TOXICOLOGY

DEF
POISON

POISON CENTER
CIRCUMSTANCE OF POISONING

GENERAL MANAGEMENT

INVESTIGATIONS

DEF
CLASSIFICATION

FACTOR INFLUENCING ACTION OF POISON

ACCIDENTAL
SUICIDAL
HOMICIDAL
STANDARD SUPPORTIVE CARE

CLINICAL DIAGNOSIS

D ~ DECONTAMINATION

E ~ ENHANCE ELIMINATION

ANTIDOTE

SYMPTOMATIC

TOXICOLOGICAL ANALYSIS

NON TOXICOLOGICAL

MODE OF ACTION

SOURCE

ORG TOXICITY
PERIOD OF EXPOSURE

AMOUNT OF POISON
STATE
METHOD OF ADMIN.
STATE OF STOMACH

AGE OF PATIENT
STATE OF PATIENT HEALTH
TOLERANCE
IDIOSYNCRACY
SYNERGISM AND POTENTIATION
20-25%
40-45%
0-1%
A & B ~ CARE OF RESPIRATION

C ~ CARE OF CIRCULATION
NEUROLOGICAL STATUS

HISTORY AND CIRCUMSTANCE

PHYSICAL EXM.

OCULAR
DERMAL
GIT

INDICATION
DIURESIS

DIALYSIS

LOCAL

PHYSIOLOGICAL
CORRECT ACID-BASE & WATER BALANCE
TREAT HYPOGLYCEMIA
CORRECT ELECTROLYTE IMBALANCE
CORRECT THERMAL DISTURBANCE
CATHETERIZATION
NURSING CARE

ATTEMPTED SUICIDE
SAMPLING

TYPE

kidney/liver function test

blood gases
electrolyte
radiological finding

LOCAL

REMOTE
DOUBLE
NATURAL
ARTIFICIAL
acute 24hr
subacute 24hr-1month
subchronic 1-3 month
chronic >3 month
gas>liquid>solid
i.V>inhalation>S.C>I.M>ingestion> mucous membrane
empty/full
type of food
disease

incerase dose to get same effect

unusual reaction to drug

maintain clear air pathway

creat artificial airway
monitor blood gases
treat hypotension
treat cardiac arrythmias
asses
treat seizures
sign & symptom

doubt poisoning in

EMESIS

GASTRIC LAVAGE

POWDERED ACTIVATED CHARCOL

MMULTIPLE DOSE ACTIVATED CHARCOAL(GUT DIALYSIS)

CATHARICS

WHOLE BOWEL IRRIGATION

FORCED FLUID
ALKALINE

PERITONEAL

HEMODALYSIS

HAEMOPERFUSION

PHYSICAL

CHEMICAL
acidosis
dehydration
<70mg/dL
hypokalemia
hyperkalemia
hypothermia/subnormal temp.
hyperthermia
oral hygiene
regular half hour turning of patient
half hour vital measurements
HOSPITALIZE
LIVING

DEAD

SCREENING

CONFIRMATORY

all mineral acid

alkali
organic acid
plant poison
drugs
metallic poison
animal
plant
synthetic chemicals

PaO2
PaCo2

Matthew & Lawson Scale

Glasgow Coma Scale

gastrointestinal affection
skin affection
cardiovascular system affection
respiratory system affection

CNS affection
etc.

technique
indication

contraindication

technique
precaution

indication

contraindication

complication

action
contraindication

poison that is poorly adsorbed

complication

dose
advantage

indication

example

contraindication

solution
indication

contraindication

indication

contraindication

complication
disadvantage

contraindication

complication

character of poison removed by hemodialysis

indication

contraindication
complication

indication
precaution
complication

water
demulcents
powdered activated charcoal
cholstyramine
sodium bicarbonate

i.v dextrose

vomitus
blood
urine

colour test
spectrophotometry
immunological method
chromatography
gas chromatography
high performance liquid chromatography
gc/ms
atomic absorption spectrophotometry

<60mmHg
<50mmHg

mechanical
emetics
recent ingestion of poison
concious patient
poison that not adsorbed by charchoal
comatosed patient
corrosive posioning
kerosene poisoning
patient with convulsion
poisoning with drug that have anti emetic effect
poison causing depression
other
cuffed endotracheal tube in comatosed patient
remove dentures
put patient of left side with head at lower level than boddy
drowsy or comatosed patient
concious patient
corrosive posions
kerosene poison
patient with convulsion
drug swalloed for >6hr
shocked patient
chronic poisoning
other
pulmonary aspiration
perforation
epistaxis
adsorb the poison
corrosive poison, hydrocarbon
absence of bowel sound
sign of inestinal obstruction
alcohol,cyanide,heavy metal,corrosive, hydrocarbon
constipation and mechanical bowel obstruction
aspiration if introduced throufh stomach with unprotected airway with endotracheal tube
adsorption of physiological oral antidote
vomiting
1g/Kg/body weight or 50g in adult
rapid
charcoal is effective in inaccurate poison history

charcoal slurry can easily pass through pylorus which is primary site of drug absorption
prevent absorption

after absorption
magnesium sulphate
sodium sulphate
sorbitol
absence of bowel sound
intestinal obstruction
electrolyte imbalance
patients with diarrhea
polyethylene glycol
patient ingesting large quantities of sustained released tablet
poison that charcoal poorly adsorb
body packers
bowel obstruction
paralytic ilieus
hematemesis
peritionitis

poison with weak acid

renal elimination of poison is primary excretion route
poison with low protien binding
poison active form is not excreted in kidney
shocked patient
cardiac decompensation
impaired renal function
poison produce pulmonary edema
lack of facilities to monitor plasma electrolyte level
patient with hepatic insufficiency
fluid overload
electrolyte imbalance
24hr dialysis is equal to 4hr hemodialysis
not effective in case of poor catheter placement
not effective in case of poor return of dialyzate
severe poisoning
significant hypotension
if toxic agent is not dialyzable
abdominal pain
intraperitoneal bleeding
intestinal/bladder perforation
peritonitis

water/electrolyte imbalance
protein loss
low molecular weight
low plasma protein binding
low lipd solubility
high water solubility
dialyzable poison
lethal blood level of poison
renal/hepatic insufficiency
prolonged comma
non dialyzable poison
patient is hemodynamically instable
spontaneous hemorrhage
hypotension
venous thrombosis
cardiac arrythmia
infection
high lipid bound/high lipid soluble poison
high dose administration of anticoagulants
hemorrhage
hypotension
hypoglycemia & hypocalcemia
infection

Hand/mechanical ventilation

syrup of ipecac

failed emesis
patient taking drug with antiemetic effect

airway with endotracheal tube

rimary site of drug absorption

drugs that remain in git for long time

poison with enterohepatic recirculation

poison that re excreted in stomach

anticholinergic that delay dgastric emptying

long acting sustained realeased prep.
salicylate that produce concretion in stomach

theophylline