Professional Documents
Culture Documents
THERAPEUTIC
AGENTS
Dr Jatin Dhanani
Most Frequently
Involved in Human
Poisoning
Substance
Analgesics
Personal care products
Cleaning substances
Sedatives-hypnotics
antipsychotics
Foreign bodies
Topical preparations
Cold and cough
medications
Antidepressants
%
12.5
9.1
8.7
6.2
5.1
4.5
4.5
4.0
Sedatives-hypnotics
antipsychotics
Acetaminophen
Opioids
Antidepressants
Cardiovascular drugs
Stimulants and street
drugs
Alcohols
Aspirin
Toxic dose: Acute (150-200mg/kg)
Chronic (100 mg/kg for 2 or more days)
PRESENTATION
Acute
Burning pain in throat and stomach, & Vomiting
f/b hyperpnoea, tinnitus, and lethargy
Respiratory alkalosis and compensatory
metabolic acidosis
Severe intoxication seizures, hypoglycemia,
hyperthermia, pulmonary edema , and coma
Death by CNS failure and cardiovascular collapse
Chronic
Elderly persons taking salicylates
therapeutically
confusion, dehydration, and metabolic
acidosis
Cerebral and pulmonary edema is more
common
morbidity and mortality rates are much
higher
Circumstances:
Acute suicidal
Chronic accidental or as therapeutic toxicity
Treatment
Emergency and supportive measures
ABC
Decontamination
Emesis
Gastric lavage
Paracetamol
Paracetamol
metabolism
N-acetyl-P-benzoquinoneimin
glutathion
Detoxification
Liver & renal damage
Toxic Dose:
200 mg/kg in children and 6 7 gm in adults
PRESENTATION
Asymptomatic or Anorexia, nausea, or
vomiting
massive overdose - altered mental status &
metabolic acidosis
Transient prolongation of the prothrombin time
(PT/INR)
hepatic necrosis (raise AST & ALT)
acute fulminant hepatic failure with
Encephalopathy, metabolic acidosis, and a
continuing rise in PT/INR - Poor prognosis
Treatment
Emergency and supportive measures
General supportive care of liver and renal failure
Liver transplant
Antidotes
N-acetyl cysteine orally 5% sol 140 mg/kg f/b 70
mg/kg every 4 hr for 3 days
Decontamination
Administer activated charcoal orally within 3 hours
Avoid Gastric lavage
Enhanced elimination
Hemodialysis
effective but is not generally indicated
considered for very high levels (eg, >1000 mg/L) complicated
by coma and/or hypotension
Poisonings
DRUG CLASS EXAMPLE(S)
MENTAL
STATUS
H B R T PUP OTHER
R P R
IL
SIZE
Tremor,
diaphoresis
Ileus,
flushing
Sympathomi Cocaine
Agitation
metic
Amphetamine
Anticholinerg Diphenhydrami Delirium
ic
ne
Belladonna
atropa
Cholinergic Organophospha Somnolence/co
tes
ma
Opioid
Heroin
Somnolence/co
Oxycodone
ma
Sedative- Benzodiazepine Somnolence/co
hypnotic
s
ma
Barbiturates
Salicylate Aspirin
Confusion
SLUDGE
fasciculation
Diaphoresis,
vomiting
Therapy of
Poisoning
1. Emergency management
2. Decontamination
3. Enhancing the elimination
4. Antidote therapy
Decontamination
Gastric Lavage
Saline lavage: 10 to 15 mL/kg (up to 250 mL) of fluid is
administered and withdrawn
Orogastric tube (24 FG for children & up to 40 FG for
adults)
Activated Charcoal
Dose: 0.5-2 g/kg up to 75-100 g
Complications: vomiting, constipation, pulmonary aspiration,
and death
C/I : suspected GI perforation, unconscious and delirious
patients
Elimination
Manipulating Urinary pH: Urinary Alkalinization
Weakly acidic drugs: "ion-trapping" in the urine
E.g. - Aspirin, phenobarbital, chlorpropamide,
methotrexate, and chlorphenoxy herbicides
100-150 mEq of sodium bicarbonate in 1L of D5% is
infused intravenously then titrated
C/I : in the presence of renal failure - worsen pulmonary
edema or congestive heart failure
Antidote
POISONING INDICATION(S)
ANTIDOTE
Acetaminophen
Acetylcysteine
Organophosporus and carbamate Atropine sulfate, Pralidoxime
pesticides
chloride (2-PAM)
Valproate hyperammonemia
Carnitine
Iron
Deferoxamine
Cardiac glycosides
Digoxin immune Fab
Lead, mercury, arsenic
Dimercaprol (BAL)
Lead
EDTA, CaNa2
Methanol, ethylene glycol
Ethanol, Fomepizole
Benzodiazepines
Flumazenil
Cyanide
Hydroxocobalamin hydrochloride
Ca2+ channel blockers
Insulin (high dose)
Methotrexate
Leucovorin calcium
Opioids
Naloxone hydrochloride
Lead, mercury, copper
Penicillamine
Anticholinergic syndrome
Physostigmine salicylate
Isoniazid seizures
Pyridoxine hydrochloride
Coumarin, indanedione
Vitamin K1 (phytonadione)
The
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You