toxidromes

• Factors affecting Toxic Response:

  • Sudden deterioration in conscious level in a previously healthy patient
  • Sudden development of excessive vomiting without a history of food poisoning
  • Presence of psychiatric problems
• Factors related to the Poison:

  • Amount taken
  • Route of administration
  • Form of the poison
  • Cumulation
• Factors related to the Patient:

  • Stomach condition (empty or full)
  • Age
  • Disease (chronic diseases that can alleviate the response to toxicity)
  • Tolerance
  • Hypersensitivity
• Amount Taken:

  • The greater the poison dose taken, the more serious the symptoms
• Route of Administration:

  • Intravenous injection is the quickest and most dangerous route
  • Inhalation and intramuscular injection can be 100% bioavailable
  • Subcutaneous injection, absorption through mucus membranes, ingestion, and skin absorption
• Form of Poison:

  • Gas forms are most rapidly absorbed
  • Liquid poisons are more rapidly absorbed than solids
  • Fine powders are more rapidly absorbed than tablets
• Cumulation:

  • Repeated small doses of certain drugs can lead to poisoning, similar to a single large dose
• General Approach to the Poisoned Patient:

  • Evaluation
  • Examination
  • Investigations
• Evaluation:

  1. Initial Assessment and Stabilization

  • Airway: Ensure airway patency
  • Breathing: Assess ventilation and assist if necessary
  • Circulation: Take pulse, blood pressure, and assess volume, rate, and rhythm
  • Neurological status: Assess level of consciousness
• To assess reflexes in a patient, pressure can be applied to the patient's fist and placed on their chest at a 90-degree angle. Observing the patient's reaction to pain can help determine their reflexes
• Assessing a patient's reflexes involves observing their reaction to pain, which can cause them to either grimace or sit up due to the pain
• When assessing a patient's reflexes, determining pupil size and reactivity to light is important
• In toxicology, obtaining a careful history is crucial. This includes personal history, history of present illness (intoxication history), and general examination of vital signs
• The history of present illness in toxicology involves asking about the 5 W's of toxicology: Who, What, When, Where, and Why
• In toxicology, the general examination of vital signs includes assessing pulse, blood pressure, body temperature, and respiratory rate
• Laboratory studies in toxicology should include regular and emergency investigations, as well as specific toxicological tests to identify the presence of certain substances in the body
• Toxidromes are collections of integrated data from vital signs and clinical examination that help identify manifestations specific to a toxic agent
• Toxidromes can aid in diagnosing toxic syndromes such as Anticholinergic syndrome, Cholinergic syndrome, Sympathomimetic syndrome, and Opioid syndrome