1. Focus on Pharmacology Essentials for Health Professionals
Jahangir Moini, MD, MPH
Chapter 28 Toxicology

2. 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

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

4. 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

5. 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 heavy metal and corrosive chemical poisoning

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

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

8. Specific Poisons: Ethylene Glycol
Antifreeze, windshield de-icing solutions
Signs/symptoms: within 1–12 hours: nausea, vomiting, seizures, cerebral edema, coma, death; 12–14 hours: tachypnea, cyanosis, tachycardia, pulmonary edema, pneumonitis
Treatment: gastric lavage within 30 minutes; 10% solution of ethanol; and hemodialysis

9. 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

10. Specific Poison: Antihistamines
Signs/symptoms: CNS excitement or depression; drowsiness, stupor, coma
Supportive treatment; phenobarbital or diazepam to control convulsions

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

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

13. 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)

14. 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

15. 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

16. 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

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

18. 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: reducevenom absorption; incision and suction; ice should not be applied to bite