Toxi lec m3

• FACTORS AFFECTING POISONING EFFECTS 1. Pediatrics is not yet fully developed which may cause the accumulation of drugs even when given at normal doses.

  2. Geriatrics have slower metabolizing rates as compared to adults aged 20-40

  3. Kidney function: excretion ; liver function: metabolism

  4. Habits: Smoking Cigarettes -> Enzyme induction

  5. Alcohol:

  Acute-> enzyme inhibitor

  Chronic-> Enzyme inducer
• POISON RELATED FACTORS

  Concentration

  • As the dose is increased, probability of toxicity increases.

  Solubility

  • the higher the lipophilicity, the higher the toxicity
• ROUTE OF ADMINISTRATION

  ➔Oral medications have slow absorption thus management (treatment) is higher.

  ➔Intravenous medications goes directly to the venous circulation; cannot be retracted

  ➔Inhalational - faster effect
• How to manage patients with poisoning • Substance name -To start intervention and give antidotes ●Time of exposure -The longer it stays on thebody, the higher the possibility it causes damage ●Amount or concentration ●Route of exposure ● Type of intoxication ● Signs and symptom
• How to manage patients with poisoning

  • Substance name

  -To start intervention and give antidotes

  ●Time of exposure

  -The longer it stays on thebody, the higher the possibility it causes damage

  ●Amount or concentration

  ●Route of exposure

  ● Type of intoxication

  ● Signs and symptom
• Physical Examination

  • Vital signs (Body temperature, PR/HR, BP, RR) • Neurological signs -Altered mental status (agitation, delirium, sedation, coma, seizure) -pupillary size (miosis, mydriasis, nystagmus) -movement disorders (akinesia, dyskinesia) • Dermatological signs • Gastrointestinal signs • Toxidromes
• Physical Examination

  •Vital signs (Body temperature, PR/HR, BP, RR)

  • Neurological signs

  -Altered mental status (agitation, delirium, sedation, coma, seizure)

  -pupillary size (miosis, mydriasis, nystagmus)

  -movement disorders (akinesia, dyskinesia)

  • Dermatological signs

  • Gastrointestinal signs

  • Toxidromes
• Cyanosis - bluish cast to the skin and mucous membrane.

  Peripheral cyanosis - bluish discoloration on hands and feet. Usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood in the body.

  Medications/Poisons that can cause cyanosis:

  aniline, methylene blue, nitrates &nitrites, opium, oxalic acid, sulfides
• • Cyanosis - bluish cast to the skin and mucous membrane. Peripheral cyanosis - bluish discoloration on hands and feet. Usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood in the body.
  • Medications/Poisons that can cause cyanosis: aniline, methylene blue, nitrates &nitrites, opium, oxalic acid, sulfides
• • Erythema - (greekerythos - red) is the redness of the skin or mucous membranes caused by hyperemia(increased blood flow) in superficial capillaries
  • Medications/Poisons that can cause erythema: anticholinergics,antihistamines,ethanol
• • Ecchymosis - a discoloration of the skin resulting from bleeding underneath, typically caused by bruising
  • Medications/Poisons that can cause ecchymosis: anticoagulants
• • Icterus/Jaundice yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary tract obstruction
  • Medications/Poisons that can cause Icterus: acetaminophen,chlorinated hydrocarbon,arsenic, gold, iron,phosphorous
• • Acneiform - characterized by papules and pustules resembling acne vulgaris
  • Medications/Poisons that can cause acneiform: bromine, iodine, lithium, steroids
• • Boiled Lobster - the skin resembles the color of a lobster
  • Medications/Poisons that can cause boiled lobster: boric acid
• • Bullous Lesion - a bulla is a fluid-filled sac or lesion that appears when fluid is trapped under a thin layer of the skin.Larger than 0.5 centimeters (5 millimeters) in diameter can be classified as a bulla
  • Medications/Poisons that can cause bullous lesion: Barbiturates, opium
• • Trace marks
  • Medications/Poisons that can cause trace marks: IV drugs
• • Keratinization
  • Medications/Poisons that can cause keratinization: Thallium, arsenic
• • Steven Johnson's Syndrome (SJS)-disorder of the skin and mucous membranes;usually a reaction in medication that starts with flu-like symptoms,followed by a painful rash and blisters
  • Medications/Poisons that can cause SJS: amoxicillin, carbamazepine, erythromycin,phenobarbital,phenylbutazone,sulfa drugs
• • Skin necrosis - is a premature death of cells which occurs due to autolysis; occurs due to external injury or trauma in a particular organ
  • Medications/Poisons that can cause skin necrosis: potassium, sodium, phenytoin
• • Mees' lines
  • Medications/Poisons that can cause mees lines: arsenic, thallum
• • Beau lines
  • Medications/Poisons that can cause beau lines: antineoplastics
• Chemical agents that cause nail stains:

  ★Brown - Iodine
• Chemical agents that cause nail stains:

  ★Yellow-Brown - Nicotine
• Chemical agents that cause nail stains:

  ★Blue - Copper salts
• Chemical agents that cause nail stains:

  ★Red - Mercury
• Chemical agents that cause nail stains:

  ★Gray - Formaldehyde
• Gum Lines

  ●Blue - bismuth, lead

  ●Black - arsenic, mercury
• MANIFESTATIONS IN BREATH ODOR:

  • Airplane glue – aromatic hydrocarbon, toluene
• MANIFESTATIONS IN BREATH ODOR:

  • Bitter almonds – cyanide
• MANIFESTATIONS IN BREATH ODOR:

  Rotten egg – hydrogen sulfide, disulfiram, N-acetylcysteine
• MANIFESTATIONS IN BREATH ODOR:

  • Burnt rope (hemp) – marijuana
• MANIFESTATIONS IN BREATH ODOR:

  • Carrots – cicutoxin of hemlock
• MANIFESTATIONS IN BREATH ODOR:

  • Chico – ethanol
• MANIFESTATIONS IN BREATH ODOR:

  • Sweet – acetone, isopropanol, salicylates
• MANIFESTATIONS IN VOMIT COLOR:

  • Blue-green – boric acid, copper salts, cyanide, nickel, iodine with starch
• MANIFESTATIONS IN VOMIT COLOR:

  • Luminous – phosphorus, arsenic
• MANIFESTATIONS IN VOMIT COLOR:

  • Brown – iodine, sulfuric acid (ground coffee)
• MANIFESTATIONS IN VOMIT COLOR:

  Pink – ethchlorvynol
• MANIFESTATIONS IN VOMIT COLOR:

  • Yellow-green – chromium
• MANIFESTATIONS IN BOWEL COLOR:

  • Black – bismuth, charcoal, iron, magnesium dioxide, lead, silver nitrate