Name poison

Salicylate

Paracetamol

Barbiturates
SAB & LAB
GIT
Injection sites
Liver

Absorption

Stomach

GIT

Metabolism

Liver

Excretion

Kidney

Liver
Conjugation with
glutathione
-

Toxic dose

200-300mg/kg
Fatal: >120mg%

10 grams
140mg/kg

Pathophysiology

+ respiratory center->
Glutathione depleted
resp. alkalosis
causing centrilobular
Metabolic Acidosis:
hepatic necrosis
Accumulation of
metabolites
Severe dehydration
Interfere Vita-K
Enhance G6P activity ->
hypoglycaemia

CNS: depression
GABA like-action
CVS: shock
GIT: depress smooth
muscle
Kidney: depress kidney
function
Skin: bullae; toes and
fingers

Depress CNS
Local irritant on
mucous membrane
Toxic effect on liver,
kidney and heart
Tolerance, dependence
and withdrawal
syndrome

Induce intense
stimulation of CNS
Release of
catecholamines
-epinephrine
-norepinephrine
-dopamine

Clinical picture

Hyperventilation,
sweating & acid base
disorders
Metabolic acidosis
Hypoglycaemia
Hypoprothrombinemia
Cyanosis, oliguria,
renal failure &
pulmonary oedema

S1: nausea, vomiting

and diaphoresis
S2: hepatic tenderness,
elevation of bilirubin
and prolongation of
Prothrombin time
S3: hepatic necrosis,
coagulation defects,
jaundice, renal failure
S4: death cause by
hepatic failure

CNS: stupor and deep

coma
Resp: slow and shallow
with cyanosis
CVS: arrhythmia,
hypotension
Pupil: constrict->
dilated
Nausea and vomiting
on and empty stomach

CNS: acute anxiety rxn

Euphoria, Hallucination
Aggressive and violent
CVS: tachycardia,
palpitation,
hypertension,
Muscular dyskinesia
GIT: N, V, D, dry mouth
Skin: urticaria,
erythema of the face

Investigation

Urine test
Plasma salicylates level
ABG, blood pH, acid
base status
Prothrombin level
Blood glucose
ECG, chest X-ray

Serum acetaminophen
level, 4-6hours after
Liver test
Renal test
Blood glucose test
Prothrombin test

Undetectable in
plasma
Determination of
plasma
trichloroethanol

Urine and blood test

ECG, CT, ABG
Acid base status
Electrolytes
Kidney function test
Elevation of Creatine
kinase

Treatment/
Antidote

Haemodialysis
Symptomatic
treatment

ABCD
5% dextrose IV in 10
hours
Blood/ fresh plasma
transfusion
Injection of clotting
factor or vita-K
Liver transplant
Antidote:
N-acetycysteine (NAC)
Act as glutathione
substitute

CNS: stupor->coma
CVS: clammy skin, low
BP, oliguria, weak
pulse, sweating
Respiration: slow and
shallow, cheynestokes,
cyanosis
Hypoxic paralytic
pupillary dilatation
Hypothermia
Paralytic ileus
Bullous skin
Coma +resp depress+
hypothermia
Colour test on urine
Plasma barbiturate
level
Acid base status, ABG,
ECG, Chest X-ray
Kidney function test
Artificial ventilation
and O2 inhalation
NEVER elevate the BP
to normal level
Alkalinisation of the
urine by IV NaHCO3
Symptomatic
treatment

ABC
Demulcent and
activated charcoal
Lavage or emesis are
contraindicate cause of
irritant substance
Haemoperfusion
Haemodialysis less
effective

A-B
C: hypertension by
phentolamine
D: ipecac, activated
charcoal + cathartic,
lavage
E: alkalinisation of
urine by NaHCO3
Haemodialysis
Antipsychotic drugs
Symptomatic
treatment.

SAB-poorly by renal
and good hepatic
degradation
LAB- good by renal
Read barbiturate
dependence page: 152

Chloral hydrate

Amphetamine

GIT

Oral/ IV administration
GIT and Blood
Liver
Hydroxylation and
deamination
Renal
Non-metabolized is
pH-dependent
In acidic urine only
Over 100mg

Liver, kidneys, RBC

(trichloroethanol and
trichloro-acetic acid)
Renal in urine

Theophylline
(asthma)
Oral administration

Carbon monoxide

Chloride

OPI

Lungs

External exposure and

ingestion

Liver
P450 cytochrome
oxidase
Adult: 10%unchange
Neonates: 50%
unchanged

Bound to Hb
life 4-5 hours

GIT, skin, conjunctiva,

lungs
Liver
Oxidation and
hydrolysis by esterase
Urine and faeces

Decrease metabolism
leads increase toxicity
>20ug/ml
Occurs in:
Liver and heart failure
Drug inhibit P450
Adenosine blocked-loss
heart ve feedback
Endogenous release of
catecholamine - CVS and
metabolic toxicity
Increase intracellular Cahigh contraction
GIT: N, V, D, Bleeding
CNS: seizures, lead to
rhabdomyolysis,
lethargy, coma
CVS: tachyarrhythmia,
hypotension & cardiac
arrest
Metabolic: respiratory
alkalosis, metabolic
acidosis, hypokalemia,
hyperglycaemia,
hypercalcaemia
Serum theophylline
concentration
ECG, Blood glucose,
electrolytes, ABG, acid
base status, brain CT
Myoglobin in urine
Chest X-ray

COHb level above

15%

Produce acidic
condition and
corrosive
Cl+H2O will produce
HCL and Hypochlorus
acid
Formation of
chloramine and thiol
radical

According to ChE
inhibition

Pulmonary edema
Skin bullae
Lactic metabolic
acidosis
Arrhythmia, ECG
changes
Coma, convulsion

Mucous membrane
irritation
Cough, wheezing,
haemoptysis
Nausea, vomiting,
metabolic acidosis

COHb level
ABG
Blood glucose
Electrolytes level
ECG, CT, X-ray

Evidence of exposure
Sign and symptoms
Chest X-ray

Muscarinic effect:
Wet findings due to
excessive secretion
Constricted pupil
(DUMBELS)
Nicotinic effect:
Muscle weakness
Dilated pupil
Tachycardia &
hypertension
CNS: anxiety,
convulsion, coma
Assay by erythrocyte
or plasma ChE activity
level:
20-50% mild
10-20% moderate
<10% severe

A-B
C: propranolol for
tachyarrhythmia
D: cant use ipecac
Lavage and activated
charcoal + cathartic
E: Haemoperfusion
Haemodialysis if
perfusion unavailable.

Symptomatic
treatment.
100% oxygen
inhalation
Hyperbaric oxygen

Symptomatic
treatment and relieve
treatment.

Respiratory system

Shift curve to left and

make O2 less
available

Inhibition of acetyl
cholinesterase in
nervous system and
myoneural junction
Stimulation-> paralyze

ABC: suction of
secretion and IV fluid
avoid dehydration
Antidote:
Atropine- until
atropinisation known
2mg IV repeated every
10-15 min
Oximes- break the
bond, direct react and
detox, anticholinergic
effects.