1. 10
Toxicology

2. Multimedia Directory
Slide 19 Mechanism of Action of Cocaine Animation

3. Toxicology 10 million people are poisoned in U.S. each year.
Attempted suicide
Accidental legal drug overdosage
Illegal drug overdosage
Snake, spider bites
Exposure to toxins in workplace

4. Cathy Melloan / PhotoEdit, Inc.
Figure In the majority of accidental childhood poisonings, poisonous materials are left in easy reach of children.

5. Prevention Child-resistant packaging Poison Control Centers
Medication error prevention
Safe storage of toxins in home

6. Figure 10-2 Child-resistant packaging.

7. Poison Detection
Some poisons have specific symptoms to assist in giving an accurate diagnosis:
Cyanide: unmistakable odor of bitter almonds
Insecticides: GI hyperactivity, salivation, pupillary constriction
Carbon monoxide: cherry-colored flush of skin and mucous membranes

8. Treatment of Poisoning
Emetics (e.g., ipecac): trigger vomiting; contraindicated in ingestion of corrosives
Absorbents (activated charcoal): bind poison molecules to charcoal and excreted; effective in cardiac glycoside and methylxanthine poisoning, heavy metal and corrosive chemical poisoning

9. Treatment of Poisoning
Cathartic agents: shorten transit time of chemicals through GI tract; work by retaining water in bowel to stimulate peristalsis

10. Table 10-1 Poisons and Antidotes

11. Specific Poisons: Acetaminophen
Acetaminophen (Tylenol): nausea and vomiting (early stages); liver injury after 2–3 days
Antidote: acetylcysteine given within 8–10 hours

12. Specific Poisons: Alcohols
Ethanol or ethyl alcohol
Treatment includes:
Emesis, gastric lavage
Hemodialysis

13. Specific Poisons: Ethylene Glycol
Antifreeze, windshield de-icing solutions
Signs/symptoms: within 1–12 hours: nausea, vomiting, ataxia, seizures, cerebral edema, coma, death; 12–14 hours: tachypnea, cyanosis, tachycardia, pulmonary edema, pneumonitis

14. Specific Poisons: Ethylene Glycol
Treatment: gastric lavage within 30 minutes; 10% solution of ethanol; and hemodialysis

15. Specific Poison: Methanol
Wood alcohol; antifreeze, windshield-washer fluid, solvent in photocopier solutions
Signs/symptoms: visual disturbances, bradycardia, seizures, metabolic acidosis, respiratory depression, coma; blindness, and permanent retinal damage

16. Specific Poison: Methanol
Treatment: gastric lavage, IV administration of 10% solution of ethanol; hemodialysis

17. Specific Poison: Heparin and Warfarin
Heparin signs/symptoms: hemorrhage, ecchymoses, melena
Heparin treatment: slow IV infusion of protamine sulfate
Warfarin signs/symptoms: hemorrhage
Warfarin treatment: phytonadione (vitamin K); blood products with clotting factors

18. Specific Poisons: Amphetamines
Methamphetamine most common; also pseudoephedrine, ephedrine
Signs/symptoms: agitation, restlessness, acute psychosis, hypertension, tachycardia, brain damage, renal failure
No specific treatment

19. Mechanism of Action of Cocaine Animation
Click on the screenshot to view an animation showing the mechanism of action of cocaine.
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20. Specific Poison: Antihistamines
Signs/symptoms: CNS excitement or depression; drowsiness, stupor, coma
Supportive treatment, phenobarbital or diazepam to control convulsions

21. Specific Poison: Benzodiazepines
Signs/symptoms: CNS depression occurs within 30 minutes; coma, respiratory depression
Treatment: activated charcoal, respiratory support

22. Specific Poison: Bleaches
Signs/symptoms: corrosive action in mouth, pharynx, esophagus
Treatment: dilute ingested bleach with milk or water

23. Specific Poison: Carbon Monoxide
Signs/symptoms: cherry color in skin and mucous membranes, coma, death
Treatment: pure oxygen, ventilation support, diuretics and steroids (to treat resultant cerebral edema)

24. Specific Poison: Corrosives
Ingestion almost always with suicidal intent
Signs/symptoms: irritation; severe pain; bleeding; severe burns in mouth, esophagus, stomach; profound shock
Treatment: immediate dilution with water or milk; emesis or gastric lavage contraindicated

25. Specific Poison: Cyanide
Medical emergency
Signs/symptoms: odor of bitter almonds
Treatment: nitrite to produce methemoglobin; supportive measures such as 100% oxygen

26. Specific Poison: Digoxin
Signs/symptoms: anorexia, nausea, vomiting, lethargy, abdominal cramping, diarrhea, vertigo, fatigue, muscle weakness, blurred vision, seizures, diplopia, electrolyte imbalance, bradycardia
Treatment: ipecac, activated charcoal, lavage

27. Electrolyte Imbalances
Magnesium: treatment is IV of 10 mL of a 10% solution of calcium gluconate
Potassium: treatment is calcium administration, sodium bicarbonate or glucose/insulin
Iron: treatment is whole bowel irrigation, deferoxamine

28. Specific Poison: Isoniazid (INH)
Signs/symptoms: fever, peripheral neuritis, jaundice, skin rash, hepatic injury
Treatment: pyridoxine, gastric lavage, activated charcoal, sodium bicarbonate, hemodialysis

29. Specific Poison: Lead
Signs/symptoms: metallic taste, abdominal pain, vomiting, CNS depression, respiratory failure
Treatment: chelating agents, IV EDTA and dimercaprol, gastric lavage

30. Specific Poison: Lithium
Signs/symptoms: tremor, diarrhea, polydipsia, anorexia, polyuria, vomiting, blurred vision, hypothyroidism, hyperglycemia, weight gain
Treatment: gastric lavage within 1 hour, activated charcoal, whole bowel irrigation, sodium polystyrene sulfonate, volume resuscitation

31. Specific Poison: Mercury
Signs/symptoms: burning sensation in throat, metallic taste, discoloration and edema of mouth, vomiting, bloody diarrhea, shock
Treatment: gastric lavage, activated charcoal, IM dimercaprol

32. Specific Poison: Opioids
Signs/symptoms: euphoria, drowsiness, constricted pupils, hypotension, bradycardia, hypothermia, coma, respiratory arrest
Treatment: gastric lavage or emesis, activated charcoal, naloxone

33. Specific Poison: Organophosphates
Signs/symptoms (30 minutes–2 hours): nausea, vomiting, urinary and fecal incontinence, abdominal cramps, increased bronchial secretions, wheezing, coughing, salivation, sweating, blurred vision

34. Specific Poison: Organophosphates
Treatment: remove clothing, wash skin with soap and water; activated charcoal; supportive measures: treatment of seizures, ventilatory assistance, oxygen

35. Specific Poison: Petroleum Distillates
Signs/symptoms: pulmonary edema, pneumonitis, resembles alcohol intoxication, nausea, headache, burning sensation in chest
Treatment: emesis (if alert), oxygen therapy

36. Specific Poison: Salicylates
Signs/symptoms: vertigo, hearing impairment, nausea, vomiting, diarrhea, sweating, drowsiness, fever, headache, convulsions, hallucinations, cardiovascular collapse, coma
Treatment: emesis, gastric lavage, activated charcoal, osmotic cathartic, artificial ventilation

37. Specific Poison: Theophylline
Signs/symptoms: hypokalemia, hyperglycemia, hypercalcemia, hypophosphatemia, acidosis; nausea, vomiting, abdominal pain, tachycardia; seizures, hypotension, dysrhythmias
Treatment: endotracheal intubation and gastric lavage, activated charcoal, benzodiazepines and phenobarbital to treat seizures; hemoperfusion or hemodialysis

38. Bites and Stings
Scorpion: treatment is antivenom, calcium gluconate, and phenobarbital
Spiders: antivenom, IV calcium gluconate, antibiotics, tetanus immunization, oxygen, antihistamines, adrenalin, muscle relaxants
Snake bites: reduce venom absorption; incision and suction; ice should not be applied to bite