Toxicology - Management of poisoning PDF

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Summary

GENERAL MANAGEMENTFactors affecting poisoning effectsGeriatric Pediatric Pediatric is not yet fully developed which may cause the accumulation of drugs even when given at normal doses. Geriatric have slower metabolizing rates as compared to adults aged 20- Kidney function: excretion, Liver function:...

Description

GENERAL MANAGEMENT Factors affecting poisoning effects Geriatric

Pediatric

1. Pediatric is not yet fully developed which may cause the accumulation of drugs even when given at normal doses. 2. Geriatric have slower metabolizing rates as compared to adults aged 20-40 3. Kidney function: excretion, Liver function: metabolism Poison-related factors ●

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Concentration - as the dose is increased, probability of toxicity increases Solubility - the higher the lipophilicity, the higher the toxication ROUTE OF ADMINISTRATION

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Gut Liver Venous Circulation Right side of the heart Lungs Left side of the heart Arterial Circulation

➔ Oral medications have slow absorption thus management (treatment) is higher. ➔ Intravenous medications goes directly to the venous circulation; cannot be retracted ➔ Inhalational - faster effect

Factors affecting poisoning effects Habits ● Smoking Cigarettes ○ enzyme induction ● Alcohol ○ Acute - enzyme inhibitor ○ Chronic - enzyme inducer Development of Tolerance ABCDE ● ●

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Airway (check for gag reflex) Breathing (way the patient breathe) ○ Give 100% oxygen to patients with difficulty in breathing Circulation ○ Heart rate ○ Capillary refill time Disability (level of consciousness) ○ Alert ○ Voice responsive ○ Pain responsive ○ Unresponsive Exposure STARTS

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Substance name ○ To start intervention and give antidotes Time of exposure ○ The longer it stays on the body, the higher the possibility it causes damage Amount or concentration Route of exposure Type of intoxication Signs and symptoms

Physical Examination ● Vital signs ○ Body temperature ○ Pulse rate or Heart rate ○ Blood pressure ○ Respiratory rate ● Neurological signs ○ Altered mental status ■ Agitation, delirium, sedation, coma, seizure ■ Pupillary size ● Miosis, mydriasis, nystagmus ■ Movement disorders ● Akinesia, dyskinesia ● Dermatological signs

Icterus/Jaundice yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary tract obstruction

Medications/Poisons that can cause Icterus:

Acneiform characterized by papules and pustules resembling acne vulgaris

Medications/Poisons that can cause acneiform:

acetaminophen, chlorinated hydrocarbon, arsenic, gold, iron, phosphorous

bromine, iodine, lithium, steroids Boiled Lobster - the skin resembles the color of a lobster

SKIN COLOR

Medications/Poisons that can cause boiled lobster: boric acid

Cyanosis - bluish cast to the skin and mucous membrane. Peripheral cyanosis - bluish discoloration on hands and feet. Usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood in the body.

Medications/Poisons that can cause cyanosis:

Erythema - (greek erythos - red) is the redness of the skin or mucous membranes caused by hyperemia (increased blood flow) in superficial capillaries

Medications/Poisons that can cause erythema:

Ecchymosis - a discoloration of the skin resulting from bleeding underneath, typically caused by bruising

Medications/Poisons that can cause ecchymosis:

aniline, methylene blue, nitrates & nitrites, opium, oxalic acid, sulfides

anticholinergics, antihistamines, ethanol

anticoagulants

Bullous Lesion - a bulla is a fluid-filled sac or lesion that appears when fluid is trapped under a thin layer of the skin. Larger than 0.5 centimeters (5 millimeters) in diameter can be classified as a bulla

Medications/Poisons that can cause bullous lesion:

Trace marks

Medications/Poisons that can cause trace marks:

Barbiturates, opium

IV drugs Keratinization

Medications/Poisons that can cause keratinization: Thallium, arsenic

Steven Johnson’s Syndrome (SJS) disorder of the skin and mucous membranes; usually a reaction in

Medications/Poisons that can cause SJS: amoxicillin, carbamazepine,

medication that starts with flu-like symptoms, followed by a painful rash and blisters

erythromycin, phenobarbital, phenylbutazone, sulfa drugs

Skin necrosis - is a premature death of cells which occurs due to autolysis; occurs due to external injury or trauma in a particular organ

Medications/Poisons that can cause skin necrosis:

Alopecia - hair loss whole including eyebrows

Medications/Poisons that can cause alopecia:

potassium, sodium, phenytoin

Chemical agents that cause nail stains: ★ Brown - Iodine ★ Yellow-Brown - Nicotine ★ Blue - Copper salts ★ Red - Mercury ★ Gray - Formaldehyde ●

Breath Odors ● Airplane glue - aromatic hydrocarbon, toluene ● Bitter almonds - cyanide ● Rotten egg - hydrogen sulfide, disulfiram, N-acetylcysteine ● Burnt rope (hemp) marijuana ● Carrots - cicutoxin of hemlock ● Chico - ethanol ● Sweet - acetone, isopropanol, salicylates

chemotherapy, heavy metals Alopecia areatau portion by portion

Medications/Poisons that can cause alopecia areata: amiodarone, fluconazole

Hirsutism - excessive production of hair

Medications/Poisons that can cause hirsutism: androgen, corticosteroids, diazoxide, phenytoin, progestin

Diaphoresis - excessive sweating

Vomit Color ● Blue-Green - boric acid, copper salts, cyanide, nickel, iodine with starch ● Luminous - phosphorous, arsenic ● Brown - iodine, sulfuric acid (ground coffee) ● Pink - ethchlorvynol ● Yellow-Green - chromium

Medications/Poisons that can cause diaphoresis: amphetamines, cocaine

Mees’ lines

Medications/Poisons that can cause mees’ lines: arsenic, thallum

Beau lines

Medications/Poisons that can cause beau lines: antineoplastics

Gastrointestinal signs

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Gum Lines Blue - bismuth, lead Black - arsenic, mercury Bowel Color ● Black - bismuth, charcoal, iron, magnesium dioxide, lead, silver nitrate

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Clay-like - alcohol, barium White (smoke-like) aluminum hydroxide Blue - boric acid, iodine, methylene blue Green - indomethacin, copper sulfate

Toxidromes ○ Anticholinergic syndrome ○ Sympathomimetic / Hallucinogenic syndrome ○ Opioid syndrome ○ Cholinergic syndrome ○ Sedative-hypnotic syndrome ○ Serotonergic syndrome ○ DUMBELLS - Diuresis, Diarrhea ■ Urination ■ Miosis ■ Bradycardia ■ Emesis ■ Lacrimation ■ Lethargic ■ Salivation...