| Toxin |
Source |
Symptoms / Mechanism |
Treatment |
| DDT Chloro pheno thane (DDT) |
Insecticide |
Very high dose in lab animals, produces seizures.
Convulsant: Mechanism of CNS stimulation appears to
be delayed closing of Na+ channels and
prevention of opening K+ channels.
Biomagnification: Increase in presence through food chain ------>
egg-shell thinning, decreased population of fish-eating
birds. |
|
|
| Dibromo chloro- propane |
Fumigant
Soil fumigant for controlling nematodes |
Pulmonary edema, gastric carcinoma in rats.
Occupational exposure can cause oligospermia. |
|
| Diethy lene Glycol |
Solvent
Glycol |
Renal toxicity same as with Ethylene Glycol. No longer used. |
|
| Digi talis
(Digo xin) |
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. |
| Dinitro phenols
(Dinitro -Ortho cresol) |
Herbicide |
They are thermogenic. They uncouple oxidative
phosphorylation with ATP production, release heat.
High fever which can be fatal. |
Ice baths, correct fluid and electrolytes, O2. |
| Dioxin (TCDD)
2,3,7,8- Tetra chloro -p- dioxin |
Herbicide
Chlorophenoxy
Contaminant of some chlorophenoxy herbicides, Agent Orange |
Long half life of about 7 years. Potent inducer of Cyt-P450 enzymes.
Deadly to guinea pigs, hamsters. Much less toxic to humans.
May be carcinogenic in large quantities. Chloracne =
Severe dermatitis caused by dioxin. |
|
| Dithio carba mate |
Fungicide |
|
|
| Ethanol |
Drug overdose
Solvent; Alcohol |
Severe respiratory depression, cardiorespiratory arrest. |
Respiratory support. |
| Ethy lene Dibro mide |
Fumigant
Soil fumigant for controlling nematodes |
Pulmonary edema, gastric carcinoma in rats. |
|
| Ethy lene Glycol |
Solvent
Glycol
Antifreeze, automobile radiators |
Biotransformed by Alcohol Dehydrogenase and Aldehyde Dehydrogenase
into Oxalic Acid, which chelates Ca+2 and
damages the kidney. Also, metabolic acidosis
from the oxalic acid. |
(1) Ethanol, to displace ethylene glycol from its
substrate.
(2) NaHCO3 for the metabolic acidosis.
(3) Parenteral Ca+2, to replace chelated Ca+2
and prevent tetany. |
| Fibrino lytic agents:
Strep toki nase, Uroki nase |
Drug overdose |
Hemorrhage |
Aminocaproic Acid or Tranexamic Acid
is given to counteract the effects of the fibrinolytic agents. |
| Fluoride |
Metal
Added to drink ing water |
High concentrations: discoloration of teeth.
Extreme concentrations: Brittle bones. |
|
| Gaso line and Kero sine |
Solvent
Aliphatic Hydrocarbon |
CNS Depression. Ingestion is dangerous because it can lead to
aspiration into lungs ------> hemorrhagic pulmonary edema
and death within 24 hrs. |
Gastric lavage is usually contraindicated, because of danger of
aspiration. |
| Glycol Ethers
(Ethy lene Glycol Mono methyl Ether, Ethy lene Glycol Mono ethyl
Ether) |
Solvent
Glycol Ether
Films, wire insulation, paint, fingernail polish. |
Teratogenic, testicular atrophy. |
|
| 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. |
| Hexa chloro benzene |
Fungicide |
Caused 300 deaths in Turkey in the 1950's. Caused cutaneous
porphyria with skin lesions, porphyrinuria, photosensitization. |
|
| 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. |
| Iso niazid |
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. |
| Isopro panol |
Solvent
Alcohol
Rubbing Alcohol |
Produces CNS depression and severe gastritis.
Can also cause kidney injury. |
|
| Lead |
Metal
Heavy Metal
Paint-chips in older homes, leaded gasoline, water laced with
lead from lead pipes, improperly glazed pottery, occupational. |
Lead Line along gingiva. Lead palsy, lead
colic.
Lead encephalopathy: Mental retardation, convulsions
in children. Peripheral neuropathy is seen in
adults.
Hem: Basophilic stippling, microcytic hypochromic anemia, ALA +
coproporphyrin found in the urine. |
CaNa2 EDTA is first-choice chelator.
Add Dimercaprol (BAL) in more
severe cases. Add Succimer in cases of severe lead
poisoning in kids.
Calcium Gluconate can be given for the relief of
lead colic. |
| Lindane, Toxa phene |
Insecticide |
Less persistent than DDT and used as a pesticide. |
|
| Manga nese |
Metal |
Chronic exposure produces Parkinson-like syndrome. |
Treated similar to Parkinson's Disease |
| Mercury, Organic
(Methyl mercury)
(CH3Hg) |
Metal
Heavy Metal
Fungicide
They are accumulated in algae and concentrate in fish through the
food chain. |
Paresthesias, ataxia. Visual-field Constriction. Mental retardation
if developing fetus is damaged, even at levels that are not symptomatic
to the mother. |
Don't use dimercaprol: It increases mercury levels in the
brain!
Non-absorbable polythiol resin will help excrete
organic mercury that is in enterohepatic circulation. |
| Mercury Inorganic Salts
(HgCl, HgCl2) |
Metal
Heavy Metal
Industrial discharge into rivers. In the past, medicinal sources:
acne skin creams, diuretic, cathartic, antiseptic. |
Intestinal pain, colic, vomiting. Concentrates in kidney
and can have effects in kidney.
Acute poisoning: tubular nephritis, shock, diarrhea, superficial
corrosion.
Mercury Line along gingiva may be seen chronically,
ashen-gray appearance in the mouth. |
Gastric lavage.
Dimer caprol IV for sympto matic patients. Don't give
it orally.
Succimer is a new orally effective chelator that
seems to be effective. |
| Mercury, Elemental Vapor
|
Metal
Heavy Metal
Usually occupational, dental amalgams. |
Lead Line along gingiva.
Neuropsychologic. Tremors, depression, insomnia, shyness, reduced
self-esteem. |
Dimercaprol, Succimer. Same as mercury salts,
except gastric lavage is not helpful. |
| Methanol |
Solvent
Alcohol
Canned fuels, paints, paint-removers, anti-freeze. |
Formaldehyde and formic acid are
products of metabolism.
Metabolic acidosis, blindness, both due to the
accumulation of formic acid.
Formaldehyde effects: (1) It irritates mucous membranes, (2)
Occupational exposure can cause asthma, (3) It can
provoke skin reactions in sensitive subjects. |
Correct the acidosis.
Ethanol: Ethanol has a 100-fold better affinity for
alcohol dehydrogenase than methanol, thus it will displace methanol as a
substrate.
4-methylpyrazole is a specific inhibitor of alcohol
dehydrogenase that may be used instead of ethanol.
Dialysis may be necessary. |
| Methyl Bromide |
Solvent
Halognated Hydrocarbon |
Lung toxicity when inhaled. |
|
| Methyl bromide |
Fumigant |
|
|
| Methy lene Chloride 1,1,1- Tri chloroe thane Tri chloro ethylene
Tetra chloro ethylene |
Solvent
Halogenated Hydrocarbon |
All are relatively safe halogenated hydrocarbons used in commerce
and industry.
High levels will cause CNS Depression. |
|
| Mirex, Kepone |
Insecticide |
Similar to DDT. Convulsions at high doses, oligospermia, liver
injury. Enterohepatic circulation and biliary excretion. |
Cholestyramine can promote their fecal excretion. |
