Toxic outbreaks

Question 1

Describe clinical toxicology

Answer 1

Clinical subspecialty focused on diagnosis, management and prevention of poisoning/toxicity and adverse effects (due to medications, chemicals, toxins and biological hazards)

Question 2

Describe harm in poisoning

Answer 2

Injury, damage, or disruption of normal physiologic functioning to cells, tissues, organs

Question 3

Define poisoning

Answer 3

Denotes harm from exposure to substance

Question 4

Describe exposure in poisoning

Answer 4

External - direct contact with epithelial surfaces or mucosa
Internal - Absorbed into bloodstream, distributed to tissue, intracellular or extracellular speces

Question 5

What are the routes of exposure in poisoning

Answer 5

Ingestion, inhalation, eye, topical (skin), oral/mouth, parenteral, other

Question 6

Describe relationship between caffeine and dose

Answer 6

Higher the dose = more severe side effects

Question 7

Describe therapeutic index

Answer 7

between toxic dose and effective dose
- wide
- narrow - less space before negative effects

Question 8

Describe Bhopal disaster

Answer 8

Industrial accident
Lung and airway injuries
Toxic cause = methyl isocyanate

Question 9

Describe Itai-itai disease

Answer 9

Industrial pollution of river basin
Bone and kidney abnormalities
Cadmium in drinking water

Question 10

Describe panama cough syrup

Answer 10

Chemical substitution
Kidney failure and neurologic effects
Diethylene glycol

Question 11

Describe synthetic cannabinoids

Answer 11

Contamination of illicit chemical
Abnormal bleeding and coagulation
Brodifacoum (superwarfarin)

Question 12

Describe collecting information

Answer 12

List signs and symptoms of affected individuals
Look for common exposures
Find toxins capable of causing signs/symptoms
Identify overlap/commonality

Question 13

How to link exposures and cases

Answer 13

Establish exposure pathway
Identify possible source and cases and obtain samples
obtain clinical specimens from affected individuals
Perform confirmatory testing for suspected toxin (if possible)

Question 14

LiverTox amphetamines advice and actions

Answer 14

Drug-induced liver injury diagnosis of exclusion
GP to chase bloods and notify NPC of results
Contacted ESR regarding sample testing
- Go over timeline

Question 15

Describe outbreak summary of amphetamines

Answer 15

Cluster of 7 patients suffered acute liver injury following ingestion of 4,4-methylenedianiline thought to be ecstasy
- Days-weeks early onset of symptoms
- 7-10 days jaundice
- Several weeks resolution and liver injury
Response
- Analytical conformation of substance
- Information sharing
- Engagement with drug checking and groups