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poison

Poison elimination

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Logic would have it that in the case of coming into contact with poisons, one should remove from the body any toxic substance that has entered it, but clinical observations have shown that this approach is often practiced by only a few people and with questionable benefits. In addition, impairments in physical state may result from the substances administered for this purpose.

Environmental exposure

Steps must be taken to stop the exposure of toxic substances. Anyone in a polluted atmosphere should be removed and taken to fresh air without endangering rescuers. In case toxic gases and vapors are exhaled or inhaled, ventilation of the room can be encouraged, trying to speed up the removal of the toxic substance.

Skin contamination

If a toxic substance is deposited on the skin , it is possible to see skin reactions; in fact, only some garments are totally impermeable. In this case, the patient should be undressed immediately and the skin washed with soap and water. The eyes also need to be rinsed with plenty of water or saline solution.

Stomach emptying

Many times it happens that poisons enter the body by ingestion. In this case, the toxic substance must be recovered before it advances down the alimentary canal. The simplest way isgastric aspiration and a gastric lavage. This procedure is not without dangers and should not be considered as a method that should always be applied.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Ingestion of poisonous substances

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Ingested poisons normally stay in the stomach for a short time. Absorption occurs after the poison has passed through the small intestine. A poisonous substance does more damage to the intestines than to the gastric system. Symptoms include abdominal pain and cramps, nausea, vomiting, diarrhea, burns, drowsiness, and loss of consciousness.

What to do?

  1. In the event that you have ingested poisonous substances you need to acquire key information about the victim. If a corrosive or caustic substance has been swallowed, drink water or milk immediately. If the victim is unconscious, check vital signs and call an ambulance.
  2. Call the poison center. Through their advice it is often possible to solve poisoning problems without hospitalization of the patient.
  3. Place the patient on the left side to delay gastric emptying in the small intestine where the poison is absorbed faster.
  4. Try not to induce vomiting unless advised by a poison control center. Do not use salt water, raw eggs or mustard and do not induce vomiting.
  5. Bring any container of poison to the hospital along with the patient.

Source: Mediserve‘s Pocket Guide to First Aid.

Methods of poisoning: barbiturates

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Today, compared with years past, barbiturate poisoning has greatly decreased, as they are no longer prescribable as before. Short- and medium-acting barbiturates are more toxic than long-acting ones. The mode of action has not yet been clarified.

Signs and symptoms

With a barbiturate overdose there is a loss of consciousness and a deep depression of breathing. You can also have a cardiovascular collapse that is accompanied by renal failure. They are very pulmonary complications are common, and bullous lesions may appear.

Diagnosis and treatment

The picture of barbiturate overdose is not much different from coma due to other causes. Diagnosis can only be unequivocal through blood samples. Most patients are treated by avoiding stimulants and antidotes. Emptying the stomach can be very helpful if done within 6 to 8 hours of ingestion.

Source: Vadecum of poisoning therapy by Roy Goulding

Methods of poisoning: blockers (propranolol, atenolol, oxprenolol)

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An overdose of such drugs in children may occur accidentally, while in adults it may be voluntary or from therapeutic overdose. By their blocking action on nerve endings, these drugs exert a powerful negative inotropic and chronotropic effect on the heart. The main symptoms are hypotension, convulsion and, in severe cases, coma.

Diagnosis and treatment

Diagnosis is derived from the medical history as laboratory tests are of little help in emergency situations. The stomach can be emptied even many hours after ingestion, and the treatment is directed to clear the body and stimulate the cardiovascular system. If blood pressure does not rise, prenalterol can be administered in a dose of 5-10 milligrams into a vein. As a last resort, application of an intravenous pacemaker may be necessary.

Source: Vadecum of poisoning therapy by Roy Goulding

Poisonings: clinical monitoring

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Laboratory investigations date back more than 150 years, when analysis was first used. quantitative chemistry. The main purpose was to solve cases uncertain legal. The transition from the cautious and demanding approach is not been a simple matter, as the correlations between laboratory findings and clinical status are not very precise. For this very reason, we do not it is surprising that even today the toxicology laboratory does not occupy a place of prominence in the poisoning unit.

Clinical Chemistry

In the treatment of a poisoning it is also necessary to assess the patient’s biochemical status, which can only be safeguarded if the pH of the blood can be recorded and of urine, plasma electrolytes and blood gases.

Chemical Toxicology

When it comes to an emergency, knowing the poison is not an absolute necessity. It should, instead, always collect stool samples, vomit samples, and heparinized blood that does not should ever be destroyed, as they provide invaluable evidence of the value. Even in the ward, most overdose cases are of modest entities, so they can be treated without the need for specific knowledge of toxicology. Of course, there are always situations where an analysis is needed. toxicology.

Screening

Through a screening qualitative chemistry it is possible to have much clarification regarding poisoning. The laboratory chemist can only report the results, while the physician Is up to the interpretation of such. A screening program is never fully comprehensive and a negative answer does not rule out poisoning outside the of the scope of screening capabilities.

Quantitative methods

Ensure the presence of a substance has its limits, in fact you can get more Information from the determination of the concentration of toxic agents. Often procedures can take a long time. For many of the poisons you see In practice, tables have been published showing the levels that are should wait in a therapeutic regimen and those who depose for an overdose of the drug. Of course, the response may vary from patient to patient.

Drug addiction

People addicted to drugs are unreliable in medical history. Moreover, in order to obtain more “generous” prescriptions, they tend to exaggerate the extent of the abuse done. When they fear incurring justice they try to convince of the innocence of what happened. It is difficult to carry out quantitative studies on patients who are dependent toward a drug. It should be kept in mind that even the results of qualitative studies performed on urine cannot be transposed to serum levels and are exposed to criticism from a medico-legal point of view for narrow validity.

Source: Vadecum of poisoning therapy by Roy Goulding

Methods of poisoning: antidepressant drugs

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Today patients with antidepressant drug overdose. represent a large portion. The pharmacological properties of the antidepressants are multiple and include interference with release of adrenaline at the level of brain neuromas, a reduction in the activity of the parasympathetic nervous system and a picture of cardiac disturbances.

Signs and symptoms

Symptoms of poisoning are: numbness, dryness of the jaws, dilated pupils, tachycardia, and heightened tendon reflexes. Subsequently, sudden cardiac arrest is possible.

Diagnosis and treatment

If the patient suffers from depression and has been prescribed antidepressant medication, the diagnosis can be made with some confidence. Many patients take mild overdoses of antidepressant drugs and survive with just assistance. In cases of large overdoses, high mortality is possible. It is necessary that the patient’s stomach be emptied with induction of vomiting or gastric lavage. In the meantime, normal supportive measures should be undertaken, with special attention to breathing. In case convulsions occur, it is important to administer 5-10 mg of Diazepam intravenously. If cardiac arrhythmias persist, antiarrhythmic drugs should be used.

Source: Vadecum of poisoning therapy by Roy Goulding

Hymenoptera venom allergy

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Allergy due to the components of the venom contained in the sting of hymenoptera can cause extensive local reactions or systemic reactions. As for the extensive local reactions edema appears at the injection site of the diameter greater than 10 cm, which can persist for 24 hours. As for the systemic reactions there are 4 degrees:

  • Grade 1: Hives, itching, malaise and anxiety.
  • Grade 2: 1st grade + angioedema, nausea, vomiting, chest tightness, diarrhea, pain abdominals and dizziness.
  • Grade 3: 1st and 2nd degree + two of the following symptoms: dyspnea, stridor, hissing, dysarthria, confusion, dysphagia and feeling of distress.
  • Grade 4°: 1°+2°+3°+ two of these symptoms: collapse, incontinence, loss of consciousness, cyanosis, and drop in blood pressure.

It is necessary to quickly remove the stinger using tweezers. Then evaluate whether ECG and blood gases are needed, but also skin tests for hymenoptera. As for treatment take antihistamines, corticosteroids, cold compresses, immobilization and elevation of the affected limb. In the case of mild forms, observation of vital parameters is recommended until symptoms improve for at least 12 hours. If severe forms observation for at least 24 hours.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Methods of poisoning: cardioactive glucosides

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Overdose of these drugs is chronic and is almost always due to careless treatment. The reactions can be seen as an exaggerated expression of their pharmacological properties. Once toxic levels are reached, the subject experiences mental confusion, vomiting, diarrhea and visual disturbances. Subsequently, bradycardia and overlapping arrhythmias occur, which may result in tachyarrhythmias.

Diagnosis and treatment

History and clinical signs are sufficient to make the diagnosis, but at least for digoxin it must be with measurement of plasma levels. Within 18 to 20 hours after acute ingestion, the stomach should be emptied by inducing vomiting, immediately after which a dose of activated charcoal (100gr for an adult, 25 for a child) can be given. IV potassium can be administered for hypokalemia. For individuals with heart disease and those showing atrioventricular blockade, an intravenous pacemaker may be necessary.

Source: Vadecum of poisoning therapy by Roy Goulding

Paracetamol: what to do?

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In some countries, paracetamol is sold in quantities greater than aspirin. Most people, they do not know the differences between the two substances. For this reason, poisoning by paracetamol in children.

There are mainly two therapeutic doses: in small part is eliminated by the kidney, while for the most part it is eliminated always from the kidney, but in the form of inactive metabolites.

Signs and symptoms

Those who take an overdose of paracetamol may remain disappointed by not experiencing any symptoms during the first day. Subsequently, however, the presenting picture is that of acute liver failure. The patient may experience abdominal pain. Histologically, the cellular damage liver is initially centrolobular, so it tends to become confluent.

Diagnosis and treatment

From a clinical point of view, the difficult thing is to decide whether the patient has ingested acetaminophen in such quantities as to require administration of the antidote. The medical history is of great help because if less than 15 grams have been ingested there is little to worry about. If the dose has been exceeded then liver damage is certain and death is almost inevitable. If the history is certain, no further time should be wasted and methionine should be administered immediately orally or intravenously. The side effects of these antidotes are minimal, especially if given within 10 hours of taking acetaminophen. Ancillary measures include gastric lavage, which can be performed within 6 hours.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: salicylates

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The most common type of poisoning is from aspirin, a drug that contains acetylsalicylic acid. Aspirin tablets are very popular among adults intent on poisoning. In the body, salicylates exert complex actions on the breath centers, electrolyte balance, metabolism and stimulation of certain brain structures.

Signs and symptoms

With an overdose during therapy, the toxic effects tend to occur slowly. Even if the patient remains vigilant complains deafness, blurred vision, ataxia and also often shows tremor and irritability. Subsequently, the patient enters hyperventilation and the dehydration can be a sequela.

Diagnosis and treatment

The presence of a very nuanced symptomatology should not reassure, as in a short time it is possible for a serious deterioration of the condition to occur, especially in children. Once the diagnosis is clear, it is important that any kind of imbalance be corrected. An attempt can, therefore, be made to empty the stomach: with children, induction of vomiting can be used, while in adults, gastric lavage is best. It is also necessary to monitor the lungs to prevent the onset of pulmonary edema. Should renal failure occur, hemodialysis is mandatory.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: quinine, quinidine

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The two compounds differ only in their optical isomerism, but toward living systems quinidine is more toxic. Quinine overdose is less common than before, as it is mainly used for abortion. Both drugs are muscle depressants and both are excreted rapidly.

The main symptoms are nausea, headache, vomiting, ataxia, Diarrhea, abdominal pain, and tinnitus. Tachycardia is associated with arrhythmia heart rate and to drop blood pressure. Some subjects may manifest these symptoms even at very low doses.

Diagnosis and treatment

Diagnosis is almost always based on history, and because of rapidity in treatment, plasma-type investigations are excluded. Due to the presence of spontaneous vomiting, active emptying of the stomach is unnecessary. Supportive measures are the basis of treatment, with bilateral stellate ganglion block maneuvers by direct injection of a local anesthetic.

Source: Vadecum of poisoning therapy by Roy Goulding

Tranquilizers as a method of poisoning

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Drugs of this type are divided into 2 groups major: minor tranquilizers and major tranquilizers.

Tranquil minors

These drugs are certainly less dangerous than the barbiturates, whose place they took. Of course, it is possible that taken together with other drugs there is a potentiating effect. Ataxia, the loss of consciousness and respiratory depression generally respond to a symptomatic treatment, whereas if the ingestion occurred a few hours earlier it may gastric emptying be helpful.

Tranquillant majors

They have greater effects than minor tranquilizers and are capable of causing various disturbances in the functions of the body. The presence of these drugs in the urine can be ascertained by colorimetric reaction. The diagnosis is deduced from the history, seen together with the symptom complex. In addition to usual treatment, it may be necessary to quell symptoms with benzotropin. forced diuresis, hemodialysis, and hemoperfusion are unable to promote the elimination of these drugs from the body.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: carbon monoxide

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Carbon monoxide is definitely one of the most frequent occurrences of poisoning. Until recently, a source of monoxide carbon was given by city gas taps. Nowadays in many countries it is been replaced by methane or “natural gas,” which is devoid of constituent toxic. Today, the main source of carbon monoxide it’s due to the exhaust gases from internal combustion engines. Most of these cases of poisoning are accidental, although it is still a method of choice for commit suicide.

Signs and symptoms

Carbon monoxide is odorless and its presence is recognizable only because of the harmful effects it generates in beings living. Early manifestations can be mistaken for hysterical symptoms. The gastrointestinal system may be affected with vomiting and incontinence fecal. The skin and mucous membranes may take on a pinkish tinge, and it is possible that bullous lesions appear at some pressure points.

Diagnosis and treatment

Although the initial symptoms are not characteristic, the history and circumstances often lead to the diagnosis. Confirmation that it is poisoning is by measuring the level of carboxyhemoglobin in the blood. At this point the patient should be removed from the polluted area and oxygen administered. If there is no quick recovery, it is necessary to transfer the patient to a hyperbaric chamber. To cope with possible cardiac complications, the patient should be kept at absolute rest with ECG monitoring.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Chlorine-organic insecticides

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Chlor-organic insecticides include aldrin, dieldrin, endrin, dicophane and lindane. Because they are substances that resist chemical degradation, they can persist in the environment, and as a result, it is mandatory to withdraw them from use in almost all countries. All chloro-organic insecticides act as central nervous system stimulants. Chronic exposure promotes the accumulation of these substances in adipose tissue, which sequesters the substance. Stimulation of the nervous system leads to excitation, convulsions and muscle fasciculations.

Diagnosis and treatment

A blood sample can be taken to confirm the diagnosis and wait for the objective examination. Exposure almost always occurs parenterally, but if a substance is ingested it is necessary to empty the stomach and administer a saline purgative. As for seizures, it is possible to control them with diazepam.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: alcohol.

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In the case of ethanol poisoning, the central effect is. strictly dose-dependent, with progression of brain structures more specialized. Methanol, on the other hand, exerts less depression on the system central nervous system, but it damages the eye.

As for ethanol, it initially determines. a change in mood, characterizing an empty-headed feeling, excitement and exaltation. The picture evolves with dulling of the sensorium, The slowing of reaction time and obvious incoordination. In the stadium more advanced you will have muscle flaccidity, depression of tendon reflexes, stupor, coma and respiratory depression.

Methanol intoxication, however, is different in that stupor and stupor occur 12-36 hours later, when vomiting, abdominal pain, and ataxia assail the patient.

Diagnosis and treatment

The medical history may be unreliable. Breath testing can be useful as a primary screening to determine whether alcohol introjection is involved. The blood test is simple and reliable, and through it the alcohol level can be measured.

For ethanol intoxication, the basis of treatment is intensive supportive therapy, including gastric lavage. For methanol poisoning, the latter should be done within 4 hours of ingestion, and acidosis should be treated by administration of intravenous sodium bicarbonate.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: ethylene glycol

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Ethylene glycol can be considered an alcohol polyhydroxylated. It appears to be low in toxicity but with the intake of other medication could cause death. A dose of 100 ml is very dangerous, if well some people are also cured by ingesting larger amounts. The clinical picture is the same as ethanol intoxication. After some time appear nausea, vomiting, muscle twitching, depression, convulsion and coma.

Diagnosis and treatment

Apart from the history, confirmation of intoxication is obtained by classical aspiration, through which the presence of a blue-colored liquid can be noted. In fatal cases, autopsy reveals diffuse cerebral edema with deposits of calcium oxalate crystals in the meninges. If the patient presents a few hours after ingesting the ethylene glycol then gastric lavage can be performed and sodium bicarbonate administered to correct the acidosis. When hypernatremia is high, it can be reduced with hemodialysis.

Source: Vadecum of poisoning therapy by Roy Goulding

Pentachlorophenol poisoning

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Pentachlorophenol is used as a protective coating on beams. Occupational exposure occurs mainly through the skin. This substance acts as an uncoupler of oxidative phosphorylation. There are several controversies for chronic pentachlorophenol poisoning , due to the presence of trace amounts of dioxin found as end products during the production process of the substance.

Overexposure to such a substance leads to a state of hypermetabolism similar to that seen with dinitro compounds, but without the Yellowish discoloration of the skin.

Diagnosis and treatment

Chemical tests are of little assistance to the clinician except to identify the type of compound. Treatment follows the same course of action as dinitro-compound poisoning.

Source: Vadecum of poisoning therapy by Roy Goulding

Carbamate insecticides: what are they?

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Carbamate insecticides are being used more and more often as commercial pesticides. The pharmacological action is similar to that of the organophosphorus compounds, with the difference that binding to cholinesterases Is spontaneously reversible. Clinically, it is not possible to distinguish carbamate poisoning from that of organophosphorus.

Diagnosis and treatment

In terms of diagnosis, it is necessary to rely solely on the history, signs and symptoms. The treatment is the same as that from organophosphate poisoning.

Source: Vadecum of poisoning therapy by Roy Goulding

Paracetamol abuse

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Paracetamol is mainly used as an analgesic as an alternative to salicylates and is characterized by toxicity, which should not be overlooked. Toxic doses vary from person to person, so many have determined that the amount needed to induce liver damage is 15 grams, while the fatal risk requires 25 grams.

During the first day, symptoms are nonspecific: pallor, vomiting, nausea, and sweating. Then liver damage appears, eventually progressing to hepatomegaly, jaundice, hypoglycemia, and encephalopathy.

What are the principles of therapy?

  • Induction of vomiting, gastric lavage and activated charcoal if action is taken within 6 hours of ingestion.
  • Methionine, specific antidote or N-acetyl-cysteine
  • Silymarin
  • Vitamin K

Source: Medical Guard Handbook edited by Piercarlo Salari (Mediserve)

Poisonings: dinitro-compounds

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These compounds are used in orchards as a “winter wash” and as a herbicides in summer. From a toxicological point of view, their action biochemistry is common to all compounds. The most obvious symptoms are tints yellowish on the skin, fatigue, sweating, agitation, tachycardia, weight loss and collapse.

Diagnosis and treatment

A person’s medical history and appearance are sufficient for diagnosis, but if not, a blood sample must be taken to assay dinitro-compound levels. There is no antidote; complete rest, oxygen administration and adequate ventilation are required.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: opiates

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Opiates are considered opium, morphine, pethidine, diamorphine, methadone, pentazocine, and dextropropoxyphene. These are able to sedate pain and result in drug dependence. Their production and sale are under strict control of the law. Overdose can be due to therapeutic excess, voluntary or negligent self-administration. In addition to the analgesic effect, these drugs have the ability to depress the entire central nervous system. The triad formed by coma, respiratory depression, and point myosis is diagnosed and often associated with cyanosis. Usually skeletal muscles are flaccid, and cardiovascular collapse is not severe.

Diagnosis and treatment

Circumstances usually lead to the diagnosis, and the sign of a recent injection is an important clue to look for in any case. Treatment is a true urgency and should never be postponed. To combat coma and respiratory depression, a specific antidote must be administered. Within a few minutes there is an improvement in breathing. In case there is no improvement one must opt for a different cause than opiate poisoning.

Source: Vadecum of poisoning therapy by Roy Goulding

Poisoning by anticoaugulants

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Anticoagulants are based on warfarin and related substances. The material found commercially is ready to be diluted, so that the content of baits prepared to keep rodent populations down is usually low. The animals that die are those that repeatedly eat the substance, reaching very low coagulation levels. If you do not ingest a large dose, it is difficult to be harmed; in fact, you need to swallow more than 1 kg of bait to take a big risk.

Diagnosis and treatment

The diagnosis can be substantiated by the finding of a prolonged prothrombin time in the absence of organic pathology to justify it. Treatment is carried out by administering vitamin K1.

Source: Vadecum of poisoning therapy by Roy Goulding

Types of poisoning: chlorates

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Sodium and potassium chlorates are still used today to clean the soil of all vegetation. These substances in their dry state are strong oxidizing agents and present a high risk of flammability, with the possibility of explosion. For workers, there are no major risks, but if someone ingests the substance it can be highly toxic, as a single dose si 15 g can be lethal for an adult. Immediately after ingestion there is a burning sensation in the mouth and tongue, followed by abdominal pain, vomiting, mental confusion and cyanosis. Subsequently, seizures and kidney damage may appear.

Diagnosis and treatment

The clinical picture is generally diagnostic. Gastric lavage and administration of a saline purgative is required within a few hours after ingestion.

Source: Vadecum of poisoning therapy by Roy Goulding

Types of poisoning: fluoroacetates

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Fluoroacetates are powerful poisons and their use is limited to special conditions, such as aboard ships or in sewers. Fluroacetates block the tricarboxylic acid cycle of carbohydrate metabolism. Their toxic action occurs within one to two hours after ingestion. The symptoms that occur are agitation, convulsions, heart irregularities, collapse, and coma.

Diagnosis and treatment

Clinically, it is not possible to wait for the results of laboratory tests. It is possible to analytically assess the concentration of fluoroacetate in the blood, but usually the result is used after death. Besides fighting seizures with diazepam all that can be done is to maintain breathing and ensure all supportive measures.

Source: Vadecum of poisoning therapy by Roy Goulding

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