poisons 3

• Cosmetics


  • Deodorant
  • Depilatories
• Aluminum


  3rd most abundant element, most abundant metal, used for healing burns & as abrasive in industries, has constipating & astringent effects
• Zinc

  Used in the galvanizing of iron & container for battery cells, Deficiency: Parakeratosis (inflamed & scaly skin), Toxicity: Metal Fume Fever (muscle aches & fever), Treatment: Aspirin + Bed rest (recovery occurs after 12 days)
• Depilatories


  For hair removal, contains sulfides or thioglycolates
• Chloramin T


  In milk products, Signs & Symptoms: Transform in CN-, Treatment: NaNO2 + NaS2O3
• Tartrazine


  FD & C no. 5, Signs & Symptoms: Anaphylaxis in allergic reaction
• Monosodium Glutamate (MSG)


  Signs & Symptoms: light headedness (🠉 pressure in the head), Tightness of the feet, Seizure, Treatment: Lessen MSG in foods
• Saccharin & Aspartame


  Artificial Sweeteners, Signs & Symptoms: diarrhea, Abdominal pain, Nausea, Pain, Aspartame: Aspartic Acid, Methanol, Phenylalanine (cause Phenylketonuria)
• Naphthalene


  Moth Balls, Coal Tar, Signs & Symptoms: Jaundice, Oliguria (low urine output), Convulsion, Treatment: ASA
• Acids


  Causes Coagulative Necrosis
• Alkali (Bases)


  Causes Liquefaction Necrosis
• Treatment for Acid/Alkali Poisoning

  Dilutional Therapy (large amount of water + milk), Sp. Treatment for Alkali Poisoning: Vinegar; Fruit Juice, Sp. Treatment for Acid Poisoning (Ex: HCl): Antacid, CI: Gastric Lavage, Do not Neutralize, Emetic, Cathartics
• Hydrogen Fluoride (HF)


  Source: Fluorinated Water, Signs & Symptoms: Hypocalcemia, Treatment: Ca Gluconate
• Paraquat


  Agriculture: Weed Killer, Signs & Symptoms: Pulmonary edema, Pulmonary Fibrosis, Alveolitis, MOA: (-) inhibit superoxide dismutase
• Permanganate


  Strong Oxidizing Agent, can cause Met Hgb
• Phenol


  MOA: Protein denaturation, Local: Mucosal/ Local Irritation, Redness of Skin, Corrosive, Systemic: Seizure, Coma, Liver damage, Kidney Damage, Dx: Chemical Evidence= Phenol + FeCl2 🡒 Blue violet (+), Tx: Castor Oil (Resinoleic Acid: cathartic)
• Phosphorus


  Luminous vomitus, Garlic Odor, Tx: CuSO4 (Blue Vitriol), Types: Red (granular; non-toxic; matches), Yellow/White (toxic;can be seen in pyrotechniques & fireworks)
• Picric Acid & Tannic Acid


  Signs & Symptoms: Hepatic Injury
• Cyanide


  Sources: Prunus sp., MOA: Inhibits Cytochrome Oxidase 🡒 🠋O2 Consumption, Signs & Symptoms: CNS & CV disturbances; Seizure; Respiratory Depression; Death; Odor of Bitter Almonds; Cherry Red Blood, Treatment: NaNO2 (IV), Amyl Nitrite (Inhalation), Methylene Blue, Sodium thiosulfate (IV), Alternative: Dicobalt edentate (Kelocyanor®), Hydroxocobalamin 🢣 Vitamin B12
• Carbon Monoxide


  Result from incomplete combustion, secondary to smoking, most common cause of air pollution, MOA: CO 🢣 Hg 🢣 Carboxyhemogginemia 🡒 200x nonbinding capacity than Hg, Signs & Symptoms: Cherry red Color of the Blood, Hypoxia 🡒 anoxia 🡒 death, Psychomotor Impairment 🡒 Headache 🡒 Confusion 🡒 Tachycardia 🡒Coma, Treatment: 100% O2; Hyperbaric O2 🡒 revives death tissue; Artificial Air 🡒 80% helium + 20% Oxygen
• Hydrogen Sulfide


  MOA: Binds with Hemoglobin to form another abnormal form of hemoglobin which is Sulfhemoglobinemia, Signs & Symptoms: Dyspnea (difficulty of breathing) 🠋O2 Consumption, Treatment: Hyperbaric O2, Hyperbaric Oxygen Supplementation
• Insecticide & Pesticides


  • Organophosphates
  • Carbamate
  • Rodenticides
  • Chlorinated HC Pesticides
  • Botanical Insecticides
• Organophosphates


  MOA: Binds to Acetylcholine forming a stable phosphate−ester bond 🢣inactivation of Ache 🢣 🠉 Ach (irreversible without treatment), Signs & Symptoms: DUMBBELSS, Treatment: Atropine – inhibit Ach, Pralidoxime – aid for the treatment −enzyme deactivation (Acetylcholinesterase), Edrophonium−Tensilon® −Dx of Myasthenia Gravis (Muscle weakness), Delayed neurotoxicity associated w/ exposure to organophosphates characterized by polyneuropathy, paralysis, & axonal degeneration has been attributed to Inhibition of the Neuropathy target esterase
• Carbamate


  MOA: Reversibe binding to AChe, Signs & Symptoms: DUMBBELSS, Treatment: Atropine, Pralidoxime
• Rodenticides


  Agents to kill mice & rats
• Coumarin derivatives


  MOA: Inhibit Gamma decarboxylation of the Vitamin K dependent factors, Signs & Symptoms: Hemmorage/ Excessive Bleeding, Parameters: INR (International Normalize Ratio), Treatment: Vitamin K (Phytomendaione), Fresh Frozen Plasma
• Heparin


  MOA: Direct thrombin Inhibitor, Signs & Symptoms: Hemmorage/ Excessive Bleeding, Parameters: aPIT (activated Partial Thromboplastin Time), Treatment: Protamine Sulfate
• Chlorinated HC Pesticides


  DDT; Chlordane, known to be Neurotoxin, MOA: Inhibit the inactivation of Na channel, Signs & Symptoms: Seizure, N/V (Nausea & Vomiting), Paresthesia, Respiratory Depression, CNS Stimulation (primary toxidrome)
• Botanical Insecticides


  • Nicotine
  • Rotenone
  • Pyrethrum
• Heavy Metals


  • Arsenic
  • Cadmium
  • Lead
  • Mercury
  • Iron
  • Thallium
• Arsenic


  Lewisite Metal, for treatment of syphilis (Arsphenamine/Salvarsan/606), manufacture of insecticides, glaswares, result to hyperkeratosis & hyperpigmentation, causes "black foot disease", proplasmic poison, choice of professional posoners, MOA: Coagulation of protein by binding to −SH groups, Signs & Symptoms: "Mee's Line" (white line in the nails), Abnormal Weigh gain, Watery Diarrhea, Milky/rosy complexion,Garlic odor of breath, Luminous vomitus, Alopecia, Black line on gums/ bleeding gums, "Raindrop" pattern of Hyperpigmentation & Hyperkeratosis, Treatment: BAL/ Dimercaprol (+Penicillamine if severe)
• Cadmium


  Itai-itai Disease (through consumption of cadmium-contaminated rice in Japan), Sources: Anti-dandruff Shampoos, Smoke & stink bamboos, solder(metal alloys), Signs & Symptoms: Osteomalacia, Fractures. Renal Abnormalities, Gait disturbances, Treatment: EDTA (for acute ingestion)
• Lead


  "Plumbism" (Absorption of Lead via Respiratory Tract), most ubiquitos of the toxic metals, exposure may be through air,water or food sources, Main target: Hematopoietic system & nervous system, Factors predispose to increased Lead absorption: Decreased Dietary Calcium, Iron deficiency, Ingestion on an empty stomach, Pharmacokinetics: Lead can cross the placenta & pose a potential hazard to the fetus, Yong children have greater degree of absorption of ingested Lead than adults, The major route of excretion of Lead is through Urine, Skeletal Muscle (Bone) –is the primary repository site of inorganic lead in the body of an adult, Sources: Canned goods, Automobile exhaust, wine glasses, Old pipes, Cables, Paints, MOA: Inhibits cytochrome, Inhibiys heme synthesis ⮑ 🠋O2 Consumption ⮐, Signs & Symptoms: Pb encephalopathy, Hemolytic Anemia, Abdomical Colic, Elevated Liver Enzymes, Pb palsy − wrist/foot drop, Milky vomitus, Black stools, Fanconi-like syndrome ( proteinuria- hematuria), Treatment: Penicillamine, BAL, EDTA
• Mercury


  aka. Quicksilver, Messenger of the Gods, Minimata Disease (mercury poisoning), through consumption of fish & shellfish, MOA: Coagulation of protein by binding to −SH groups, Signs & Symptoms: Acrodinia ( photophobia, anorexia, restlessness, stomatitis, oliguria, severe diarrhea, pains in arms & legs, pink palms & toes), Gingivitis (hyperplasia), Erethism (behavioral pattern characterized by change in mood), Treatment: Na Formaldehyde Sulfoximate (Antidote of Choice), BAL (for high level of exposure), Penicillamine (for low level of exposure), Chelation w/ Unithiol may diminish nephrotoxicity that may result from acute exposure to inorganic Mercury, Three types of Mercury: Elemental Mercury, Inorganic Mercury, Organic Mercury
• Iron


  For hemoglobin & myoglobin production, Chronic excessive exposure to the metal can lead to deposition in various organs & tissues causing the development of conditions such as secondary DM, restrictive cardiomyopathy, & hepatic failure; Hemachromatosis, Hemorrhagic gastroenteritis –is the most consistent manifestation of acute overdose of Iron in Children, cause of toxicity: Overingestion of OTC preparations, Lethal Dose: 200−300mg/kg, Toxic Dose: >600mg/kg, Phases of toxicity: I. −nausea, vomiting, diarrhea, GI bleeding, hypotension, II. −clinical improvement seen 6−24 hours postingestion, III. −metabolic acidosis, renal & hepatic failure, sepsis, pulmonary edema & death, Treatment: Deferoxamine/Deferoxime (Antidote of Choice)
• Thallium


  MOA: Binf to −SH group, Signs & Symptoms: Gastroenteritis, Paresthesia (numbness), Alopecia, Treatment: Prussian blue/ Ferric Ferrocyanide