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Toxicology

toxicology

QuestionAnswer
Poisoning exposure to non pharmocological substances
Overdose exposure to drugs (legal or olleagal
70% of poisonings in what age <6
80% of suicides are overdoses
routes ingestion,injection,inhalation,absorption
Ingestion most common route of entry
Immediate effects corrosive substances (acids/alkalis)-burns to lips tongue,throat
Delayed effects due to absorption from GI tract, most absorptions occurs in small intestine
inhalation absorption occurs capillary alveolar membrane
Absorption occurs through cappilaris in skin
Injected absorbption occurs directly into body through break in the skin
Gastric Lavage to be done within 1 hr
Decontamination -reduce absorption of toxins -Enhance elimination of toxin-cathartics,whole bowel irrigation
Activated Charcoal -most effective in 30 mins of ingestion -effective with ASA,amphetimines,strychnine,dilantin, theophylline and phenobarbitol
Cathartic Agent (in charcoal) commonly sorbitol like lactulose -dangerous if aspirated, speeds passage thru GI
Emesis involves -vomit center in medulla -CTZ Chemoreceptor triggering zone, stimulates vomiting indirectly, located in basal ganglia/midbrain
Gases and Vapors miz with air and distribute freely throughout airway
Mists liquid froplets in air-the larger the droplet the more exposure
Fumes fine particles of dust in the air
Inhaled posions S/S tachyapnea,dyspnea,CP,coughing, STRIDOR 80% occluded, wheezing, rales,rhonchi
Inhaled abuse-(Ipecac,charcoal and lavage not indicated) -most common in 13-15yrs seen in 6-8 yrs -AKA-gateway substances -sniffed (from container),huffing(substance placed on cloth),bagging (placed in bag) -dilated pupils,tinnitus,n/v
Cyanide -pits of cherries,peaches,apricots apples n pears -WPD, vapors disperse rapidly -enters thru resp n GI tracts n skin -heart n brain most sensitive to it -inhibits cellular respirations -bitter almond odor
Cyanide S/S -cyanosis n cherry red skin,agitation,anxiety,confusion,HTN w/reflex brady,acidosis
Cyanide Antidote Kit -2 amps of sodium nitrate 3% 300mg -2 vials of sodium Thiosulfate 25% 12.5 iv -Boric acid n or Sodium hydroxide to adjust pH -12 ampules of Amyl Nitrate inhalants USP 5min 0.3 ml
Nitrates (amyl and sodium) converts iron in hemoglobin to trivalent (Fe3+) form called methemoglobin (loves cyanide)= = CN-Met-Hgb/still must be detoxified + Thiosulfate= Thiocyanate. then excreted by kidneys and returned to hemoglobin
Carbon Monoxide -colorless,odorless,tasteless gas -200-250x >affinity for O2 -forms carboxyhemoglobin -cherry red skin and cyanosis -death from MI n ischemia due to hypoxia -half life in room air is 4-7hrs tx hyperbaric chamber
Alkalis cause fat and lipids in cell membranes to dissolve, cells fall apart
Acid's cause proteins to precipitate, forms dense clots over injured area
hydrofluoric Acid -penetrates deeply like alkaline burn -deactivated by Calcium fluoride -cell fx is disruptes,bones are destroyed -Tx.Mg++/Ca++ or benzethonium chloride,immerse limb in ice water
hydrocarbons Organic:carbon and hydrogens -s/s burns,wheezing,SOB,hypoxia,pneumonitis,HA,dizzy,cardiac dysryhtmias.tx-lavage
TCA's tricyclics Tofranil,elavil,norpramin,pamelor,amitriptyline -blocks reuptake of NE/serotonin in presynaptic neuron A2 primarily -do not use flumazenil,may cause seizures
SSRI's prozac,zoloft,paxil -do not block cholinergic receptors
MAO-I Nardil
overdose common in ages 20-29
Tachycardia in OD's are an early sign of toxicity
Monoamine Oxidase breaks down tyramine in liver tyramine increases relase of NE potent vasopressor)
Lithium for bipolar,moves into cells like Na+ but not pumped out easily, changes reuptake of NE causing anti adrenergic effects -tx-control seizures,alkaline urine w.sodium bicarb, osmotic diuresis with mannitol,possible hemodyalisis
Salicylate Toxicity amount ingested mild-<150 mg/kg mod-severe-150-300 mg/kg Severe->300 mg/kg Fatal ->500 mg/kg
Acetaminophen -Rx analgesic/antipyretic agent -forms a hepatotoxic metabolite if no mngd in 16-24hrs -30 tablets are toxic-Tx mucomist
Iron -exceeds bodys ability to store, causes disruption of cellular functions,anaerobic metabolism and acidosis -leads to Myocardial depression,venodilation and cerebral edema -corrosive to intestinal mucosa,liver injury -20 mg/kg van be lethatl, CV collaps
Iron OD treatment Deferoxamide-Chelating Agent -binds to iron less moves into cells and tissie,Charcoal contraindicates
Lead-slow onset kids most common victims-paint chip ingestion -causes brain and nervous system damage -adults exposed thru inhalation
Mercury poisoning -only metallic element that is liquid at rm temp,inhalation most common route -accumalates in organs mainly brain n kidneys
Food/Plant poisonings tx -activated charcoal -lavage
Food posioning due to Bacteria,Virus, toxic chemical
Salmonella -swells stomach and intestinal linings -incubation-6-48 hrs -lasts 5-7days -abd pain,fever,diarrhea,N/V -tx.Antibiotics -sudden ABD pain
Shigellosis Acute bacterial infection of bowel,resistant to stomach acid,infects colin leading to colitis -diarrhea,fever,abd pain,rectal pain -incubation 1-7 days,lasts 7 days
Complications of Shigella toxic Megacolon: severe inflammation causes colon to dilate or stretch, thin colon will eventually tear -diaffhea suddenly stops, abd swells -causes dysentary
Botulisim (bacterial) -life threatning, caused by clostridium botulinum -blocks ACh release from motor neurons, leads to muscle paralysis from head to toe, develops w/out gastric upset, severe CNS symptoms -incubation 4hrs-8days
Norwalk Virus (Viral) causes intestinal ilness, swallowing food or water contaminated with stool,raw shellfish -S/S occur 1-2 days post ingestion, recovery 2-3 days
Mushrooms-7 toxic classes Cylopeptide group (deadly) -contains amanita (cause 90% of deaths) toxic to liver -s/s-excess saliva,tears,sweating,abd cramps,n/v,diarrhea brady.
Food posioning onsets Chemical-30mins bacterial-1-12 hrs Viral-12-48hrs
Poisonis plants onset several hrs post ingestion, some delayed 1-3 days
Family hymenoptera Wasps,bees,hornets, fire ant
Serum Sickness symptoms (delayed reaction) occurs 10-14 days after sting fever,malaise,HA,urticaria,polarthiritis
Brown Recluse -local tissue necrosis -dark,dry spots-violin mark on back, unaware of bite, becomes ischemic and ulcerates
Brown recluse S/S -Local/ pain, redness,swelling, tissue necrosis -Systemic/chills, fever,n/v,joint pain, bleeding disorder, disseminated intravascular coagulation, hepatic injury
Black Widow orange red hourglass,black abdomen,very potent venom, causes excessive neurotransmitter release-severity influenced by age,weight,gen health
Black Widow S/S immediate localized pain,redness swelling within 1 hr-muscle cramps,abd rididity without tenderness -TX. Calcium Gluconate, antihypertensives, antiserum,valium 2.5-10mg
Scorpion Tx-active April-August constricting band 3/4-1.5 inches wide, occlude lymphatic flow only, cool compress,venom stored at bulb tail -Only Bark scopion is fatal-pain occurs 3hrs post bite
Scorpion Venoms effects Effects Na+ channels, ACh released from preganaglionic neuron, depolarization occurs and SNS is stimulated, leads to hyperactivity and convulsions -Severe envenomation-Propranolol-SNS blockage, no analgesic-systemic symptoms? antiserum
Pit vipers Rattlesnakes, cottonmouths, and copperheads -distinct pit between eye and nostril
Vipers venom contains destructive proteins, polypeptides, hydroclytic acid -destroys cell membranes, proteins, n other tissue, affects blood clotting,can cause renal failure-produces infection and tissure necrosis at site
Snake bite Tx -do not allow to walk, do not apply cold compress,give pain meds anything PO, or suction venom,. -restrict movement, keep limb below heart, immobilize, most deaths occur 6-30hrs , 90% within 1st 48hrs
Coral snake red and black bands, red on yellow kill a fellow-hangs on and chews-venom is neuro toxic, blacks ACH receptor sites, no necrosis or edema-CNS S/s, causes respiratory and skeletal muscle paralyisis w/in 12-24 hrs
King snake resembles a coral snake, red on black venom lack
Marine animals Coelenterates,echinoderms, stingrays -vey painful inhuries
Nematocysts Venomous stinging cells-hollow threadlike tube, serves as a hypodermic needle, contains venom
Jellyfish portuguese man-of-was is the most dangerous -tentacles up to 100ft
Sea anemone Fire corals bottom dwellers, flower like appearance, razor sharp exoskeleton
Colenterates Tx rince with sea water, fresh water is bad, flush with alcohol(isopropyl), baking soda, meat tenderizer, remove with forceps,immobilize
Starfish calcium carbonate crystals that secrete toxins, could result in sstemic reaction
Sea cucumber produce liquid toxin from anal tentacle, Tx, apply heat or hot water
Stingray sting produces laceration 15-20 cm long, localized and systemic reaction. TX-irrigation w/fresh water, remove stinger, immerse in hot water
Physiological dependence removal of drug causes adverse physical reactions
Psychological dependence use required to prevent or relieve tension or emotional stress
Tolerance must use more to get desired effect
Narcotics CNS depressants, cause respiratory distress S/S= PINPOINT pupils
Sedative hypnotics Benzodiasepines (anxiety,stress, insomnia,alcohol withdrawl,epilepsy,) Barbituates (anxiety, insomnia) TX: lasiz, sodium bicarb
Amphetamines benzedrine, dexedrine, cocaine, ritalin (S/S=DILATED pupils, SNS afects) TX: treat dysryhthmias, Valium 5-10 for seizures, Haldol for hyperactivity)
Drug ingestion OD 1st-heroin, 2nd-alcohol,3rd-cocaine
Cocaine CNS A2 blocker-produces profound SNS discharge- Freebase-cocaine mixed with alkaline soluion (dilated pupils)-fatal dose 1200mg.TX for seizures Valium 5-10mg
Hallucinogens PCP and LSD,MDMA, weed,srooms-Dilated pupils-TX-valium and haldol
Rohypnol-potent benzo causes sedation and amneisa
Alcohol most abused drug-absorbed in intestines in 30-120 mins, inhibits ADH=increaseddiuresis TX: chemstrips, 25 gm og D50, 100 mg thiamine
3 dependence factors personality, environment, addictive nature
Alcohol Dependence Stage 1-tolerance to drug, stage 2-memory lapses during drinking episodes, stage 3 lack of control, stage 4 prolonged binges, mental complications
Organophosphates inhibits effects of AChE-cholinergic overdrive-TX: remove clothes, wash water n soap,Atropine, 2-5mg every 5-15min,diazepam 5-10mg for seizures, Pralidoximine 2pam chloride-600mg IM or 1-2 gm IVP over 15-30
Methanol tx: PO/lavage, 30-60 ml of 80 proof ethanol-administer ethanol through lavage
Methanol posoining wood alcohol, GAS lin Antifreeze,no more toxic than ethanol but metabolites are extremely toxic-10-15 ml of 40% solution can cause death, (4cc can cause blindness)-liver converts alcohol to formaldehyde n in mins to formic acid=metabolic acidosis,
Methanol " onset f S/S-40mmin to 72 hrs, dilated sluggish pupils,blindness
Ethylene Glycol in antifreezes, pains,-Lethal dose 60 ml, toxicity caused by glycolic and Oxalic acids, causes hypocalcemia, Oxalate prevents Ca++ from being absorbed
Ethylene S/S CNS effects-1-12hrs, cardio pulm 12-30hrs-renal effetcs 24-72. TX gastric lavage within 1hr, charcoal, IV isotonic solution, sodium bicarb, 80% ethanol 30-60 ml,(blocks conversion to metabolites) Thiamine to degrade glycolic acid, calcium gluconate or
" calcium chloride for hypocalcemia, diazepam for seizures
Created by: rebeccabelleth