Acetylene: general information, incident management and toxicology
General ToxicologyGeneral Toxicology
Transcript of General ToxicologyGeneral Toxicology
NMT11
1 General toxicology
General ToxicologyGeneral ToxicologyGeneral ToxicologyGeneral Toxicology
1111)))) Classification of Poisons?Classification of Poisons?Classification of Poisons?Classification of Poisons? 2222)))) Factors affecting action?Factors affecting action?Factors affecting action?Factors affecting action? 3333)))) Fate.Fate.Fate.Fate. 4444)))) Diagnosis.Diagnosis.Diagnosis.Diagnosis. 5555)))) Treatment.Treatment.Treatment.Treatment.
ClassificationClassificationClassificationClassification
� Origin (Source)
� Onset (Mode of exposure)
� Organ
� One Site or > 1 site (Site of action)
Origin & SourceOrigin & SourceOrigin & SourceOrigin & Source::::
1111.... PlantsPlantsPlantsPlants 2222.... MineralsMineralsMineralsMinerals (Metals)(Metals)(Metals)(Metals)
3333.... AnimalAnimalAnimalAnimal 4444.... SyntheticSyntheticSyntheticSynthetic
1. Opium
Morphine
Heroine
2. Atropine
3. Strychnine
4. Digitalis
-Lead
-Mercury
-Arsenic
-Antimony
-Ph
-Fe
-Snake.
-Scorpion.
-Sea
Marine animal’s venom
A �Analgesics
B � Barbiturates
(Hypnotics)
C� Cyclic
Antidepressant
(Psychotropics)
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2 General toxicology
Organ Specificity:Organ Specificity:Organ Specificity:Organ Specificity:
1- Arsenic Liver (Hepatotoxic).
, Paracetamol
2- Digitalis Heart
Cardiotoxic.
3- Aconite Heart. �� ا����
4- Mercury Micturation (Nephrotoxic).
, Phenol (Kidney)
5- Neuro Toxins Convulsants & Depressants.
6- Ocular Toxins Methanol & Nicotine.
7- Dermal Toxins Corrosives & AS & Hg.
8- Respiratory Toxins Kerosene & Fumes.
Site Site Site Site of Actionof Actionof Actionof Action: : : :
Local� Immediate & Far � Act after Mixed Severe Destructive Absorbtion (Double Action) effect Strong Remote Local irritant Action & systemic effect
Mild - Flowers � e.g. Atropine. - Metals
Corrosives - Factories� Synthetic Drugs -Mild Corrosives
Oxalic acid Phenol
Acids Alkalis (Carbolic acid)
Mode Mode Mode Mode ofofofof Exposure:Exposure:Exposure:Exposure: 1- Acute � Single High Dose of the Poison.
2- Chronic � Repeated Small Dose of the Poison.
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Factors Factors Factors Factors aaaaffecting ffecting ffecting ffecting action of the paction of the paction of the paction of the poisonoisonoisonoison
PoisonPoisonPoisonPoison
3333 S S S S Patient Patient Patient Patient 5555 PharmaPharmaPharmaPharma
1- Quantity (Dose)
2- Quality (Form). 3Qs
3- Quickest
(Route Of Administration)
1- Quantity (Dose)
� X Severity
� Vomiting � less effect.
� Fatal Dose � Smallest
amount� Death
2- Quality (Form)
� Gas > Liquid > Solid
Powders > Lumps
� Solubility
� Concentration
3- Quickest route
(route of administration)
IV > Inh. > IM > s.c (skin) >
through mucous membrane >
intradermal (skin).
“3S”
1- Small Or Old (Age)
Children can tolerate Atropine.
2- Strong Or Not (Healthy)
Liver Kidney Detoxification &
Execretion
Toxicity
3- Stomach
(MCQ) Empty Or Full.
ا�آ� ا�ا��
)�� ( )���( Fatty Meals
Rapid Absorption
e.g.
Achlorohydria + Ph +Mercury -As -Alcohol
e.g.: HCL
KCN HCN
Non Toxic Toxic
Toxicity Of KCN
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”arma5 ph“
1)Allergy small non-toxic
abnormal exaggerated
response
irinspA
enicillin Puffer S spirinA
y crasdiosyn2) I
Crazy
response
e.g. Morphine (Abnormal response
due to genetic factor)
3) Tolerance (in addicts)
Toxicity
Dose Produce same effect
4) Interaction
i) Synergism� � ص�آ�س و ا
Barbiturates + Ethanol
ii) Antagonism→رد�����ي وا� ا
Ethanol + methanol
5) Cummulation
E.g. Digitalis
Lead
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5 General Toxicology
Fate of the poison:Fate of the poison:Fate of the poison:Fate of the poison: ADMEADMEADMEADME
AAAAbsorption DDDDistribution MMMMetabolism EEEExcretion
1- Ingested
a)GIT
Stomach
Circulation
b) Vomiting
c) Stool
____
later
• Liver
Non-toxic
Toxic
Paracetamol
Parathion
Methanol
(1) Kidney:
- Urine
- Saliva
- Sweat
(2) GIT:
� Stomach
- Morphine
- Antimony
� Descending colon
- Arsenic
� Caecum
- Mercury
(3) Bile to Duodenum:
- Barbiturates
- Digitalis
- TCA
“Entero-hepatic
circulation”
2- Inhaled
Lung
Circulation
3- Injected
IV IM Skin
Muscle skin
Circulation
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SchemeSchemeSchemeScheme
1111.... Condition of poisoningCondition of poisoningCondition of poisoningCondition of poisoning
Accidental Suicidal Homicidal
Children Anything
Workers except stuff with Therapeutic characteristic smell Addicts
ن �رع ا����� �ا���ب ا���ت � ا���م Cyanide Alcohol Opium Nicotine - Organo - Phenol
(bitter (bars) (perfumes) (Cigarettes) phosphorous
almond - Kerosene ز�� �
oil)
2222.... Fatal Fatal Fatal Fatal dosedosedosedose
3333.... Fatal periodFatal periodFatal periodFatal period
4444.... ActionActionActionAction
5555.... Clinical pictureClinical pictureClinical pictureClinical picture
6666.... TTTTtttttttt
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7777.... PostPostPostPost----mortum picturemortum picturemortum picturemortum picture
±±±± 8888.... Source [classification]Source [classification]Source [classification]Source [classification] ±±±± 9999....Kinetics [ADME]Kinetics [ADME]Kinetics [ADME]Kinetics [ADME] 10101010.... Diagnosis Diagnosis Diagnosis Diagnosis (((([investigation[investigation[investigation[investigation) ) ) ) Talk about (1) Circumstantial evidence
(2) C/P
(3) PM picture
(4) Investigations (living and dead)
11. D.D.
Investigations
Living ارج�Dead ا �� ��ا
(1) Blood
(2) Urine
(3) stool
(4) Vomitus
+ (5) Hair/nail
(1)Stomach
(2)Intestine
(3)Blood
(4)Kidney
(5)Liver
(6) Brain
(7) H / N / B / T Metals ال ��
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General toxicologGeneral toxicologGeneral toxicologGeneral toxicologyyyy
6) CNS “3Cs”
• Coma
• Cyanosis
• Central asphyxia
ActionActionActionAction Clinical pictureClinical pictureClinical pictureClinical picture 1) GIT • Nausea
• Vomiting
• Colic
• Diarrhea
2) Heart • Pulse Arrest
• Blood pressure
3) Sensory nerve
then
• Tingling
• Numbness
• Hypersensation then
• Hyperthesia Anaesethea
•
4) Motor nerve(N-M junction)
then
• Twitches
• Tremors
• Fasciculations then
• Convulsions Paralysis
5) CNS C H A I R
Restlessness
Irritability
Anxiety
Hypertension
Convulsions
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7) Renal failure
Oliguria + A B C then
Anuria
Albumin Blood Casts
8) Hepatic failure
1- Pain + tenderness in Rt
hypochondrium.
2- Jaundice + Bleeding
3- Bilirubin + SGOT + SGPT
4- Albumin + Prothrombin time
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SUS
SES
PostPostPostPost----Mortem PictureMortem PictureMortem PictureMortem Picture B P
P
“SUS” Stomach
Smell Ulcer Seeds or tablets
+
“SES” Skin
Smell Eschars Site of injection (needle)
+ Edema
+ “B”rain If there is CNS affection
Congestion
+
Internal
+ “P”assages Respiratory Death from asphyxia
External signs of asphyxia (from forensic)
+
“P”ost-Mortem changes Hypostasis
(Look at the colour change)
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Treatment:Treatment:Treatment:Treatment:
1111---- Prevention of further exposure.Prevention of further exposure.Prevention of further exposure.Prevention of further exposure. 2222---- Supportive or symptomatic treatment.Supportive or symptomatic treatment.Supportive or symptomatic treatment.Supportive or symptomatic treatment.
3333---- Elimination of poison from GIT.Elimination of poison from GIT.Elimination of poison from GIT.Elimination of poison from GIT. 4444---- Destruction of poisonDestruction of poisonDestruction of poisonDestruction of poison in GIT &in GIT &in GIT &in GIT & absorption (local antidotes).absorption (local antidotes).absorption (local antidotes).absorption (local antidotes).
5555---- Excretion of the absorbed poison.Excretion of the absorbed poison.Excretion of the absorbed poison.Excretion of the absorbed poison. 6666---- Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).Counteraction of the absorbed poison (physiological antidote).
TreatmentTreatmentTreatmentTreatment
1111---- Prevention of further exposure:Prevention of further exposure:Prevention of further exposure:Prevention of further exposure: Masks, gloves • Factory (Industrial exposure) Periodic-Medical Examination Removal of patients • Clinic i.e. Hospitalization Addicts
Suicidal & Homicidal
• House Accidental poisoning among children
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2222---- Supportive & Symptomatic treatment:Supportive & Symptomatic treatment:Supportive & Symptomatic treatment:Supportive & Symptomatic treatment: • Respiratory depression.
• CVS.
• Coma.
3333---- Elimination of poison from Elimination of poison from Elimination of poison from Elimination of poison from GIT:GIT:GIT:GIT: (ECG)
Emesis Cathartics Gastric lavage
4444---- Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption:Destruction of poison in GIT & absorption: (Local antidotes)
5555---- Excretion of the absorbed poison:Excretion of the absorbed poison:Excretion of the absorbed poison:Excretion of the absorbed poison: Blood Diuresis + Dialysis + Haemoperfusion
6666----Counteraction of the absorbed poison:Counteraction of the absorbed poison:Counteraction of the absorbed poison:Counteraction of the absorbed poison: Blood Physiological antidote
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3333---- Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)Elimination of poison from GIT: (ECG)
1111))))Emetics:Emetics:Emetics:Emetics: aaaa---- Def:Def:Def:Def: Vomiting (3hrs) bbbb---- Types:Types:Types:Types: A-Mechanical B-Chemical
Gag Reflex Local Central Mixed (Stomach) (C.T.Z)
a- NaCl b- Mustard Powder
(obsolete cause death)
Apomorphine
• Hypernatreuria Contra CNS • Convulsions 6mg → Adults • Hypertension 1-2 mg→ children
Syrup of Epicac
1-Source: Plant (safe) 2-A.P: Emetine + Cephaline
3-Dose: 30ml/30 min 15ml/30min for children 4-Action
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3333---- ContraindicationsContraindicationsContraindicationsContraindications::::
Poisons Patients
1- Corrosives & Kerosene fear of fear of chemical perforation pneumonitis
Because it is volatile
Stomach Esophagus
Where vomitus is going back through the esophagous to the mouth.
1- Comatosed Asphyxia Aspiration pneumonia 2- Convulsions: Vomiting can stimulate
convulsions. 3- Cardiac. 4- GIT Esophageal varices
Recent gastric operation 5- Cough reflex e.g. old 6- Pregnant.
7- Elderly patients.
2222---- Cathartics: Cathartics: Cathartics: Cathartics: “Purgatives”“Purgatives”“Purgatives”“Purgatives”
aaaa---- ActionActionActionAction: Faster passage of poison through GIT absorption bbbb---- Types Types Types Types (Osmotic) ��� ز�� Castor oil MgSO4 (30 g in 300 ml H2O & 250 mg/kg)
(Osmotic Purgative) 10% solution in children Avoid in fat soluble poison
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3- Gastric lavage: aaaa---- DefDefDefDef. Evacuation / W bbbb---- IndicationIndicationIndicationIndication 3 hrs post
Most effective
Easily absorbed drugs • Hysterical • Comatosed • Uncooperative c- Procedure (Refere to book) 1- Nurse Remove denture, give gag
plaster 2- Patient 3- Doctor
___________________________________
Ensure Patient
___________________
Close with forceps
to avoid any residues to get aspired
General Toxicology
Evacuation / Washing / Tube
s post-ingestion & emesis failed
Exception: can be done after 12 hrs in 1) Secreted e.g. Morphine+Antimony
Most effective 2) Slow Barbiturate 3) Sticky Aspirin
• Hysterical • Comatosed • Uncooperative
efere to book) H2O, Head (lt) to stop stomach movments
Nurse Remove denture, give gag
Tube 50 cm
1.5 cmplaster paraffin 1.5m
Swallow Introduction
___________________________________ 1- Cough
Ensure Patient 2- Dyspnea 3- Cyanosed 1- Ear
Doctor 2- Hands 3- Eye
_______________________________________ 1- Funnel
H2O to avoid any residues 3- Forceps Closes the tube during
to get aspired avoid aspiration of any residue of in into air passages
hrs in: ecreted e.g. Morphine+Antimony
Barbiturate
to stop stomach movments
cm
___________________________________
Dyspnea
____________________
Closes the tube during withdrawal to avoid aspiration of any residue of in the tube
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dddd---- ContraindicationContraindicationContraindicationContraindication:::: I- Absolute CI: 1- Corrosives Perforation by tube because friable tissue
II- Relative CI : 2- Kerosene (volatile) insert cuffed endotracheal tube 3- Coma due to fear from aspiration pneumonia 4- Convulsions Inhalation anesthesia (Ether) to avoid ↑ freq. & severity of convulsions
eeee---- Complications (Hazards)Complications (Hazards)Complications (Hazards)Complications (Hazards)::::
1- Oesophagus Perforation & bleeding
2- Trachea Asphyxia
3- Lung Aspiration pneumonia
4- Heart Cardiac arrest
5- Psychic trauma
6- Gaging
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3333---- Destruction of the poison in GITDestruction of the poison in GITDestruction of the poison in GITDestruction of the poison in GIT::::
Local antidotesLocal antidotesLocal antidotesLocal antidotes
A – PHISCO-MECHANICAL: 1-Demulcent e.g. olive oil –egg white –milk � corrosives 2-Dissolvents e.g. 10% alcohol or glycerine �phenol (followed by rapid gastric lavage ) 3- Cotton 4-Charcoal (adsorbent)
aaaa----originoriginoriginorigin : plant bbbb----usesusesusesuses:::: plants metal
enterohepatic *rew: bile to duodenum cccc----dosedosedosedose: 50 gm / 500 ml H2O every 4 hrs
dddd----precautions :precautions :precautions :precautions : do not give it before syrup of epicac � it will be adsorbed
eeee---- action :action :action :action : absorb the poison and it is not absorbed � raw charcoal
B-CHEMICAL:
By Chemical Reaction
1111---- NNNNeutralization eutralization eutralization eutralization Acid + weak alkali exothermic Obsolete � because react. Alkalis + weak acid co2 production
2D 2C
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2222---- oxidationoxidationoxidationoxidation H2O2 or KMNO4
-Plants O2 ���� -Organophosphorus O2 و� -Cyanide ���� �و را
3333---- precipitationsprecipitationsprecipitationsprecipitations ���� ي��
a) Tannic acid ا���ح
1) Plants ) ا���� ( 2) Antimony ) ��) ا�! ��
b) Fe (OH)3 "����ا� Arsenic (Napolion)
c) MgSO4 Carbolic acid
4444 ) ) ) ) RRRReduction eduction eduction eduction
a) Ferric vitamin C ferrous Citrus fruit after meal
b) Mercuric Na formaldehyde mercurous . sulfoxylate
4444---- ELIMINATION OF POISON : ELIMINATION OF POISON : ELIMINATION OF POISON : ELIMINATION OF POISON :
1 – LIVER Detoxification ( Biotransformation ) 2- LUNGS Resp. stimulant 3- GIT Purgative 4- KIDNEY Diuresis
5- BLOOD Blood
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KIDNEYKIDNEYKIDNEYKIDNEY Types
Diuresis Contraindication
TypesTypesTypesTypes
1)Saline Diuresis #$%
Na thio-sulphate %)�دن
Heavy Metal Poisoning
2)Osmotic Diuresis
Mannitol 10% 10gm IV infusion
3) Forced Diuresis
1111))))PrinciplePrinciplePrinciplePrinciple 2222))))TypesTypesTypesTypes
3333))))SubstSubstSubstSubstanceanceanceance
4444))))PoisonPoisonPoisonPoison 5555))))PrecautionsPrecautionsPrecautionsPrecautions
Change PH of urine Ionization ↓Absorption
↑Excretion (Ion trap Phenomena)
1)Alkaline (PH>7)
*NaHco3 *Na lactate
Acid *Salicylic acid *Babituric Acid
Fluid balance & electrolyte balance should be monitored
2)Acid (PH 5)
*NH4Cl *Vit C (Ascoribic Acid)
*Amphetamine *Quinine
Contraindications of Contraindications of Contraindications of Contraindications of renal diuresis:renal diuresis:renal diuresis:renal diuresis:---- 1) Poison +,-.
Not renal
2) Renal failure - /% +,-.
3) H2o Shock
4) K Heart Failur
BLOODBLOODBLOODBLOOD a)Dialysis
b)Haemoperfusion
c)Plasma phoresis
d)Exchange blood transfusion
e)Chelators
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IIII----DialysisDialysisDialysisDialysis ****IndicationIndicationIndicationIndication 1)x x Diuresis
2)Renal failure
3)Coma
****PrecautionPrecautionPrecautionPrecaution Dialysable drugs only!!
A) PeritonealA) PeritonealA) PeritonealA) Peritoneal
B) Haemo (Artificial B) Haemo (Artificial B) Haemo (Artificial B) Haemo (Artificial Kidney)Kidney)Kidney)Kidney)
*Procedure*Procedure*Procedure*Procedure
1) Evaluate bladder 2) Catheter
dialyisate fluid similar to plasma ѐ dextrose, hepraine ѐ procaine
3) 2 L after 1h 4) Syphonage
*Uses*Uses*Uses*Uses
ا�������ت
Methanol & Ethylene
glycol
*Procedure*Procedure*Procedure*Procedure Blood + poison Peritoneal membrane cellophane
Blood - Poison *Disadvantages:*Disadvantages:*Disadvantages:*Disadvantages:
4 HIGH
“ Ineffective” 1)High ptn blood
2)High Vol of
Distribution
3)High Lipid Bulk,
passes the tissues
4)High Molecular
weight
1111) ) ) ) DDDDialysis ialysis ialysis ialysis :::: - Haemoperfusion → passage of anticoagulated blood via charcoal or resin
columns . severe intoxication
1) ) ) ) IIIIndicationndicationndicationndication high → barbiturates
hypothermia , hypotension , etc → coma
2) PPPProcedurerocedurerocedurerocedure → adsorbs the poison
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21 General Toxicology
3) ) ) ) EEEEffective forffective forffective forffective for: : : : removal of lipid soluble & ptn bound poisons e.g. barbiturates , salicylates & meprobamates .
- Exchange bl. Transfusion → 1) xxx dialysis
→ 2) ↓ VD → highly conc. In blood
- Plasma pheresis → removal of the plasma ( vol. of distribution from the
blood replace it with another sub )
2222) ) ) ) chelators chelators chelators chelators : : : :
----Def.Def.Def.Def. → + metals → non – toxic comp. → soluble & ↓ urine
----Types :Types :Types :Types : 1) BAL
2) DMSA
(5) 3) EDTA
4) Penicillamine
5) Desferol
1111))))BALBALBALBAL → AAAAnti nti nti nti –––– llllewsite ewsite ewsite ewsite = ( = ( = ( = ( 2222 ---- 3333 Dimercaprol Dimercaprol Dimercaprol Dimercaprol ) ) ) ) ↓ BBBBritish ritish ritish ritish
2SH 3 Routes of admin Disadvantage
Uses : Uses : Uses : Uses :
Lead Mercury Arsenic Antimony Gold Bismuth
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22 General Toxicology
2SH
2222 Analogues Analogues Analogues Analogues ( DMSA & DMPS )
Routes of admin. :Routes of admin. :Routes of admin. :Routes of admin. : IM , eye drops & skin ointment
NEVER IV →→ embolism Hr days
Dose :Dose :Dose :Dose : 2.5 mg ⁄ kg 2.5mg/kg/6 2
2.5mg/kg/12 7 then Hr days
Disadvantages of BAL : Disadvantages of BAL : Disadvantages of BAL : Disadvantages of BAL : 1) plumbism ( pb ) : limited value in ttt as it chelates only lead in blood but not in bone & tissues .
2) pyrexia (anti-histaminics ) → antihistaminics given to avoid allergic reaction .
3) bean ( G-6-PD ↓↓↓ ) → haemolysis
4) BAL- Fe complex ( iron ) → more toxic than Fe
N.B. Answer for BAL + DMSAAnswer for BAL + DMSAAnswer for BAL + DMSAAnswer for BAL + DMSA
2222---- DMSA DDMSA DDMSA DDMSA Dimercaptoimercaptoimercaptoimercapto----succinic acid (succimer )succinic acid (succimer )succinic acid (succimer )succinic acid (succimer )
Less toxic analogue 10mg /kg/8 5 10 mg/ kg/ 12 2 Of BAL Hr day Hr weeks a) Plumbism : from bone, blood&tissues
b) Less toxic analogue of BAL Better than BALBetter than BALBetter than BALBetter than BAL C) G-6-PD DEF. : NO HAEMOLYSIS
d) Fe
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e) Orally : without chelating with essential menirals (Ca, Mg , Fe, Cu, Zn ) f) Lead : ALAD enz. ( A- aminolevulinic acid dehydrogenase ) EDTA like
3333---- DDDD----penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : penicillamine ( cuprimine ) : source source source source ::::penicillin Dose :Dose :Dose :Dose : 1 capsule/6h/10 days (as Antib) -copper & zinc toxicity -chronic toxicity of lead & mercury -Contain 1 SH group ( mono-thiol )
4444---- DDDDesferol : (or desferoxamine ) esferol : (or desferoxamine ) esferol : (or desferoxamine ) esferol : (or desferoxamine ) - Fe toxicity - Acts on iron in storage areas ( ferritin & haemosidrin )
# # # # DoseDoseDoseDose des fer ol
"� 4hr د ���� آ�ر� 2 4 1 2
2ampoules 1ampoule 4hrs twice
1st : 2 ampoules 2nd : 1ampoule every 4 hrs 2 times
still red (wine color ) normal→ stop ttt. means that he still has iron Continue ttt as before BUT don not exceed 12 ampoules / day = 6 gm / day Urine : normal → stop ttt
UrineUrineUrineUrine
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5555---- EDTA : ( Ethymine EDTA : ( Ethymine EDTA : ( Ethymine EDTA : ( Ethymine –––– diamine tetraacetic acid )diamine tetraacetic acid )diamine tetraacetic acid )diamine tetraacetic acid )
Ca → ,�0 ا�$�
Lead→ ),67ل 34 %�ا �-(,�0 ا�!�ء اآ�-→ ,9وب 34 ا� /- Glucose Dose :Dose :Dose :Dose : 1 2 5-2 1gm Twice / day 5 days Stop ttt 2 days then continue (to give chance for pb )
TypesTypesTypesTypes 3 1) di-sodium EDTA (has Ca ) �lead toxicity
2) di-sodium EDTA (non- Ca ) � digitalis toxicity 3) di-cobalt EDTA ( kilocyanor ) � cyanide toxicity
1111---- DiDiDiDi---- sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) sodium EDTA ( with Ca ) + Ca to spare body calcium , prevent chelation of Ca , prevent hypocalcaemia & tetany . -If you Chelate any metal that has greater affinity for EDTa than Ca
e.g this is the case for lead which can replace Ca in complex forming poorly dissociable chelate that is rapidly excreted in urine .
2222---- DiDiDiDi----sodium EDTA (Non sodium EDTA (Non sodium EDTA (Non sodium EDTA (Non –––– Ca ) Ca ) Ca ) Ca ) Given in digitalis toxicity because ppl with digitalis toxicity has hypercalcaemia
3333---- DiDiDiDi----sodium EDTAsodium EDTAsodium EDTAsodium EDTA::::
In cyanide toxicity
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5555---- CCCCounteraction of the absorbed poisonounteraction of the absorbed poisonounteraction of the absorbed poisonounteraction of the absorbed poison:
**** physiological / systemic antidote **** physiological / systemic antidote **** physiological / systemic antidote **** physiological / systemic antidote
1) Chemical inactivator 2) Antagonistic antidote 3) Competitive antidote 4) Chelators ( as before ) + include it in answer
1111) ) ) ) CCCChemical inactivators hemical inactivators hemical inactivators hemical inactivators
e.g. N C B12
Na→Na thiosulfate → for metals→non toxic compounds Ca → oxalic acid → inactivation Ba→ Hydroxycobalamine + cyanide toxicity → vit B12 (cyanocobalamine )
2222) ) ) ) AAAAntagonistic antidote: ntagonistic antidote: ntagonistic antidote: ntagonistic antidote: Antagonise the pharmacological action of physiological mechanism . e.g.
Atropine Organophosphorus Mephenisine Strychnine (Muscle relaxant)
3333) ) ) ) CCCCompetitive ompetitive ompetitive ompetitive antidote:antidote:antidote:antidote: antidote → compete with the poison for the
receptor or compete with the receptor for poison
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26 General Toxicology
Examples : 3 M
a) Morphine: compete with the poison for receptors :
e.g. naloxone , nalorphine , levalorphine …. Compete with Morphine on the opiate receptor b) Metals : compete with the receptor for the poison e.g. BAL & Resp. enz.compete for the Metals c) Mobeedat ( organophosphorus ) : oximes compete with the receptor → choline esterase enz. For the organophosphorus → preventing its binding to the enz..
*********
SSSSupportive & symptomatic ttt :upportive & symptomatic ttt :upportive & symptomatic ttt :upportive & symptomatic ttt :
* S* S* S* Supportive ttt : upportive ttt : upportive ttt : upportive ttt : 1) Respiratory depression 2) CVS → shock or collapse 3) CNS → coma 4) Acute hepatic failure 5) Kidney failure
1111) ) ) ) RespiratoryRespiratoryRespiratoryRespiratory depression:depression:depression:depression: 3333AAAA
Air passages Suction tube ( remove secretions ,vomitus, FB ) Endotracheal tube Tracheostomy tube (in laryngeal obstruction & edema of
Epiglottis)
Air → Carbogen maintain respiration
95% O2- 5% CO2 ( stim. Respiration)
Artificial respiration
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27 General Toxicology
2222) ) ) ) CVSCVSCVSCVS → SHOCK OR COLLAPSE SHOCK OR COLLAPSE SHOCK OR COLLAPSE SHOCK OR COLLAPSE
1) elevate the leg with head downwards
2) vital signs affection : * Respiratory → ↓ → give O2
* Temp. → ↓ → ttt by warming
*B.P. → ↓ → dopamine / dobutamine → ↑ BP → plasma expanders e.g. glucose , manitol , …etc .
* Pulse → Digitalis → Defibrillator
→ Anti-arrythmic drugs
3333) ) ) ) CNSCNSCNSCNS � ComatozedComatozedComatozedComatozed
a) Change the posture ( avoid bed sores & avoid pneumonia) 2C
b) Catheterization (prevents urine retention & calculate amount of fluid coming out to balance fluid level)
c) Take care with respiratory affection (as before)
d) Care of cardiovascular (as before)
4444----KidneyKidneyKidneyKidney Dialysis & Haemoperfusion failureDialysis & Haemoperfusion failureDialysis & Haemoperfusion failureDialysis & Haemoperfusion failure
*R.F. Due to :*R.F. Due to :*R.F. Due to :*R.F. Due to :----
Direct Cause of R.FDirect Cause of R.FDirect Cause of R.FDirect Cause of R.F Indirect Cause of R.FIndirect Cause of R.FIndirect Cause of R.FIndirect Cause of R.F 1-Mercury → Mictureiton ↓Blood →Shock
2-Phosphorus ↓H2o dehydration or electrolyte imbalance
5555----Liver Failure:Liver Failure:Liver Failure:Liver Failure:---- Causes Causes Causes Causes a) Arsenic (Napolion)
b) Paracetamol
NMT 11
28 General Toxicology
ttt: ttt: ttt: ttt: Special diet ↓ Protein ↑Glucose +Vitamins → Vit K + Electrolytes e.g. Ca-Gluconate -Glutathione Because ↓ albumin → No carrier for Ca
****Symptomatic ttt:Symptomatic ttt:Symptomatic ttt:Symptomatic ttt:----
1111)))) Cerebral EdemaCerebral EdemaCerebral EdemaCerebral Edema 2222)))) ConvulsionsConvulsionsConvulsionsConvulsions 3333)))) Pulmonary EdemaPulmonary EdemaPulmonary EdemaPulmonary Edema
1111----Cerebral EdemaCerebral EdemaCerebral EdemaCerebral Edema Osmotic Diuresis (By mannitol)
+ Cortisol (Add it to any symptomatic ttt of edema)
2222----Pulmonary edemaPulmonary edemaPulmonary edemaPulmonary edema Osmotic Diuresis
( Mannitol )+ Cortisone + Suction → Open passages by bronchodil.
+ O2 under pressure
3333----Convulsions:Convulsions:Convulsions:Convulsions:---- Strychnine Most common Cause ttt of convulsions ttt of Strychnine
NMT 11
29 General Toxicology
Mephensin + Mg So4 (slow I.V)
S E M S E M S E M S E M Ether inhalation (Anaesthesia) ا;:$�6ي #$% Succinyl-Choline (Ms.relaxant) -IM → acts as Ms relaxant
-Oral →Acts as purgative 10mg (slow IV)
+ 2B (Any Convulsions) * Barium→ Diazepam “Valium” *Barbiturate