1. Bimel kottarathil

2. A poison is any substance that causes
harm if it gets into the body. . Almost any
chemical can be a poison if there is enough
in the body.

3. The amount of a chemical substance that
gets into the body at one time is called the
dose.

4.  Depends upon availability and culture
 Uk –paracetamol is a problem
 Srilanka –pesticides
 South india –copper sulphate

5.  Acute exposure
 Chronic exposure

6.  Through mouth by swallowing
 Through lungs by breathing
 Contact Through skin
 Injection through skin

7.  Most common route
 Children are commonly involved
 Can be accidental or deliberate
 Eg. Pesticide poisoning

8.  Gas, vapour, dust
 Fine spray or droplet
 Poison enters to lungs and then spread
across the whole body
 Eg. carbon monoxide

9.  chemical is sprayed or splashed onto the
skin
 if they wear clothes soaked with chemical.
 E.g. pesticide

10.  Poisons can be injected through the skin
from a syringe or a pressure gun
 During tattooing
 The bite or sting of a poisonous animal,
insect, fish or snake.

11.  DRUGS ,OTHER CHEMICALS
 Ethylene glycol
 Methanol
 Amphetamine
 Anticonvulsants
 Corrosives
 Anti diabetic drugs
 Antimalarials
 Batteries
 Benzodiazepines

12.  Calcium channel blockers
 Insecticide
 Carbon monoxide
 Cocaine
 Cyanide
 Digoxin
 House hold products
 Nail polish
 Heavy metal poisoning
 Organophosphorous poisoning

13.  Antidepressants
 Acetaminophen
 NSAID
 Antipsychotics
 Methyl xanthine
 Theophylline
 Snakes

14.  Ethylene glycol is a sweet-tasting substance
that is a common constituent of antifreeze.

15.  The clinical course of ethylene glycol
intoxication can be divided into three
phases
The first phase
 The first phase occurs less than 1 h after
ingestion and is characterized by mental
status depression, similar to that of alcohol
intoxication ,coma ,seizurs, and respiratory
depression

16. Second phase
 Cardio pulmonary toxicity
 Acidosis ,heart failure and pulmonary
oedema
Final stage
 Flank pain
 Acute tubular necrosis
 Hypocalcaemia
 Renal toxicity due to calcium oxalate

17.  Air way support
 Circulatory support
 Correction of metabolic abnormalities
 Control of seizures
 Bicarbonate to correct acidosis
 Fomepizole is the new antidote by FDA
 Haemodialysis

18.  Industrial alcohol
 Toxic alcohol
 Used in antifreeze,paint,thinner rubbing
alcohol

19.  Oxidised to formaldehyde then to formate
 Formate produces toxic effect and acidosis

20.  Cns depression
 Head ache
 Lethargy
 Convulsions
 Delirium
 Coma
Ocular symptoms
 Photophobia
 Central scotoma (loss of central vision )
 Visual field defects
 Fixed pupils

21.  Difficuilty in light adaptation
 Optic disc oedema
 Optic atrophy
Other symptoms
Nausea ,vomiting ,diaphoresis ,abdominal
pain
(due to pancreatitis)

22.  airway protec-tion
 circulatory support
 correction of metabolic abnorm-alities
 control of seizures.
 ethanol and fomepizole for specific
treatment
 Hemodialysis

23.  commonly known as ecstasy drug or party
drug, has been abused world-wide.
 Amphetamines are CNS and cardiovascular
stimulants

24.  Euphoria, extrovert behavior, lack of desire
to eat or sleep, tremor, dilated pupils,
tachycardia and hypertension
Severe intoxication
 Agitation, paranoid delusions, hallucinations
and violent behavior. Convulsions,
rhabdomyolysis, hyperthermia and cardiac
arrhythmias
 Intracerebral and subarachnoid
Hemorrhage(rare)

25.  Base line support
 Agitation is controlled by diazepam 10-20
mg i.v.
 chlorpromazine 50-100 mg i.m. injection

26.  Carbamazepine.
 Phenytoin.
 Sodium valproate.
 Gabapentin.
 Lamotrigine
 Topiramaie

27.  Drowsiness, respiratory depression,loss of
consciousness, moclonic jerks, seizurs
 Lethargy, ataxia, slurred speech,
nystagmus
 Posturing, agitation ,hallucinations

28.  charcoal 50-100 g oral
 Hemodialysis

29.  Corrosive agents:
 Acids: hydrochloric acid, sulfuric acid,
hydrofluoric acid
 Alkali: sodium hydroxide, potassium
hydroxide, ammonia, sodium hypochlorite
 Other: zinc chloride, mercuric chloride,,
phenols, potassium permanganate, button
batteries

30.  Do not put NGT
 Acid exposure is life threatening
 Maintain ABC
 Specific antidots given to nutralise acid or
alkali
 Sodium bi carbonate in acid poisoning
 Soda ,lemon juice ammonia in alkali
poisoning

31.  Insulin
 Sulfonylurea

32.  drowsiness, coma, twitching, convulsion
depressed limb reflexes,apnea, pulmonary
oedema, tachycardia and hypoglycemia

33.  Ensure plasma glucose concentration
 Intra venous glucose
 Glucogon is also used
 Maintatanance with continuous glucose
infusion with kcl

34.  Chloroquine.
 Quinine.

35.  Hypotension
 acute heart failure, pulmonary oedema and
cardiac arrest. Agitation and acute
psychosis, convulsions and coma Brady
arrhythmias and tachyarrhythmia's are
common and ECG conduction abnormalities
are similar to those seen in quinine
poisoning (QT prolongation)
 tinnitus, deafness, vertigo, nausea,
headache and diarrhea

36.  Common suicidal agents
 Rarely produce severe poisoning
 Mostly in elderly with respiratory disease

37.  drowsiness,
 ataxia,
 dysarthria
 nystagmus.
 Coma
 respiratory depression

38.  Respiratory depression is managed by
Airway support
 Flumanezenil 0.5-1.0 mg iv is the drug of
choice

39.  act by blocking voltage-gated calcium
channels, Overdose of these drugs,
particularly with verapamil and diltiazem,
are serious with heart block and
hypotension causing a significant fatality
rate.


40.  Hypotension
 Myocardial depression
 Conduction block
 Sinus bradycardia
 Heart block
 Pulmonary oedema
 Nausea
 Vomiting
 Seizures
 Lactic acidosis

41.  Activated charcoal
 Intravenous hypotension with intravenous
crystalloid
 Iv glucagon
 Dopamine to treat hypotension

42.  Carbonate insecticides inhibit acetyl
cholinesterase
 this effect is comparatively short-lived,and
milder
similar to Organophosphorous poisoning
Atropine is the drug of choice

43.  The commonest source of carbon monoxide
is an improperly maintained and poor,
ventilated heating system. The affinity of
hemoglobin for carbon monoxide is some
240 times greater than that for oxygen.
Carbon monoxide combines with
hemoglobin to form carboxyhaemoglobin

44.  Symptoms of mild to moderate exposure to
carbon monox-ide may be mistaken for a
viral illness
 In headache and mild exertional dyspnoea
 Higher concentrations of COHB are
associated with coma, convulsions and
cardio respiratory arrest

45.  High flow oxygen
 Et intubation and mechanical ventillation

46.  Assess airway and breathing
 Intubations
Primary intervention
 Oxygen administration
 Intubation
Subsequent assessment
 History,determine, LOC ,asses complaints
 Vital signs , look for rales or wheezes

47.  Cocaine hydrochloride ('street' cocaine,
'coke') is a water-soluble powder or granule
that can be taken orally, intrave-nously or
intranasally.

48. Initial euphoria, agitation, tachycardia,
hypertension, sweating, hallucinations,
convulsions ,metabolic acidosis,
hyperthermia, rhabdomyolysis, ventricular
arrhythmias. Dissection of the aorta,
Myocarditis, myocardial infarction, dilated
cardiomyopathy, subarachnoid Hemorrhage,
and cerebral Hemorrhage

49.  Diazepam 10 mg iv to control agitation
 Active cooling
 Phentolamine 2-5 mg iv for hypertension

50.  Primary assessment and interventions
 Subsequent assessment
 General interventions

51.  Cyanide reversibly inhibits cytochrome
oxidase a3 so that cellular respiration
ceases. Cyanide and its derivatives are used
widely in industry

52.  Chest tightness
 Dyspnoea
 Coma
 Convulsion
 Metabolic acidosis

53.  Support ABC
 Dicobalt edetate
 Sodium thiosulphate
 hydroxocobalamin

54.  Toxicity occurring during chronic
administration is common, though acute
poisoning is infrequent

55.  nausea, vomiting, dizziness, anorexia and
drowsiness. Rarely, confusion, visual
disturbances and hallucinations
 SVT with or without heart block VPC
 hyperkalemia

56.  Atropine
Digoxin –fab –specific antibody to
neutralise
Digoxin

57.  bleach, cosmetics, toiletries, detergents,
disinfectants and petroleum distillate
Management
 Symptomatic

58.  Arsenic
 Mercury
 Cadmium
 Iron
 Aluminium
 Lead

59.  Arsenic is the most common cause of acute
heavy metal poisoning in adults

60.  Symptoms of acute exposure are cough,
sore throat, and shortness of breath;
metallic taste in the mouth, abdominal pain,
nausea, vomiting and diarrhea; headaches,
weakness, visual disturbances, tachycardia,
and hypertension.

61.  It is used in nickel-cadmium batteries
 chronic exposure could include alopecia,
anemia, arthritis, learning disorders,
migraines, growth impairment,
emphysema, osteoporosis, loss of taste and
smell, poor appetite, and cardiovascular
disease

62.  most of the toxic effects of iron occurs
because iron is absorbed rapidly in the
gastrointestinal tractMost overdoses appear
to be the result of children mistaking red-
coated ferrous sulfate tablets or adult
multivitamin preparations for candy

63.  Although aluminum is not a heavy metal
Symptoms of aluminum toxicity include
memory loss, learning difficulty, loss of
coordination, disorientation, mental
confusion, colic, heartburn, flatulence, and
headaches

64.  Lead accounts for most of the cases of
pediatric heavy metal poisoning. It is a very
soft metal and was used in pipes, drains,
and soldering materials for many years.
Target organs are the bones, brain, blood,
kidneys, and thyroid gland exposure to lead
occurs occupationally

65.  abdominal pain-vomiting, constipation and
encephalopathy (seizures, delir-ium, and
coma) may develop in more severe cases.

66.  chelation therapy
 sodium calcium acetate 75 mg/kg/day
has been the chelating agent of choice

67.  Organophosphorous insecticides are used
widely throughout the world and are a
common cause of poisoning, causing
thousands of deaths, in the developing
world

68.  anxiety, restlessness, tired-ness, headache,
and muscarinic features such as nausea,
vomiting, abdominal colic, diarrhoea,
tenesmus, sweating, hypersalivation and
chest tightness.
 intermediate syndrome

69.  Support ABC
 Gastric lavage
 Activated charcol
 Atropine 2 mg i.v. Should be given to
reduce pulmonary oedema

70.  Tricyclic antidepressants (TCAS) are
potentially lethal in overdose. TCA agents
act on multiple receptor sites. Their
principal antidepressant action is mediated
by serotonin and noradrenalin re-uptake
inhibition.

71.  Anticholinergic effects
 Agitation, delirium
 Dilated pupils
 Dry, warm, flushed skin
 Tachycardia
 Urinary retention
 Neurotoxicity
 Sedation
 Seizures
 Coma

72.  Cardiotoxicity
 Tachycardia
 Hypotension
 Broad complex arrhythmias
 Bradycardia (late)
 Ecg changes
 Prolonged pr, qrs and qt interval

73.  Within a few hours of acetaminophen
overdose, typical symptoms include nausea
and vomiting. Tenderness and pain in the
upper right abdomen may be present.
 Very large doses can result in lactic acidosis
(a drop in pH of the blood) and coma

74.  NSAID use is associated with significant
adverse effects such as gastrointestinal
bleeding, peptic ulcer disease, high blood
pressure, edema (i.e., swelling), and kidney
disease

75.  combine with gastro protective agents
 H2 receptor antagonist
 Ppi inhibiters
Nutritional Support
Antioxidents

76. Dopamine receptors
Serotonin receptors
Muscarinic receptors
Alpha adrenargic receptors
Histamine receptors

77.  The methylxanthines theobromine and
caffeine can be found in a variety of
substances (e.g., chocolate, cocoaand
coffee beans, over-the-countersleep
prevention aids, asthma medications
[theophylline, aminophylline]).

78.  vomiting, diarrhea, polyuria, polydipsia,
hyperactivity, ataxia,
tachycardia,tachypnea, hypertension,
weakness,cardiac arrhythmias, tremors,
seizures,coma, and death

79.  Emesis
 Activated charcol
 Supportive management

80.  Theophylline has been widely prescribed for
the management of patients with chronic
obstructive lung disease and asthma.
Despite declining use over recent years,

81.  Agitation, hyperventilation, headache,
convulsions Arrhythmiasnausea & vomiting
(may be intractable), thirst, diarrhoea

82.  Asymptomatic
 Charcoal 1g/kg Observe 4 hours. If no
symptoms, discharge if not slow release
medication .If ingestion of slow release
preparation, admit for observation and
serial drug levels

83.  Symptomatic
 Charcoal 1g/kg initially unless altered
conscious state (protect airway first)
then 0.5g/kg 4 hourly, and whole bowel
irrigation with colonic lavage solution
30ml/kg/hr.Cardiac monitoringI.V. fluid
resuscitation & maintenance of adequate
hydration is vital if depressed conscious
state, arrhythmias or intractable vomiting
may need intubation

84. Features Likely poisons
Constricted pupils(miosis) Opioids, organophosphorus insecticides, nerve
agents
dilated pupils
(mydriasis)
Tricyclic antidepressants, amfetamines, cocaine,
antimuscarinic drugs
Divergent strabismus Tricyclic antidepressants
Nystagmus Carbamazepine, phenytoin
Loss of vision Methanol, quinine
Papilledema Carbon monoxide, methanol
Convulsions Tricyclic antidepressants, theophylline, opioids,
mefenamic acid, isoniazid, amfetamines

85. Features Likely poisons
Dystonic reactions Metoclopramide, phenothiazines
Delirium and hallucinations Amfetamines, antimuscarinic drugs, cannabis,
recovery from tricyclic antidepressant poisoning
Hypertonia and hyper reflexia Tricyclic anti depressants
Tinitus and deafness Salicilates
Hyperthermia Salicilates ecstasy drugs

86.  . POISON ABSORPTION
 Gut decontamination
 Gastric lavage..
 Induce vomiting
 Single-dose activated charcoal
 Cathartics
 Whole bowel irrigation

87.  Muiti-dose activated charcoal (mdac)
 Urine alkainization.
 Hemodialysis

88. Poison Antidote
Aluminum (aluminum) Desferrioxamine (deferoxamine)
Arsenic Dmsa,(dimercaptosuccinic acid)
Benzodiazepines Flumazenil
Beta -adrenoceptor blocking drugs Atropine, glucagon
Calcium channel blockers Atropine
Carbamate insecticides Atropine
carbon monoxide Oxygen
Copper D-penicillamine, dmps1

89. Poison Antidote
Opioids Naloxone
Organophosphorus insecticides atropine, hi-6, obidoxime,pralidoxime
paracetamol (n-acetylcysteine)
Thallium Berlin (prussian) blue
Warfarin and other anticoagulants Phytomenadione (vitamin k)

90. Thank you