Poisoning Flashcards
What’s a poison vs Toxin vs Venom
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
What is toxicology
WCharacterization of potentially adverse effects of foreign chemicals
Dose-response relationship
What are the toxic actions of the chemicals
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)
Common target tissues of chemicals
Lungs (vapours)
Liver (ingested drugs)
Heart (ionic gradient disturbances)
Kidney
Brain
Management of Poisoning
Airway
Breathing and oxygenation
Circulation and cardiac monitoring
Diagnosis and Decontamination
Enhancing drug clearance
Frequent re-evaluation and Further symptomatic care
Give antidote
Help
What investigations would you do
Arterial blood gas
Electrolyte and glucose
FBC and clotting profile
ECG
Kidney and Liver function test
Plasma poison concentration eg paracetamol
Urinalysis
Contraindications of Emesis
Impaired level of consciousness
Corrosive substances
Hydrocarbons
Risk of seizures
Contraindications of gastric lavage
Corrosive substance and hydrocarbons
No airway protection
Risk of GI haemorrhage
Indications of activated charcoal / when is it useful
Salicylates, paracetamol, barbiturates, digoxin, TCAs
Time since ingestion < 2 h
Longer if delayed gastric emptying
When do you multi-dose activated charcoal?
Severely poisoned patients
Sustained-release tablets
Enterohepatic cycling (estrogen, TCAs)
Drugs secreted into bile or intestine (digoxin)
When is charcoal contraindications?
Strong acids or alkalis
Iron salts
Lithium
Cyanide
Endoscopy due
Antidote by mouth
Alcohol
Petroleum products
What are the adverse effects of charcoal
Vomiting
Constipation
Intestinal obstruction
Contraindications of whole bowel irrigation
Bowel obstruction
Ileus
Compromised airway
How would you enhance drug clearance
Urinary alkalisation
Charcoal harmoperfusion
Haemodialysis
Which antidote do you give for opioids
Naloxone
Which antidote do you give for paracetamol
Acetylcysteine
What antidote do you give for digoxin
Digoxin immune fab
Which antidote do you give for benzodiazepines
Flumazenil
Which antidote do you give for iron
Deferoxamine
Complications of naloxone
Resp distress
Antidote for organophosphate
Atropine?
Education related to insulin therapy
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
