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Types of poisoning: chloralose

Chloralose is a derivative of chloral hydrate. The portion of the latter that is released into the body is rapidly metabolized to trichloroethyl alcohol. This substance is a central nervous system depressant and can cause death. Because chloralose is very potent discrete amounts must be ingested for the person to fall asleep.

Diagnosis and treatment

If there is any doubt about the diagnosis, it is necessary to measure the concentration of trichloroethanol in the blood. The treatment is the same as that used in barbiturate or chloral hydrate overdose.

Source: Vadecum of poisoning therapy by Roy Goulding

What to do in case of lead poisoning?

Lead abounds in nature as it is distributed over the earth by reaching the environment for extraction from natural deposits. Lead enters metabolism and interferes with normal heme synthesis. It also acts on the nervous system, both centrally and peripherally. True lead poisoning can only occur with certain types of salts of the metal, so toxicity is not strictly related to the metal, but to the behavior of the ingested substance.

This type of poisoning can set in very insidiously with the appearance of symptoms when the lead content in the body becomes excessive. The main symptoms are abdominal pain, nerve palsy, metallic taste, and constipation. If lead has been ingested in the intestines an X-ray may show opacities.

Diagnosis and treatment

Lead poisoning can be recognized through the symptoms described above. Additional tests include assay of amino-levulinic acid dehydrase activity in erythrocytes. Acute poisoning requires supportive treatment to balance dehydration and electrolyte loss. Chronic poisoning, on the other hand, requires specific chelation-type therapy when symptoms are evident and blood levels are above 100 mL in adults and children.

Source: Vadecum of poisoning therapy by Roy Goulding

Mercury Poisoning

Mercury when ingested has no effect in the body. The tiny droplets of mercury react with hydrochloric acid in the stomach to form chloride. Instead, when mercury comes into contact with the skin it is absorbed percutaneously, giving rise to the clinical picture known as hydrargyrism. From a biochemical point of view, mercury appears to have an affinity for sulfhydryl binding and is therefore capable of altering cellular metabolism. When mercury salts are ingested, the first symptoms are burning at the oral cavity, followed by constrictive-type pain retrosternally, with vomiting and diarrhea. If, on the other hand, mercury vapors are inhaled, a dry, hacking cough with dyspnea, pyrexia, and muscle aches appears after a few hours.

Diagnosis and treatment

The clinical picture, combined with the medical history, is almost always sufficient to make a diagnosis. Acute metal salt poisoning requires resuscitative treatment with hemodialysis. With metallic mercury the acute symptoms respond to symptomatic type measures so if there are signs of chronic poisoning dimercaprol therapy can be undertaken as with arsenic and with the same precautions.

Source: Vadecum of poisoning therapy by Roy Goulding

Types of poisoning: phosphine

Phosphine is highly toxic. Therefore, to safeguard those who are forced to use it, they are preparations were made that generate the gas on the ground. Phosphine, a when inhaled, it acts rapidly on the central nervous system and the gastrointestinal system. The main symptoms are abdominal pain and vomiting, which usually precede The occurrence of dizziness, convulsions, coma, and death.

Diagnosis and treatment

There are no diagnostic laboratory tests. The measures that are usually taken are for general support, but with this type of poisoning there is little that can be done.

Source: Vadecum of poisoning therapy by Roy Goulding

Heavy metals and metalloids: iron

Metallic iron does not give toxicity problems, although there are people with congenital defects in matabolism, for whom it behaves like a poison. Iron salts are pharmaceuticals for the treatment of anemia, and in case of overdose they can be very dangerous. Taken orally, iron salts are irritating to the gastrointestinal tract. The main symptoms are vomiting, epigastric pain, and diarrhea. Later, pulmonary edema, metabolic acidosis, and renal failure may appear.

Diagnosis and treatments

Aside from signs and history, a serum iron level above 8 mg in an adult and 5 mg in a child depicts dangerous poisoning. After determining that it is iron poisoning, gastric lavage is necessary. At the same time, vigorous resuscitative treatment should be started, taking care to restore hydroelectrolyte balance. In the case of renal failure, peritoneal dialysis or hemodialysis should be undertaken.

Source: Vadecum of poisoning therapy by Roy Goulding

Arsenic Poisoning

Although arsenic is not a metal but a metalloid, it is widespread in nature and prolonged exposure causes a carcinogenic effect. Arsenic derivatives are used within industries as pesticides or as medicines. Chronic poisoning often results from oral or percutaneous absorption. In tissues, arsenic binds to sulfhydryl enzyme systems. Acute arsenic poisoning, on the other hand, usually occurs from ingestion of arsenic trioxide. A bitter taste may be experienced, but for the next two hours nothing may happen until vomiting, diarrhea, and abdominal pain appear.

Diagnosis and treatment

Diagnosis of acute arsenic poisoning cannot wait for laboratory answers, but as for chronic poisoning, the most suitable samples for diagnosis are nail fragments or hair taken with the entire root. Regarding treatment, resuscitative and supportive therapy is required. Hydro-electrolyte depletion must be corrected as soon as possible representing the cornerstone of effective therapy. Dimercaprol also appears to be effective in the same way.

Source: Vadecum of poisoning therapy by Roy Goulding

Metals and metalloids: thallium

Although thallium comes used in industry does not appear to create employment risks. The action of the thallium at the biochemical level is not yet known and all we can say is that its metabolism is linked to that of potassium. After a single dose of thallium salts occurs a gastrointestinal reaction that can pass unnoticed. After a couple of days, a burning sensation starts in the feet and hands with Muscle weakness, ataxia, and constipation. From a clinical point of view, poisoning. by thallium is more difficult to recognize than other poisonings.

Diagnosis and treatment

If left untreated, thallium poisoning can be fatal. Once the diagnosis is clear, potassium ferrocyanate can be administered. Thallium in this way is chelated in the intestines and excreted with feces. The metal that has already penetrated the tissues is protected by the antidote.

Source: Vadecum of poisoning therapy by Roy Goulding

Heavy metals: lithium

Lithium is a metal that is quite widely used in industry. Lithium carbonate is prescribed for the treatment of manic-depressive psychosis. The action that lithium plays at the molecular level is unclear, but it appears to interact in the cell with sodium and potassium. The most common symptoms are drowsiness, thirst, diarrhea, behavior modification, and convulsions. On objective examination there is increased muscle tone, and protein is visible in the urine.

Diagnosis and treatment

Diagnosis of lithium poisoning is made by assaying blood levels, which are normally below 1.30. Treatment includes the use of diazepam if seizures occur. Peritoneal dialysis or hemodialysis is safer and more effective.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Arsina: what to do?

Arsine is a gas that is handled in its pure state in industry or is unexpectedly released from other metals when they come into contact with nascent hydrogen. Arsine has the property of hemolyzing mature erythrocytes and even at very low concentrations is inhaled, rapidly reaching the blood through the lungs. The main symptoms are vomiting and abdominal pain. In severe cases, pulmonary edema develops and it is possible for the patient to go into a coma.

Diagnosis and treatment

The diagnosis is almost always supported by the medical history. The measurement of arsenic in blood and tissues is almost always retrospective. Transfusions should be started as soon as possible, and renal damage should be treated conservatively.

Source: Vadecum of poisoning therapy by Roy Goulding

Heavy metals and metalloids: copper

Copper is widespread in nature and is an essential element for many life forms. In the metabolic disorder known as Wilson’s disease, copper accumulates in the body leading to hepato-lental degeneration. Apart from Wilson’s disease, metallic copper has no toxicity. Soluble salts can be corrosive to living tissue and in a dose of 10 grams can be fatal to humans.

Diagnosis and treatment

For this type of poisoning there is no analysis, so therapy is chosen according to the needs of the moment. Treatment is based on resuscitative therapy, with blood transfusions if hemolysis requires it.

Source: Vadecum of poisoning therapy by Roy Goulding

Poisoning from petroleum derivatives

Petroleum derivatives consist of aliphatic hydrocarbons, which may contain a small amount of aromatic hydrocarbons. Many petroleum derivatives may also contain a small percentage of organic lead.

At the time a patient ingests these products, it is best to override the attempt to empty the stomach; in fact, this could cause bronchial aspiration. Spontaneous vomiting can also lead to the same complication. Inhaled oil can be responsible for dizziness, ataxia, motor incoordination and loss of consciousness.

Treatment should be supportive, with emphasis on cardiac arrhythmias and acute heart failure. Chronic exposure can cause leukopenia and aplastic-type anemia. This can be avoided with proper occupational hygiene.

Source: Vadecum of poisoning therapy by Roy Goulding

Chlorinated hydrocarbons: what are they?

In this group of chemical compounds we find carbon tetrachloride. Similar to the latter there is chloroform and other derivatives that have replaced it.

In addition to the narcotic features that mimic inhalation anesthesia, with respiratory depression there may also be excitation in the brain. Certainly more dangerous are cardiac arrhythmias and gastrointestinal symptoms that can progress to liver failure. Again, supportive treatments are applied with maintenance of respiration followed by treatment for liver and kidney failure.

Source: Vadecum of poisoning therapy by Roy Goulding

Formaldehyde: what is it?

Formaldehyde is a gas that dissolves in water, resulting in a formalin solution. In the atmosphere, formaldehyde gas is very irritating and causes coughing, tearing, eye burning and pain, bronchial irritation and pulmonary edema. If a subject ingests formalin, it acts as a corrosive agent.

Treatment

Reactions to vapors should be treated symptomatically, with the certainty of avoiding further exposure. When formaldehyde is ingested, the treatment to be used is the same as for corrosive poisoning.

Source: Vadecum of poisoning therapy by Roy Goulding

Irritants, corrosives and caustics

There are plenty of chemicals on the market with irritating, corrosive and caustic characteristics to living tissue. Accidents can occur in both adults and children, who do not know the danger of these substances. There are, then, also people who use these substances for suicidal purposes.

Applied to the skin these substances cause inflammation, blistering, ulcers or penetrating necrosis. Most often the damage remains limited to the area of contact. With ingestion, on the other hand, there is physical-chemical trauma at the level of the gastrointestinal tract, with exposure of the sub-mucosal layer. The oral cavity and pharynx are the main targets but strangely these regions can also be spared, while the larynx may show erosions or become edematous. At first, the patient experiences a choking sensation with burning in the tongue and oral cavity. Generalized collapse or perforation of the esophagus and stomach may then appear. If 10-20 ml of concentrated hydrochloric acid, sulfuric acid, nitric acid, oxalic acid are ingested, they can be fatal.

Diagnosis and treatment

The diagnosis is usually obvious because of the circumstances and the manner in which they occur. Gastric lavage can cause far greater risks than possible benefits. Milk or water can be given to drink to dilute the substances, and if the pain agitates the patient too much, an analgesic should be administered. Cardiovascular collapse can be prevented by a strict supportive regimen with maintenance of hydroelectrolyte balance.

Source: Vadecum of poisoning therapy by Roy Goulding

Cyanide poisoning and derivatives

Cyanide ranks first as a pesticide, but it is not the only way through which you can poison yourself. Organic cyanides are highly toxic if ingested. These salts can also be absorbed percutaneously and the most dangerous is hydrogenated cyanide gas. Another source of cyanide is found in the kernel of some fruits, such as apricots and almonds. The action of cyanide is quite specific: it blocks cytochrome oxidase so that metabolism stops.

Symptoms appear in a short time. Initially, the patient experiences dizziness and agitation, followed by headache, tachycardia, and chest tightness. Other symptoms that occur are mental confusion, ataxia, weakness, and collapse.

Diagnosis and treatment

As for diagnosis , it is necessary to measure plasma cyanide levels, but in cases of acute poisoning it is not possible to wait for the results of these investigations. As a first measure, an amyl nitrite capsule should be broken under the patient’s roots, so that the volatile substance is inhaled making sure that the patient breathes by avoiding mouth-to-mouth respiration. The treatment involves dicobalt edetate, which is found to be the most effective. An alternative treatment is the injection of sodium nitrate and sodium thiosulfate.

Source: Vadecum of poisoning therapy by Roy Goulding

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