| Toxin |
Source |
Symptoms / Mechanism |
Treatment |
| Nitro gen Dio xide (NO2) |
Air Pollutant |
Can cause pneumonitis by direct effects on lungs
upon inhalation. |
|
| Ozone (O3) |
Air Pollutant |
Causes shallow, rapid breathing, decreased pulmonary compliance,
cough, tightness of chest, dry throat. Due to free-radical intermediates
generated by ozone. |
|
|
| Parti culate Matter |
Air Pollutant |
Pneumo coniosis: Caused by inhalation of dusts.
Silicosis is the most common form of pneumoconiosis.
Silica dusts are engulfed by macrophages ------> fibrotic nodules
through the lung
Asbestosis: Pulmonary fibrosis. Risk for bronchial
cancer, especially in smokers. Risk for malignant mesothelioma. |
|
| Carbon Mono xide (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. |
| Sulfur Dio xide (SO2) |
Air Pollutant
Fossil fuel combustion |
Forms sulfurous acid on contact with mucous membranes, irritating
membranes. Membrane irritation, bronchial constriction, especially in
asthmatics. |
|
| beta- Block ers |
Drug overdose |
Hypoglycemia, heart blocks, arrhythmias, cardiac failure. |
Glucagon can reverse the effects of hypoglycemia. |
| 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-benzoquinoneimine (BZQ) as a hepatotoxic
intermediate. |
N-Acetylcysteine provides reduced sulfhydryl groups
and restores glutathione to its reduced form. |
| Ampheta mines
(Cocaine) |
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 cholin ergics
(Atropine) |
Drug overdose |
|
Physostigmine, carbamate cholinesterase inhibitor
that does not enter the CNS. It increases amounts of ACh to combat the
toxin. |
| Aspi rin
(Salicylates) |
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. |
| Barb itura 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. |
| Benzo diaze pines
(Diazepam) |
Drug overdose |
Rarely fatal by itself, but effects similar to barbiturates. |
Flumazenil |
| Calcium -Channel Blockers
(Vera pamil) |
Drug overdose |
Bradyarrhythmias, heart block, cardiac arrest |
Calcium |
| Digi talis
(Dig oxin) |
Drug overdose |
GI: Anorexia, nausea, vomiting are usually the earliest signs of
toxicity.
CV: Toxicity results from severe hypokalemia,
causing arrhythmias: Bradycardia, ectopic beats, AV
block, sinus arrest.
CNS: Centrally stimulated vomiting, disorientation, color and visual
disturbances. |
Digoxin-specific antibody fragments. |
| Fibrino lytic agents:
Strepto kinase, Uroki nase |
Drug overdose |
Hemorrhage |
Aminocaproic Acid or Tranexamic Acid
is given to counteract the effects of the fibrinolytic agents. |
| Gold Salts |
Drug overdose |
Nephrosis, aplastic anemia. |
Penicillamine binds up gold salts and promotes
their excretion.
Dimercaprol can also be used. |
| Heparin |
Drug overdose |
Hemorrhage |
Protamine Sulfate, which must be dosed carefully,
as protamine sulfate is itself an anti-coagulant. 1 mg of protamine
sulfate for every 100U of heparin overdose. |
| Iron |
Drug overdose |
As few as 10 tablets can kill a child.
Necrotizing Gastroenteritis: vomiting, abdominal
pain, blood diarrhea, then metabolic acidosis, coma,
death. |
Supportive therapy, gastric lavage.
Deferoxamine (Desferal) IM or IV to chelate iron in
blood. |
| Isoni azid |
Drug overdose |
Hepatotoxicity in the elderly. Peripheral
Neuritis in slow acetylators, occurs because Isoniazid is a
competitive inhibitor of pyridoxine. Optic Neuritis.
Seizures in some people. |
Pyridoxine (Vit-B6) can reverse
convulsions and peripheral neuritis. |
| Opioids
(Heroin) |
Drug overdose |
Coma, pinpoint pupils, respiratory depression.
Histamine degranulation. Complete respiratory collapse in severe
poisoning, death by central respiratory arrest. |
Respiratory support. Careful with O2 therapy as
it may suppress stimulation of breathing in the carotid chemoreceptors.
Administer it with CO2.
Naloxone is opioid antagonist. Nalorphine
is alternative antagonist. |
| Tri- Cyclic Anti depres sants (TCA's) |
Drug overdose |
The leading cause of drug-overdose death in the U.S. is from
Tri-Cyclics. Wide variety of symptoms can be seen: Arrhythmias, CNS
confusion and hallucinations, GI disturbance, coma, stupor, death. |
Symptomatic and supportive therapy.
Physostigmine may be indicated if anti-cholinergic symptoms are
prominent.
NaHCO3 increases urinary excretion. |
| War farin |
Drug overdose
Rodenticide |
Hemorrhage |
Fresh frozen plasma, Factor IX are used when
immediate coagulation is needed.
Phytonadione (Vitamin-K) is given to reverse the
effects of warfarin, but it takes 24 hours to take effect. |
| Ethanol |
Drug overdose
Solvent; Alcohol |
Severe respiratory depression, cardiore spiratory arrest. |
Respiratory support. |
| Nitrites
p-Amino phenol
Aniline
Nitro benzene
p-Amino propio phenone
Atrazine |
Ferti lizer |
Methe moglo binemia: Especially in babies. Iron is
kept in the ferric (Fe+3) state, which cannot bind O2
------> baby dies of anoxia in extreme cases.
The baby will appear extremely cyanotic, hence methemoglobinemia is
nick-named Blue Baby Syndrome.
Methemoglobin is chocolate brown in color. |
Methylene Blue can be given as antidote, as it
helps to convert methemoglobin back to hemoglobin. |
