| Toxin |
Source |
Symptoms / Mechanism |
Treatment |
| beta- Blockers |
Drug overdose |
Hypoglycemia, heart blocks, arrhythmias, cardiac failure. |
Glucagon can reverse the effects of hypoglycemia. |
|
| 2,4 ,-Dichl orophe noxy- acetic Acid
(2,4-D) |
Herbicide
Chlorophenoxy |
Does not contain dioxin.
Rapidly excreted with short half-life.
Relatively safe. High doses have shown stiffness, neuromuscular
paralysis in lab animals. |
|
| 2,4,5- Trichl oro phen- oxyac etic Acid (2,4, 5-T) |
Herbicide
Chlorophenoxy |
Does contain dioxin.
Rapidly excreted with short half-life.
Relatively safe. High doses have shown stiffness, neuromuscular
paralysis in lab animals. |
|
| Aceta mino phen |
Drug overdose |
Central hepatocellular necrosis, hepatotoxicity.
Alcohol and starvation can cause
acetaminophen metabolism to divert to microsomal metabolism, which has
N-aceto-p-benzoquino neimine (BZQ) as a hepatotoxic
intermediate. |
N-Acetyl cysteine provides reduced sulfhydryl groups
and restores glutathione to its reduced form. |
| Aldi carb
Amino carb
Carb aryl
Carbo furan
Dime tan
Dime tilan
Isolan
Meth omyl
Prop oxur
Pyr amat
Pyro lan
Zect ran |
Insecticide
Carbamate |
They carbamy late the cholinesterase enzyme, which
is a more labile bond and thus is considered reversible.
They are not trans formed by Cyt-P450 enzymes, but rather are active
ingested form.
Symptoms: Similar but less severe than those seen for
organo phosphates. |
Atro pine.
2-PAM (Pralidoxime) does not work and in fact may make the symptoms
worse, by further potentiating ACh. |
| Alipha tic Hydro carbons |
Solvent
Alipha tic Hydro carbon |
Methane, ethane, propane, butane are harmless unless they're in such
high concentration that they displace O2.
Higher molecular-weight hydrocarbons are CNS depressants.
N-hexane is also a neurotoxin. |
|
| Alpha- Nephthyl Thiou rea |
Rodenticide |
|
|
| Alum inum |
Metal
Used in antacids |
Shaver's Disease: Pulmonary fibrosis resulting from
aluminum inhalation. |
|
| Amphe tami nes
(Coca ine) |
Drug overdose |
Moderate OD: Confusion, delirium, arrhythmias, HTN, panic.
Severe OD: Convulsions, circulatory collapse, hyperpyrexia, coma,
death. Severe intoxication is rare in adults. |
Supportive. |
| Anti choli nergics
(Atro pine) |
Drug overdose |
|
Physo stigmine, carbamate choline sterase inhibitor
that does not enter the CNS. It increases amounts of ACh to combat the
toxin. |
| Anti nomy |
Metal |
Toxicity is similar to arsenic. |
|
| Arsenic
(As+3, As+5) |
Metal
Heavy Metal
Pesticides, water. Occupational (sheep dip, vineyard sprays) |
Signs: Mees' Lines in fingernails.
CV: Vasodilation, increased capillary permeability. Blackfoot
Disease = Gangrene of extremities.
3 D's: diarrhea, dermatitis, dementia.
Diarrhea: Rice-water stools,
abdominal distress.
Dermatitis: Hyperkeratosis of palms
and soles, boils, hyper-pigmentation with long-term exposure.
Dementia: Polyneuropathy, encephalopathy.
Cancer: Squamous cell carcinoma, Basal-cell carcinoma. Lung cancer. |
Supportive.
Metal Chelators: Dimercaprol is treatment of choice.
Also penicillamine, succimer. |
| Arsine Vapor
(AsH3) |
Metal
Heavy Metal |
Acute Poisoning: Hemolysis, anemia, hemoglobinuria,
jaundice and kidney injury. GI symptoms less prominent. |
Supportive.
Metal Chelators: Dimercaprol, Penicillamine,
Succimer |
| Aspirin
(Sali cyla tes) |
Drug overdose |
Compensated metabolic acidosis, compensated by
hyperventilation.
Sx: tinnitus is often first sign of toxicity,
dizziness, confusion. At higher doses: Fever, dehydration, convulsion,
coma.
Children are more prone to it than adults. |
NaHCO3 to alkalinize urine and increase excretion of
salicylate.
Hemodialysis and respiratory support are needed in severe cases. |
| Azino phos- methyl
Chlor fenvin phos
Diazi non
Dichlo rvos
Dime thoate
Feni tro thion
Mala thion
Para thion- methyl
Tri chlor fon |
Insecticide
Organo phosphate |
Organo phosphates are choline sterase inhibitors that
irreversibly bind to and inhibit cholinesterase, increasing levels of
ACh and cholinergic activity. Thus they are cholinomimetic.
SLUD: Salivation, Lacrimation, Urination,
Defecation. Sweating, bradycardia, hypotension.
Peripheral depolarizing blockade and paralysis. Confusion, ataxia,
convulsions. Death by central respiratory arrest. |
2-PAM (Pralidoxime): Only effective within the
first few minutes of exposure. It is a strong nucleophile that can bind
with the organo phosphate, releasing it from choline sterase, before the
bond has aged.
Atro pine is treatment of choice after the bond has
aged and become irre versible. |
| Barbi tura tes
(Pheno barbi tol) |
Drug overdose |
Severe respiratory depression, perhaps some CV depression. Death by
central respiratory arrest. |
NaHCO3 to alkalinize the urine and increase excretion, as
phenobarbitol is an organic acid. |
| Barium |
Metal |
Soluble barium salts (BaCl2) produce CV and CNS effects. |
|
| Ben ene Hexa chlori des |
Insecticide |
|
|
| Ben zene |
Solvent
Aromatic Hydrocarbon
Gasoline, pumping gas. |
CNS Depression with acute exposure.
Chronic: aplastic Anemia, leukemia, due to a number
of different active metabolites. |
|
| Benzo diaze pines
(Diaz epam) |
Drug overdose |
Rarely fatal by itself, but effects similar to barbiturates. |
Flumazenil |
| Bery llium |
Metal |
Skin lesions, dermatitis, granulomas. Causes cancer in lab animals.
Causes pneumonitis by direct irritation to the lungs. |
|
| Cad mium |
Metal
Alloys, dye, batteries, plastics. In environment, concentrates in
tobacco and rice. |
The metal accumulates in the pancreas, thyroid, and testis.
Kidneys: Major site of damage. Cadmium
metallothionein complexes from the liver go to the kidney,
where the cadmium is released and damages the parenchyma.
Resp: Emphysema and pulmonary fibrosis.
Itai-Itai Disease: "Yuck-Yuck," from cadmium
exposure in Japanese rice. Cadmium caused osteomalacia.
Cancer: In lab animals, lung and prostate cancers. To a lesser
extent, kidney and stomach cancers. |
Metal chelators don't work. Supportive therapy only. |
| Calcium -Channel Bloc kers
(Vera pamil) |
Drug overdose |
Bradyarrhythmias, heart block, cardiac arrest |
Calcium |
| Carbon Tetra chlor ide (CCl4) |
Solvent
Halogenated Hydrocarbon |
It is metabolized by Cyt-P450 to the trichloromethyl
(Cl3C) free radical. Radical attacks membrane lipids ------> lipid
peroxidation ------> increased intracellular Ca+2 and cell death.
Symptoms: CNS Depression, cardiotoxicity
(sensitizes heart to catecholamines), kidney injury, liver injury, liver
cancer. |
|
| Carbon Mon oxide (CO) |
Air Pollutant
Automobile exhaust, inadequately ventilated stoves. |
Cherry Red Tissues, resulting from
carboxyhemoglobin.
Hypoxia. Headache, from cerebral edema. |
Ventilate room and remove gas. Supportive measures: respiration,
hydration, acid-base balance.
Hyperbaric O2: O2 at greater
than 100% will decrease the half-life of CO from 320 minutes to 25
minutes. |
| Chlori nated
Cycl odie nes
(Ald rin, Diel drin Hepta chlor, Chlor dane) |
Insecticide |
Similar to DDT, except they caused fatalities and can be absorbed
through the skin. No longer used. |
|
| Chlo ro form
(CHCl3) |
Solvent
Halogenated Hydrocarbon |
CNS Depression. May produce kidney injury. |
|
| Chro mium |
Metal |
Cr+3 is essential as a glucose tolerance factor and is
used therapeutically in treatment of NIDDM.
Cr+6 is a carcinogen of the respiratory tract. |
|
| Cobalt |
Metal |
Essential metal in vitamin B-12. Excess causes polycythemia, or when
combined with alcohol, it causes cardiomyopathy. |
|
| Copper |
Metal |
Wilson's Disease: Autosomal- recessive deficiency of
ceruloplasmin: retardation, biliary cirrhosis. |
Penicil lamine as the primary chelating agent, to
get rid of excess copper. |
| Cyanide |
Fumigant
Silver polish, Fumigant, metallurgy, electroplating. Burnt
plastics. |
CN- inhibits cytochrome oxidase by
forming a stable complex with ferric iron (Fe+3), preventing
it from going back down the Ferrous (Fe+2) state. This
prevent cytochrome oxidase from utilizing oxygen, resulting in tissue
hypoxia.
Venous blood is bright red because it is not being deoxygenated by
the tissues.
Hyperventilation, followed by flushing, headache,
dizziness, tachypnea. Hypoxic convulsions, death by respiratory arrest. |
Nitrite: It causes methe moglobi nemia
which can then bind up all of the extra cyanide, driving it away from
the cyto chrome oxidase.
Co2 EDTA + Hydro xocoba lamin: Takes up
cyanide, forming cyano coba lamin (Vit B12).
Thiosulfate: Give to promote the formation of
thiocyanate and its subsequent excretion. |
