CASE 6

POISONING

Definition
Poisoning is the entry of toxic substances into
the body through the digestive tract,
inhalation or direct contact causing clinical
signs and symptoms of a typical.

Classification

BY WAY OF SUCH
Self Poisoning

Patients taking medication to overdose but with the

knowledge that this dose is not harmful.
It could happen to teenagers who want to try using
drugs, without realizing that these actions can harm him.

Attempted Suicide

In this case, the patient was suicidal, but can end in death
or patient recovered because of misinterpretation in the
use of doses.

Accidental Poisoning

It is an accident without the element of intent at all.

Many occur in children under 5 years old, because of his
habit insert any objects into the mouth

Homicidal Poisoning

Crime is caused by someone deliberately poisoned

someone

EARLY BY SUCH TIME

Chronic: diagnosis is difficult to enforce
because the symptoms develop slowly and
shortly after exposure
Acute: sudden arise after exposure and often
about the many people

Diagnosis
Anamnesis and alloanamnesis
Physical examination the entry of toxin
Oral route
Inhalation
Skin and mucous
Parenteral

Diagnosis
Smell

Cause

Acetone

Isopropil alcohol, acetone

Almond

Cyanide

Garlic

Arsenic, selenium, thalium

Rotten eggs

Hydrogen sulfide, mercaptan

Urine color

Cause

Green / blue

Blue methilen

Yellow - red

Rimfampisin, iron(Fe)

Dark brown

Phenol, cresol

Whitish granules

Primidon

Brown

Myo/hemoglobinuria

Examination
Toxicology analysis
-50 ml urine, 10 ml serum, regurgitated material, feces

Radiology
- if you suspect there is aspiration of toxic substances through
inhalation or suspected perforation of the stomach

Laboratory
- blood gas analysis
- liver, kidney, urine sediment
- GDS
- a complete blood

BLOOD GAS ANALYSIS

BLOOD GAS ANALYSIS

INTERPRETATION

Respiratory asidosis
(pH < 7,3; PCO2 > 5,6 kPa)

Hypoventilation, CO2 retention, probably

due to CNS antidepressants

Respiratorik alkalosis
(pH > 7,45; PCO2 < 4,7 kPa)

Hyperventilation may be in response to

hypoxia, injury drug (aspirin) or a CNS
injury

Metabolic alkalosis
(pH > 7,45; HCO3 >30 mmol/l)

Rare in poisoning, as a result of the loss of

excess acid or alkali

Metabolic acidosis
Often the poisoning, when severe
(pH <7.45; HCO3 <24 mmol / l,
poisoning alert ethanol, methanol,
base deficit <-3) compensation if ethylene glikkol
PCO2 <4.7 kPa
High anion gap

Metformin, isoniazid, salicylates, cyanide

Primary Survey and Secondary Survey

Hydrocarbon Poisoning

Clinical feature of hydrocarbon poisoning

Type

Example

Risk of
pneumona

Risk of
sistemikToxicity

Treatment

High viscosity

-Vaselin

Low

Low

Low viscosity
Non toxic

-Motor oil
-Furniture polish
-Mineral seal oil
-Kerosene
-Lighter flow

High

Low

-Observasi Pneumoni
-Do not use emersi

Low viscosity
Unknow systemic
toxicity

-Terpentin
-Pure oil

High

variable

-Observasi Pneumoni
-Do not use emersi if less
than 1-2 ml/ kg non sistemik

Low viscosity
know systemic
toxicity

-Comphor
-Phenol
-Callorinusid
insectisida
-Aromatik
hidrokarbon,
(benzene, topluen,
ethane)

High

High

-Performe lavage
-give laxative charcort

FOOD POISONING

Organophosphate
Highly lipid soluble
Absorbed via dermal, GI, respiratory route
Work
persistently

inhibiting
acetylcholinesterase

Organophosphate

Organophosphate
Sign and Symptoms
- Salivation
- Lacrimation
- Urinary incontinence
- Defecation
- Gastrointestinal cramps
- Emesis

Organophosphate
Symptoms of muscarinic

Hypersecretion of sweat glands, tears, saliva

Nausea
Vomiting
Abdominal pain
Diarrhea
Alvi and Urinary Incontinence
Bronchoconstriction
Miosis
Bradycardia
Hypotension

Organophosphate
Symptoms of Nicotinic
Striated muscle twitching and fasciculations
Hyperactive reflexes
Muscle paralysis and respiratory muscle (diaphragm)
Fear
Anxious
Respiratory disorders
Circulation disorders
Tremor
Convulsions

Organophosphate
Complications
Hypoxia (airway obstruction)
Respiratory insufficiency (paralysis of
respiratory muscles and diaphragm)
Seizures status epilepticus
Coma

Organophosphate
Diagnostic
Plasma and RBC cholinesterase levels :
- acute exposures : plasma levels first,
followed by RBC levels
- chronic exposures : only RBC
cholinesterase activity, with a normal plasma
levels

Organophosphate
Differential Diagnosis
Mushroom : Amanita muscaria

Organophosphate
Treatment
Atropine should be given when the suspected
presence
of
severe
organophosphate
poisoning
Pralidoksim should be given immediately after
the poisoning, and will not be helpful if given
more than 38-48 hours after poisoning,
because the complex of organophosphate has
been stable and can not be activated again.

PROBLEM 6
Renata C. F. Tjieputri