توكسو

• Elemental metals


  • lead
  • boron
  • lithium
• However they have some of complications that limit their use (prolonged diarrhea, electrolyte imbalance especially in patients with renal failure and intestinal cramps)
• Whole bowel irrigation


  1. Principle: This procedure cleanses the bowel by the enteral administration of large amounts of an osmotically balanced polyethylene glycol electrolyte solution (PEG-ES) which induces a liquid stool

  2. Significance: it reduces drug absorption by decontaminating the entire gastrointestinal tract by physically expelling intraluminal contents

  3. The concentration of polyethylene glycol and electrolytes in PEG-ES causes no net absorption or secretion of ions, so nosignifi cant changes in water or electrolyte balance occur

  4. It involves the instillation of large volumes of PEG (Colyte®) into the stomach in a nasogastric tube over a period of 2 to 6 hours producing voluminous diarrhea
• Complications


  • Diarrhea
  • Drowsiness
  • Live
• Contraindication


  • Infants up to 6 months of age
  • Comatose patient because of increased risk of aspiration
  • Seizures (due to compromised gag reflex)
• Prolonged vomiting and lethargy
• Certain toxins: Hydrocarbons and volatile substances, Corrosives (Caustics)
• Ingestion of sharp objects
• Gastric lavage (G.L)


  Stomach wash
• Indications: Gastric lavage is recommended mainly for Patients who have ingested a life-threatening dose, Patients who exhibit significant morbidity and present within 1 to 4-6 hrs of ingestion
• Method


  1. Place patient on left lateral decubitus position

  2. Lubricate inserting end of tube with Vaseline or glycerin

  3. Pass tube to appropriate extent

  4. Use small aliquots of liquid (saline or plain water) alternating with warm saline

  5. Use 200-300 ml aliquots in adults, 10-15 ml/kg in children
• The ideal tube for lavage is the lavacuator (clear plastic or gastric hose), but the Ewald tube is most often used which is a soft rubber tube with a funnel at one end
• Left lateral decubitus position

  Allows liver to compress and block junction between stomach and intestine to keep toxin in stomach and prevent transfer to intestine
• Warm solution used to avoid hypothermic shock
• Cold-hypothermia should be avoided
• It is advisable to hold back the first aliquot of washing for chemical analysis
• Lavage


  Continue until no further particulate matter is seen, and the efferent lavage solution is clear
• At the end of lavage

  Infuse activated charcoal in water (1 gm/kg) with an appropriate dose of an ionic cathartic into the stomach, and then remove the tube
• G.L. can be performed in comatose patients with concurrent insertion of cuffed endotracheal intubation
• Complications


  • Epistaxis
  • Esophageal perforation
  • Empyema
  • Hypothermia
  • Electrolyte imbalance
• Contraindications


  • Bleeding varicose
  • Gastric ulcers
  • Corrosives (Caustics) intoxication
  • Ingestion of sharp objects
• Activated charcoal


  Fine, black, odorless, tasteless powder (inert nontoxic adsorbent)
• Making activated charcoal


  Burning wood, coconut shell, bone, sucrose, or rice starch, followed by treatment with an activating agent (steam, carbon dioxide)
• Each gram of activated charcoal works out to a surface area of 1000 square metres
• Mode of action of activated charcoal

  Decreases the absorption of various poisons by adsorbing them on to its surface especially with binding high molecular weight compounds due to intermolecular attractions (van der Waals forces)
• Dose of activated charcoal

  1. 2 g/kg, mixed with 70% sorbitol to avoid constipation & resorption
• Complications of activated charcoal

  • Constipation
  • Intestinal obstruction
• every Jenom is Taxan? V
• every loan is venom? X
• يغرق ما ستار
• Poisoning


  A process by which an organism is poisoned by a toxic substance or venom of animal
• Poison


  A substance that causes disturbance in organisms through chemical reaction or any other activity on the molecular scale if absorbed by organisms in a sufficient quantity
• Toxicant


  A toxic substance that is produced by or is a by-product of anthropogenic (human-made) activities
• Toxin


  A poison that is naturally produced by a living organism (plants, animals, fungi, bacteria)
• Venom


  A toxin injected by a living organism into another, usually by sting or bite, and is exclusive to animals. The difference between venoms and other poisons is the delivery method.
• Ways to classify toxic agents

  • According to their target organs
  • According to their use
  • According to their source
  • According to their toxic effects
  • According to their physical state
  • According to their chemical stability or reactivity
  • According to their general chemical structure
  • According to their poisoning potential
• Types of poisoning


  • Accidental (most cases, mainly in children, includes exposure to household products/medicines, industrial exposure, venomous bites/stings, environmental (plant/food poisoning))
  • Deliberate (suicidal attempts, attempted homicide, warfare)
• Routine poisoning management


  1. Stabilization (correct life-threatening problems, ABCD, administer glucose, thiamine, oxygen, naloxone)

  2. Evaluation (obtain history, physical exam, identify toxin class/toxidrome, design specific treatment plans)

  3. Decontamination (skin, eye, gastric, prevent absorption)

  4. Poison elimination (remove absorbed toxin, enhance excretion)
• Poisoning management approach should be essentially similar in every case, irrespective of the toxin
• Specific antidote administration


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  3. Мохоле