Medical college lectures: toxicology/poisoning 5nd year.

1. Poisons & Drug Poisoning Dr Mohamad shaikhani.

2. Accidental?

32. Paracetamol Overdose

37. Do not check a paracetamol level before 4 hours have elapsed; it is uninterpretable. If more than 8 hours since ingestion, start N-acetylcysteine immediately & only stop it if the concentration is below the treatment line

49. Cardiotoxic drugs:

62. Carbon monoxide poisoning. All comatose patients Patients with neurologic impairment by examination or psychometric testing Patients with carboxyhemoglobin levels >40% Cardiovascular involvement (chest pain, ECG changes, arrhythmias) Pregnant patients with carbon monoxide levels >15% Patients who do not respond to 100% oxygen Patients with recurrent symptoms up to 3 weeks after exposure SPECIFIC INDICATIONS FOR HYPERBARIC OXYGEN THERAPY

76. Methanol & ethylene glycol poisoning. Aggressively prevent methanol conversion by infusing IV ethanol. Correct metabolic acidosis with sodium bicarbonate; Hemodialysis to remove methanol/metabolites—indicated for patients with visual disturbance, serum methanol >50 mg/dL, or with intractable metabolic acidosis. Treat Altered mental status; coma; seizures; gastrointestinal disturbance with abdominal pain; pancreatitis in some; visual disturbances: blurred vision, diplopia, photophobia, sensation of "being in a snowstorm," blindness (end result). S&ss Methanol POISONING WITH METHANOL OR ETHYLENE GLYCOL

77. Methanol & ethylene glycol poisoning. Treat ethylene glycol with: aggressive gastric lavage; ethanol infusion or 4-methylpyrazole, sodium bicarbonate to correct metabolic acidosis, Correct hypocalcemia with calcium chloride, Hemodialysis Treatment Early Altered mental status; seizures; hypocalcemic tetany 12 hr after ingestion Congestive heart failure 24 – 72 hr after ingestion Profound renal failure Signs and symptoms Ethylene Glycol

91. Tricyclic OD – Initial ECG

92. Tricyclic OD – Recovery ECG