Professional Documents
Culture Documents
Dr. M.L.Siddaraju
History
• Egyptians are said to have studied many poisons as early as
3000BC.
• Among vedas- Atharvana veda (1500BC) describes poisons.
• Susrutha (350BC) described as how poisons were mixed
with food and drink, medicines, snuff, etc..
• Italians brought the art of poisoning to its zenith prior to 6 th
century AD.
• Orfila-(1787-1853) was first to attempt a systemic
correlation between the chemical and biologic information
of the poisons known then.
• Others who worked are Marsh, Magendie, Ambrose,
Scheelle, Robert Christison and Rudolf Kobert.
POISONING IN CHILDREN
• None(0)- no symptoms or
signs/vague symptoms judged
not to be related to poisoning.
• Minor(1)- Mild, transient &
spontaneously resolving
symptoms.
• Moderate(2)- pronounced or
prolonged symptoms.
• Severe(3)- severe or life
threatening symptoms.
Diagnosis of Poisoning
• Cardiac arrythmias. Tricyclic
antidepressants, amphetamine, aluminium
phosphide, digitalis, theophylline, arsenic,
cyanide, chloroquin.
• Metabolic acidosis. Isoniazid, methanol,
salicylates, phenformin, iron, cyanide.
• GIT disturbances. Organophosphorus,
arsenic, iron, lithium, mercury.
• Cyanosis. Nitrobenzene compounds,
aniline dyes, and dapsone.
Basic Management of a
poisoned patient
• Antidotes are available for very few
commonly encountered poisons, and
treatment is usually non-specific and
symptomatic. In such cases management
consists of emergency first aid and
stabilization measures, appropriate
treatment to reduce absorption,
measures to enhance life support
followed by psychiatric counseling.
Identification of Poison
• Epidemiology
• Clinical features
• Investigation
• Treatment
Epidemiology
10 hours
SYMPTOMS
RS – breathlessness, cough
CNS – convulsions, coma
GPE – fever, restlessness, cyanosis
GI – vomiting, diarrhea
Lab Investigations
• Blood – Leukocytosis
X – Ray changes
• >4 – Significant
• <7 – Likely to survive
• >8 –– Risk of death is increased
Management
• Avoid emetics
• Avoid gastric lavage – In case of massive
amount use a cuffed endotracheal tube
• After lavage leave magnesium or sodium
sulphate in the stomach
• Oxygen may be useful
• Assisted Ventilation
• Antibiotics - Penicillin G 50000/Kg/24 hrs IV
qid
• Kanamycin – 10-15mg/Kg/24 hrs - IM bd
• Steroids – Not helpful
Complications
• Pneumothorax
• Pneumatocoeles
• Pleural effusion
• Bronchopneumonia
• Coma
Organophosphorus
(insecticides and pesticides)
Poisoning
• Organic phosphate insecticides cause
irreversible inhibition of the enzyme
cholinesterase. As result
acetylcholine accumulates in various
tissues. Excessive parasympathetic
activity occurs. These agents are
absorbed by all routes including skin
and mucosa.
• Symptoms manifest quickly usually within
a few hours and include weakness, blurred
vision, headache, giddiness, nausea, and
pain in chest. These patients have
excessive secretion in the lungs and they
sweat profusely. Salivation is marked.
Pupils are constricted and papilledema
may occur. Muscle twitching, convulsions
and coma occur in severe cases. Reflexes
are absent and sphincter control is lost.
Treatment
• If the insecticide was in contact with skin or
eyes, these are thoroughly washed. Stomach
wash is done.
• Atropine sulphate: 0.03 to 0.04 mg/kg IV
(atropine sulphate is usually available in
ampules 1 in 1,000 or 1 mg/mL). Other
strengths may also be available. Repeat half
the dose in 15 minutes and if necessary every
hour (until signs of toxicity appear), subject
to a maximum of 1 mg/kg in 24 hours.
• Pralidoxime (PAM) is given in dose of 25-
50 mg/kg IM or IV over 30 min infusion.
The dose may be repeated in 1-2 hours,
then at 6-12 hour intervals as needed.
Monitor for hypertension. Never inject
morphine, theophylline, aminophylline or
chlorpromazine. Intravenous fluids should
only be given with caution. No oral
tranquilizers are administered. Artificial
respiration may be necessary to sustain
life.
Iron Intoxication
• Parental education
• Keep away from reach of children
• Properly capped containers
• Avoid storage in beverage bottles or
colorful containers which attract children
• Immediately seek medical care
Preventing childhood
poisoning
• Education is the major component of
any poison prevention programme.
• Keep medicines, insecticides, etc…
out of the reach and sight of your
children.
• Never store food & cleaning products
together. Store medicine and
chemicals in original containers.
• The label should be read before using the
drug. No drug should be given or taken in
the dark. Drugs after their expiry date
should be disposed in a safe manner. Avoid
taking medicine in your child’s presence.
Never suggest that medicine is candy.
• Children should be taught not to eat plants
or berries.
Laws on poison
The Drugs and Cosmetics act, 1940.
1. To control the quality, purity & strength of drugs.
2. Any patent/proprietary medicine should display on
the label or container & the list of ingredients
contained in it.
The Pharmacy Act-1948
The object of this act is to allow only the registered
pharmacists to prepare, mix or dispense any
medicine on prescription of a medical practitioner.
The Drugs and Magic remedies Act-
1954.
To ban advertisements procuring
abortion/increase of sexual
potency/treatment of veneral
diseases/correction of menstrual
disorders.