Poisoning

Question 1

What’s a poison vs Toxin vs Venom

Answer 1

Poison is a substance causing a disturbance in an organism when a sufficient amount of it is infested
A toxin is a poison produced biologically
Venom is a poisonous secretion of an animal

Question 2

What is toxicology

Answer 2

WCharacterization of potentially adverse effects of foreign chemicals
Dose-response relationship

Question 3

What are the toxic actions of the chemicals

Answer 3

Non selective actions:
Local irritation -site of exposure/application
-Injury caused by denaturing
Strong alkali or acids

Selective actions:
Interferes with specific biochemical pathways
Che,iCal has to be absorbed and distributed to specific pathways

Immediate and delayed actions
Toxins leading to symptoms quickly after exposure: organophosphate poisoning
Severe iron poisoning -3phases( early 0,5-2hours, Quiescent phase -up to 12 hours and Life threatening phase)

Question 4

Common target tissues of chemicals

Answer 4

Lungs (vapours)
Liver (ingested drugs)
Heart (ionic gradient disturbances)
Kidney
Brain

Question 5

Management of Poisoning

Answer 5

Airway
Breathing and oxygenation
Circulation and cardiac monitoring
Diagnosis and Decontamination
Enhancing drug clearance
Frequent re-evaluation and Further symptomatic care
Give antidote
Help

Question 6

What investigations would you do

Answer 6

Arterial blood gas
Electrolyte and glucose
FBC and clotting profile
ECG
Kidney and Liver function test
Plasma poison concentration eg paracetamol
Urinalysis

Question 7

Contraindications of Emesis

Answer 7

Impaired level of consciousness
Corrosive substances
Hydrocarbons
Risk of seizures

Question 8

Contraindications of gastric lavage

Answer 8

Corrosive substance and hydrocarbons
No airway protection
Risk of GI haemorrhage

Question 9

Indications of activated charcoal / when is it useful

Answer 9

Salicylates, paracetamol, barbiturates, digoxin, TCAs
Time since ingestion < 2 h
Longer if delayed gastric emptying

Question 10

When do you multi-dose activated charcoal?

Answer 10

Severely poisoned patients
Sustained-release tablets
Enterohepatic cycling (estrogen, TCAs)
Drugs secreted into bile or intestine (digoxin)

Question 11

When is charcoal contraindications?

Answer 11

Strong acids or alkalis
Iron salts
Lithium
Cyanide
Endoscopy due
Antidote by mouth
Alcohol
Petroleum products

Question 12

What are the adverse effects of charcoal

Answer 12

Vomiting
Constipation
Intestinal obstruction

Question 13

Contraindications of whole bowel irrigation

Answer 13

Bowel obstruction
Ileus
Compromised airway

Question 14

How would you enhance drug clearance

Answer 14

Urinary alkalisation
Charcoal harmoperfusion
Haemodialysis

Question 15

Which antidote do you give for opioids

Answer 15

Naloxone

Question 16

Which antidote do you give for paracetamol

Answer 16

Acetylcysteine

Question 17

What antidote do you give for digoxin

Answer 17

Digoxin immune fab

Question 18

Which antidote do you give for benzodiazepines

Answer 18

Flumazenil

Question 19

Which antidote do you give for iron

Answer 19

Deferoxamine

Question 20

Complications of naloxone

Answer 20

Resp distress

Question 21

Antidote for organophosphate

Answer 21

Atropine?

Question 22

Education related to insulin therapy

Answer 22

Injection technique and site
Insulin storage
• Recognition and treatment of acute complications,
e.g. hypoglycemia
• Self-monitoring and how to self-adjust insulin doses
– basal bolus at least 2x daily initially
• In visually impaired patients and arthritic patients,
prefilled pens and cartridges