What is definition of poisoning? Poisoning is injury or death due to swallowing, inhaling, touching or injecting various drugs, chemicals, venoms or gases. Many substances — such as drugs and carbon monoxide — are poisonous only in higher concentrations or dosages. activated charcoal – sometimes used to treat someone who's been poisoned; the charcoal binds to the poison and stops it being further absorbed into the blood. antidotes – these are substances that either prevent the poison from working or reverse its effects. There are four major routes by which a chemical may enter the body: Inhalation (breathing) Skin (or eye) contact. Swallowing (ingestion or eating) Injection.

1. ARCHANA CHAVHAN
M.PHARM (QA)
KYDSCT’S COLLEGE OF PHARMACY
SAKEGAON

2. Poison
○ A poison is defined as any substance which when
administered, inhaled or swallowed or applied
locally causes detereoious effects on the body.
○ Under the following acts the poison can be
purchased, stored or sold
1. Poison Act 1919
2. Pharmacy Act 1948
3. Drug Act 1940
4. Drug and Magic Remedies act 1954
5. NDPS Act 1985

3. Classificationof poisonous
substances
• HCl, H2SO4.
• Carbolic acid,
caustic soda
• Sodium carbonate
Corrosive
substances
• Inorganic: lead,
mercury, bromine
iodine, zinc etc
• Organic: insects,
snake, scorpion,
aloe, capsicum, ergot
etc.
Irritant
substances
• Cerebral poison:
opium, sedatives &
hypnotics
• Spinal poisons: nux
vomica
• Peripheral poison:
corium
Neurotic
• Digitalis, aconite,
tobacco
Cardiac
• Gases such as
coal gas, carbon
monoxide
Pulmonary
depressants
• Analgesics,
antipyretics,
antihistamines
Miscellaneous

4. TYPES OF
POISONING
○ Acute poisoning
♥ Symptoms appear
immediately
♥ Poison can be
detected in the
ingested subts.,
vomit, stool & urine
♥ Main symptoms are
vomiting, diarrhea or
coma
○ Chronic poisoning
♥ Symptoms appear
gradually
♥ Poison can be detected in
the ingested subts.,
vomit, stool & urine
♥ Main symptoms are
chronic ill-health
malaise, repeated attacks
of GI irritation,

5. GENERAL
TREATMENT OF
POISONING
○ 5 Basic principles of general treatment of
poisoning includes;
Remove unabsorbed poison from the body
To use antidotes
To excrete absorbed poison
To treat general symptoms of the victim
To maintain the victims general condition

6. “
To remove unabsorbed poison from the body
Poison enters the body by different routes. Following measures should be taken for
the removal of unabsorbed poison
1. Poison entered through mouth: poison may be removed by inducing vomiting
and washing the stomach(gastric lavage)
2. Poison entered through inhalation: victim immediately be taken to place
where there is fresh air. Artificial respiration should be given immediately.
3. Poison entered through skin contact, eye or wound: wash out the poison with
plain warm water and if antidote is available, neutralize the poison with it.
4. Poison entered through injection: remove poison by making incisions at the
point of injection & causing it to bleed. After this poison may be removed by
suction.

7. Vomiting:
 Emetics are given to induce vomiting.
 Emesis should not be done if poisoning is by strychnine, corrosives or
patient in coma.
 Common household emetics are mustard powder(15g), salt, ipecac(2g).
 Dose of 6mg of Apomorphine by SC injection followed by 5-10g
Naloxon hydrochgloride by IM or IV is widely used emetics.
 Vomiting is contraindicated in case of acid or alkali poisoning since it
may cause stomach rupture.

8. Gastric lavage:
 This method is employed in case of
ingestion of poison within 4-6hrs.
 This method is contraindicated in
following cases:
In corrosive poisoning
In case of convulsion
In children
In case of COMA
 Gastric lavage is done by using specific
tube referred as BOA’s Tube EWALD’s
Tube.

10. “
To use antidotes
Antidotes are substances which neutralizes the effects of poison.

11. PHYSICAL
ANTIDOTE
♥ This are the substances which inhibits the absorption
of poison
♥ E.g. demulcents such as egg albumin and fats, oil.
♥ Demulcents form a coat on the mucus membrane of
GIT and thus, inhibit the absorption of poison.
♥ Fats and oils should not be used as an antidote in
phosphorous since phosphorus is soluble in it.
♥ Banana is the best antidote is glass poisoning
♥ Charcoal is used to absorb alkaloidal poison.

12. CHEMICAL
ANTIDOTE
○ These antidotes interact chemically with a poison
to form an insoluble precipitate which is non toxic
or it oxidize the poison to its non toxic form
Poison Antidote
Acids Calcium & Mg oxide
Carbonic acid Magnesium sulphate
Lead Sulphates of alkali
Oxalic acid Lime
Phosphorus Copper sulphate
Alkaloids Tannins

13. PHYSIOLOGICAL
ANTIDOTE
○ These antidotes produces the effect opposite to that
of the poison without interacting chemically with it.
○ These are antagonists of poison.
Poison Antagonist
Morphine Caffeine, naloxone
Arsenic BAL, EDTA
Copper BAL, Penicillamine
Lead BAL.EDTA, Penicillamine
Organophosphorus Atropine
Mercury BAL, Penicillamine
Iron Desferrioxamine B

14. BAL (british anti-lewisite) (Dimercaprol):
 It is a chelating agent used in the treatment of heavy metal poisoning. The
heavy metals have an affinity for thiol(-SH) group and combine with them
in body tissues, displacing the hydrogen and depriving the body of these
enzymes whose activities depends on a thiol group.
 BAL is administered in a dose of 3-5 mg/kg. IM at the interval of 4hours
for first 2 days, interval of 4-6 hrs for additional 2 days and interval of 6-
12 hrs for additional 7 days
EDTA(ethylene Diamine tetra acetate):
 It has great affinity for the lead.
 Chelated lead is excreted in urine.
 Dose: 75mg/kg 24 hrs IM or slow IV given in 3-6 divided dose for 5 days

15. Penicillamine:
 It has stable –SH group which confers the chelating action.
 It is less toxic than EDTA & can be given orally.
 Used in copper, lead, mercury poisoning
 Dose: 100mg/kg/day in divided doses for 5 days
 For long term therapy dose should not exceed 40mg/kg/day
Desferrioxamine:
 It chelates iron in the stomach & binds iron in the blood.
 Thus, it is useful both orally & intravenously for avoiding
systemic absorption & removing absorbed iron.
 Dose: oral 8-12g in 40-60ml distilled water IV 29 in 5%
laevulose solution

16. Universal antidote:
 When the nature of poison is unknown the universal
antidote is used,
 To neutralize the acids
 To absorb the alkaloidal poison
 To chelate the metals or certain glycosides
Composition of unioversal antidote
Magnesium: 1 part
Activated charcoal: 2 parts
Tannic acid: 1 part
 The mixture should be given in dose of 1 tbs in 200ml of
water once or twice

17. To excrete absorbed poison
After 6 hrs of ingestion of poison, emesis and gastric lavage are useless.
The poison has entered the intestine and hence the following measures
should be taken to excrete poison through urine & feces.
1. Forced diuresis: use IV chlorthiazide or mannitol
2. Use of cathartics
3. Use of hot packs: for increased sweating
4. Peritoneal dialysis: for salicylate poisoning in children
5. Hemodialysis: for excretion of barbiturates, bromides

18. To treat general symptoms of the victim
When the poison is unknown symptoms provide the best clue for the
treatment.
Symptoms Treatment
Pain Morphine
Respiratory failure Artificial respiration
Circulation failure Cardiac stimulants
Dehydration Saline infusion
Glucose leven abnormal Saline infusion + sodium bicarbonate

19. To maintain victims general condition
 In case of unconscious victim, maximum
danger is of upper respiratory infection.
 To avoid this risk of infection the prophylactic
antibiotic therapy must be given
 Also management of
 hypothermia,
 Intensive supporting treatment &
 Good nursing care
 Is required to maintain the general condition of
victim

20. “
INSECTIOCIDE POISONING
• Organophosphorus compounds
The compounds of this class include;
A. Alkyl phosphates
B. Aryl phosphates
• D.D.T
• Endrin
• Naphthalene

21. ORGANOPHOSPHORUS
COMPOUNDS
A. Alkyl phosphates:
 HETP (hexaethyl tetraphosphate)
 TEPP (tetraethyl pyrophosphate
 OMPA ( octamethyl pyrophosporamide)
B. Aryl phosphates:
 Parathion
 Diazinon

22. Symptoms Fatal dose Treatment
Poison first affects the
smooth muscles and
glands and then vital
organs
HETP
IV/IM 160mg
Oral 350mg
Decontamination
Initially headache,
malaise, constriction of
chest and pupil
OMPA
IV/IM80mg
Oral 175mg
Artificial respiration
After a few hours
nausea, vomiting,
diarrhea, sweating
TEPP
IM/IV 45mg
Oral 100mg
Antidote therapy:
atropine
In severe poisoning,
pulmonary odema,
coma, convulsion
Parathion: IV/IM 80mg
Cholinestrase reactive
therapy

23. D.D.T.
Symptoms Fatal dose Treatment
Oral route: salivation,
nausea, vomiting
280mg/kg oral Poison must be removed
from GIT by lavage
Contact: irritation of eye,
nose, throat, vision,
dermatitis
150-1000mg/kg/body
weight
Adrenaline should not be
used.
Artificial respiration
endrin
Symptoms Fatal dose Treatment
Vomiting, abdominal
pain, convulsion
280mg/kg oral Poison must be removed
from GIT by lavage

24. Naphthalene
Symptoms Fatal dose Treatment
Haemolytic anaemia, acute
nephritis, optic neuritis,
pain in urethra, nausea,
vomiting.
Approximately 2g Keep the patient warm.
Stomach wash with saline
water. Use mg. Sulphates
to clear stomach and
administer sodium
bicarbonate to maintain
urine alkaline
Sever poisoning causes
kidney damage or liver
damage
After inhalation it causes
convulsion, headache,
vomiting etc
Blood transfusion may be
necessary
Hydrocortisone for
haemolysis

25. “
HEAVY METAL POISONING
Arsenic
Symptoms Fatal dose Treatment
Acute poisoning 100-200mg Stomach wash with warm water.
Ppt. of hydrated ferric oxide as antidote. IV
sodium thiosulfate 1g in 10ml sterile water
every 4-6hrs for first day
Morphine for controlling pain
Chronic poisoning 100-200mg Remove patient from exposure
IV sodium thiosulphate 1g in 10 ml sterile
water WFI 2-3times/week

26. “
lead
Symptoms Fatal dose Treatment
Acute poisoning -- Stomach wash with
10% solution of
mg.sulphate followed
with plain water.
Bowel should be
washed at regular
intervals
Chronic poisoning 05g BAL is effective in
excretion of lead.
BAL 4mg/kg/body
weight

27. “
MERCURY
Symptoms Fatal
dose
Treatment
Acute
poisoning
-- Removal by emetics or
stomach wash with 5%
solution of sodium
formaldehyde or charcoal
powder
Chronic
poisoning
-- Remove patient from
exposure.
Promote elimination by
bowels & kidney
Dimercaprol or
belladonna as antidote
Symptoms Fatal
dose
Treatment
Acute
poisoning
30g Same as mercury poisoning
600ml of pot. Ferro cyanide
in glass of water to be given
before performing gastric
lavage
Chronic
poisoning
-- Same as for chronic mercury
poisoning
COPPER

28. “
BARBITURATES POISONING
Symptoms Fatal dose Treatment
Nausea, mental
confusion, depression,
drowsiness, decrease
urine formation,
contraction of pupil,
muscle spasm.
3-5g • Gastric lavage with KmNO4.
• Artificial respiration
• 5% glucose saline IV
• Coramine 5ml IV
• Hemodialysis
• Forced diuresis
• Enema

29. “
NARCOTIC DRUG POISONING
Symptoms Fatal dose Treatment
Opium
Excitement, Sopor,Narcosis,
Increased heart rate, Deep
coma, Loss of reflex,
Cocaine
Euphoria, mydriass, dry
mouth, increase sweating,
black tongue.
Belladona
Dry mouth, fever, blur
vision, increased heart rate,
abdominal pain.
2g or 200mg of
morphine
• Stomach wash with tepid water first
& then with solution of KmNO4
• Enema
• Antagonist therapy
• Naloxone 04-0.8 mg IV every 15
minutes
• 5% glucose saline
1g
125mg

30. Toxicovigilance
• Toxicovigilance is the process of identifying and evaluating the risks
of poisoning that exist within a community, and proposing and evaluating
measures taken to reduce, eliminate or manage them.
• It involves the analysis of poisons center enquiries to identify whether there
are specific circumstances or agents giving rise to poisoning, or certain
populations suffering a higher incidence of poisoning.
• The practice of Toxicovigilance often involves the registration of cases of
poisoning by health professionals, or the analysis of enquiries made
to poison control centers. Because of this, practicing Toxicovigilance is often
one of the core tasks of a poison control center.