patient
3. physical examination
4. laboratory evaluation
5. radiographic examination

Question 4

what is done in clinical stabilization of the patient?

Answer 4

first is by assessing the patient’s airway, breathing and blood circulation

Question 5

what is meant by clinical history in poisoned patient?

Answer 5

• as to determine the substance patient was exposed to, and the extent and timing
• sometimes is unavailable –> since patient is unresponsive or history is unreliable
• accurate history can be challenging and lack completely

Question 6

what is meant by doing physical examination?

Answer 6

• assess the patient’s condition throughout the treatment (patient physical and mental health)
• features of toxidromes:
  
  • clinical signs and symptoms, when taken together is associated with exposure form certain toxicological classes of chemicals

toxidromes permit initiation of rationale treatment based on the most likely category of toxicant responsible

Question 7

what is done in laboratory evaluation?

Answer 7

• done when patient have classified the type of toxicant being exposed to the patient
• laboratory evaluation is needed to confirm the toxicant

Question 8

what abour radiographic examination?

Answer 8

• since certain formulations have enteric coating/ other sustained released agents –> are radiopaue –> can be visualized by X-ray

Question 9

what is done in preventing further absorption of poison?

Answer 9

stopping of the exposure depends on:
- inhalation exposure
- topical exposure
- oral exposure

Question 10

how is inhalation exposure stopped?

Answer 10

• by removing patient from the environment where toxicant is found
• provide ventilation and oxygenation for patient

Question 11

how is topical exposure stopped?

Answer 11

• remove patient’s clothing (that may contain chemical)
• gently wash the skin with water and soap

Question 12

how is oral exposure stopped?

Answer 12

• induce emesis (vomiting) with ipecac syrup, gastric lavage, oral activate charcoal and whole-bowel irrigation

Question 13

how is poison eliminated?

Answer 13

• alkalinization of urine
• hemodialysis
• hemofiltration
• plasma exchange/ exchange transfusion
• give oral activated charcoal

Question 14

how is supportive care given to patient?

Answer 14

• intensive care/ close monitoring is done to posioned patient
• psychiatric assessment is given for self-harm (self poisoning, suicidal ways) –> monitor patient’s mental health