Lec 2 Flashcards
What are corrosive materials?
Substances that cause local and rapid damage on contacting tissue surfaces.
List the classifications of corrosives.
- Inorganic corrosive
- Organic corrosive
Give examples of inorganic corrosives classified as alkali.
- Soap manufacturing
- Oven cleaning products
- Swimming pool cleaning products
- Automatic dishwasher detergent
- Hair relaxers
Give examples of inorganic corrosives classified as acid.
- Toilet bowl cleaning products
- Automotive battery liquid
- Rust removal products
- Metal cleaning products
What are the conditions of poisoning from inorganic corrosives?
- Accidental: occupational workers, children
- Homicidal: throwing H2SO4 on face
List the clinical presentations of inorganic corrosive poisoning in the gastrointestinal tract.
- Severe pain of lips, mouth, and stomach
- Excessive salivation
- Dysphagia and odynophagia
- Vomiting
- Symptoms and signs of GIT perforation
List the clinical presentations of inorganic corrosive poisoning in the respiratory system.
- Cough
- Dyspnea
- Hoarseness, stridor, and respiratory distress due to edema of vocal cords
- Bronchoconstriction
- Pulmonary edema
- Chemical pneumonitis
What are the skin clinical presentations of inorganic corrosive poisoning?
- Chemical burns and eschars
What are the eye clinical presentations of inorganic corrosive poisoning?
- Corneal ulcers
- Conjunctival irritation with lacrimation
- Photophobia and severe burning pain
What are the acute complications of inorganic corrosive poisoning?
- Airway obstruction
- Shock (due to pain)
- Vomiting leading to dehydration
- GIT perforation
What are the late complications of inorganic corrosive poisoning?
- Stricture leading to cachexia
What are the remote complications of inorganic corrosive poisoning?
- Carcinoma of esophagus
What laboratory tests are used for investigating inorganic corrosive poisoning?
- Routine lab investigation
What radiological investigations are performed in cases of inorganic corrosive poisoning?
- Chest X-ray for pneumothorax, pneumomediastinum, and pleural effusion
- Abdominal X-ray for pneumoperitoneum
What is the purpose of endoscopy in inorganic corrosive poisoning?
- Should be done within 12 hours for grading esophageal and gastric lesions to guide therapy
What are the grading classifications revealed by endoscopy for inorganic corrosive poisoning?
- Grade I: erythema of mucosa
- Grade II: destruction of mucosa
- Grade III: destruction of all layers of the gut beyond the mucosa
What prophylactic measures should be taken when working with corrosive chemicals?
- Safety goggles
- Protective gloves
- Coat
What is the management for asymptomatic patients after inorganic corrosive exposure?
Only observation in the Emergency Room
What supportive care is provided for symptomatic patients after inorganic corrosive exposure?
- ABC
- Strong analgesic for pain: 10 mg morphine IV
What are the contraindicated GIT decontamination methods for inorganic corrosive poisoning?
- Induced emesis
- Activated charcoal
- Gastric lavage
What is the recommended method for decontamination of skin and eyes after exposure to inorganic corrosives?
Irrigation with copious amounts of normal saline for a minimum of 15 minutes
What local antidote can be used for inorganic corrosive poisoning?
Milk to attenuate the heat generated by a caustic
What symptomatic treatments are available for inorganic corrosive poisoning?
- Corticosteroids: intralesional steroids may be given
- Antibiotics: only in cases of GIT perforation
- Proton pump inhibitors (PPIs) and H2-blockers
- Nutrition: assess endoscopic grade of lesions for nutritional support
What is a dangerous problem with hypochlorite (Clorox)?
Mixing with other household cleaners produces chlorine and chloramine gases, causing significant irritation.
List the clinical presentations of hypochlorite poisoning.
- Difficulty breathing
- Coughing
- Bronchospasm
- Rarely pulmonary edema
What are two examples of organic corrosives?
- Carbolic acid
- Oxalic acid
What is carbolic acid and where is it commonly found?
A coal tar derivative with a characteristic smell, found in Dettol, Lysol, and phenol detergent.
What are the conditions of poisoning with carbolic acid?
- Suicidal: common due to easy availability
- Accidental: common among children and workers with skin contamination
What are the local actions of carbolic acid?
- Weak corrosives leading to superficial ulcers
- Coagulative necrosis leading to thickening of gastric mucosa
- Local anesthetic action causing transient pain and vomiting
- Skin: eschars and potential gangrene
What are the systemic effects of carbolic acid poisoning?
- CNS: stimulation followed by depression
- CVS: direct myocardial depressant effect
- Acid-base imbalance: respiratory alkalosis followed by metabolic acidosis
- Methemoglobinemia
- Kidney: acute glomerulonephritis
What are the local clinical presentations of carbolic acid poisoning?
- Stomach: temporary pain and vomiting
- Skin: white eschars with a phenolic smell around the mouth or skin
What systemic clinical presentations are associated with carbolic acid poisoning?
- CNS: constricted pupils and convulsions followed by coma
- Kidney: oliguria with albumin, blood, and casts in urine
What are the causes of death associated with carbolic acid poisoning?
- Early: respiratory failure due to respiratory center depression
- Late: renal failure
What supportive measures should be taken for carbolic acid poisoning?
ABCs
What is the recommended GIT decontamination method for carbolic acid poisoning?
Gastric lavage is indicated due to the systemic effect and to decrease absorption.
What local antidotes can be used for carbolic acid poisoning?
- Milk and egg white to coagulate phenol
- Ethanol 10% to dissolve phenol
What are the elimination methods for absorbed carbolic acid?
- Dialysis (peritoneal & hemodialysis)
- Exchange transfusion
What should be done to correct methemoglobinemia in carbolic acid poisoning?
Give methylene blue (1-2 mg/kg) if more than 30%.
What treatments are available for seizures due to carbolic acid poisoning?
Diazepam, Phenytoin, or Phenobarbitone may be given.
What are examples of acute non-toxic exposures?
- Calamine lotion
- Candles (beeswax or paraffin)
- Deodorants
- Glycerine
- Glue
- Hand lotions and creams
- Hair products (dyes and sprays)
- Lipsticks
- Liquid shampoos & body conditioners
- Makeup (eye, liquid facial)
- Oral contraceptives (excluding iron-containing tablets)
- Thermometers (mercury not absorbed)
- Toothpaste (without fluoride)
- Vaseline
What are toxidromes?
Groups of signs and symptoms that consistently result from a particular toxin.
What is the sympathomimetic toxidrome characterized by?
- Hyperalertness, agitation, hallucinations, paranoia
- Mydriasis
- Fever, tachycardia, hypertension, tachypnea
- Diaphoresis, tremors, seizures
List examples of toxic agents in the sympathomimetic toxidrome.
- Cocaine
- Amphetamines
- Ephedrine
- Theophylline
- Caffeine
What is the anticholinergic toxidrome characterized by?
- Agitation, hallucinations, delirium, coma
- Mydriasis
- Fever, tachycardia, hypertension, tachypnea
- Dry flushed skin, dry mucous membranes, decreased bowel sounds, urinary retention
List examples of toxic agents in the anticholinergic toxidrome.
- Atropine
- Antihistamines
- TCA
- Phenothiazines
- Antiparkinsonian agents
What is the opioid toxidrome characterized by?
- CNS depression, coma
- Miosis
- Hypothermia, bradycardia, hypotension, bradypnea
- Hyporeflexia, pulmonary edema, needle marks
List examples of toxic agents in the opioid toxidrome.
- Opiates (e.g., heroin, morphine, methadone)
- Diphenoxylate
What are alkaloids?
Active toxic substances in some plants that behave like alkalis.
List examples of alkaloids.
- Atropine
- Hyoscyamine
- Hyoscine
- Opium (Morphine)
- Cocaine
- Cannabis
- Digitalis
- Nutmeg
- Khat
What are the uses of atropine?
- Pre-anesthetic
- Antispasmodic
- Bronchodilator
- Heart stimulant
- Mydriatic
What are the conditions of poisoning with atropine?
- Accidental: in children, therapeutic overdose
- Homicidal: to facilitate rape and robbery
What is the mechanism of action for atropine?
- Peripheral: antagonizes muscarinic action of acetylcholine
- Central: stimulates CNS followed by depression
What are the signs and symptoms due to peripheral action of atropine?
- Dry secretions
- Dilated fixed pupils
- Rapid weak pulse and rapid shallow respiration
- Flushed skin
- Decreased GIT & UT motility
What are the signs and symptoms due to central action of atropine?
- Stimulation stage: occupational delirium
- Depression stage: drowsiness to coma, central asphyxia
What is the cause of death associated with atropine poisoning?
Central asphyxia
What is the treatment for atropine poisoning?
- Supportive: ABC
- GIT decontamination: gastric lavage
- Local antidote: charcoal, tannic acid
- Antidote: pilocarpine and physostigmine
What is opium derived from?
The green unripe capsule of papaver somniferum ‘poppy’ plants.
List the classifications of opioids.
- Natural: Morphine, Codeine, Papaverine
- Semi-synthetic: Heroin
- Synthetic: Fentanyl, Meperidine, Methadone, Butorphanol
What are the therapeutic uses of morphine and codeine?
- Morphine: potent painkiller
- Codeine: used as antitussive
What are the clinical presentations of opium (morphine) poisoning?
- Euphoria followed by dysphoria
- Gradual deterioration of consciousness
- Non-cardiogenic pulmonary edema
- Pinpoint pupils
- Constipation and diminished bowel sounds
- Vomiting
- Cyanosis
What are the causes of death associated with opium (morphine) poisoning?
Central asphyxia
What are the early symptoms of opium (morphine) toxicity?
Relief of pains followed by dysphoria, gradual deterioration of consciousness, non-cardiogenic pulmonary edema, constricted pin pointed pupils, constipation, diminished bowel sounds, vomiting, cyanosis, circulatory collapse.
Symptoms include distress, anxiety, and fear.
What are the causes of death related to opium (morphine) overdose?
Central asphyxia, pulmonary edema, arrhythmias.
These are critical conditions that can arise from severe toxicity.
What supportive measures are recommended for opium (morphine) toxicity?
ABCs (Airway, Breathing, Circulation).
Essential for maintaining vital functions in emergency situations.
What is the purpose of gastric lavage in opium (morphine) overdose?
To remove the substance from the stomach, even if the patient is alert.
Morphine can be re-excreted in the stomach.
What local antidotes can be used in opium (morphine) toxicity?
*Charcoal [Adsorption]
* Tannic acid [Precipitation].
What is the antidote for opium (morphine) poisoning?
Atropine, Naloxone, Naltrexone.
Atropine blocks vagal stimulation; Naloxone is used for acute opioid intoxication; Naltrexone is used for opiate addiction.
What are the clinical presentations of cocaine toxicity?
Euphoria, agitation, insomnia, mental confusion, hallucinations, exaggerated reflexes, hyperthermia, hypertension, tachyarrhythmias, coronary artery spasm.
Cocaine presents a sympathomimetic toxidrome.
What causes hyperthermia in cocaine toxicity?
Heat gain from increased muscle contractility, decreased heat loss due to vasoconstriction, disturbances of the heat regulatory center.
Hyperthermia is a critical condition that can lead to further complications.
What are the potential causes of death from cocaine overdose?
Hyperthermia, rhabdomyolysis, coagulopathy, central asphyxia, circulatory collapse.
These conditions can result from severe toxicity.
What are the sources of cannabis?
Cannabis sativa plant, Cannabis indica plant.
Different forms include hashish, bongo, and marijuana.
What are the mental and physical clinical presentations of cannabis toxicity?
Mental: Euphoria, dysphoria, hallucinations, disorientation.
Physical: Dilated pupils, conjunctival congestion, tachycardia, respiratory depression, increased appetite, urinary frequency.
chronic toxicity from cannabis lead to?
Amotivational syndrome, reduced testosterone, decreased sperm count, ovulation issues.
Long-term use can lead to lethargy and apathy.
What are the uses of digitalis?
Congestive heart disease, certain cardiac arrhythmias.
What are the clinical presentations of digitalis toxicity?
*Cardiac: Bradyarrhythmias, ventricular tachyarrhythmias.
*GIT: Nausea, vomiting, colic, diarrhea.
*Visual: Blurring, yellow/green halos.
*Electrolyte disturbances: Hyperkalemia in acute toxicity, hypokalemia in chronic patients.
What is the treatment for digitalis toxicity?
*Prevention of further exposure.
*Supportive measures: Electrolyte management, anti-arrhythmic drugs (lidocaine, atropine).
*GIT decontamination: Gastric lavage, activated charcoal.
*Antidote: Digi bind [Fab].
