| Toxin |
Source |
Symptoms / Mechanism |
Treatment |
| Nickel |
Metal |
Nickel Carbonyl (Ni(CO)4) is the most toxic form of
nickel and can cause pneumonia.
Nickel Subsulfate: Carcinogen that is inhaled
Nickel Itch: Dermatitis caused by elemental nickel
jewelry. |
|
|
| Nicotine |
Insecticide
Botanical Insecticide
Tobacco, environmental |
Ganglionic stimulation causes salivation, vomiting.
Neuromuscular stimulation leads to depolarizing blockade, muscular
weakness.
Ultimately, convulsions and central respiratory arrest. |
|
| Nitrites
p -Amino phenol
Aniline
Nitro benzene
p -Amino propio phenone
Atrazine |
Fertilizer |
Methemo globinemia: 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 methemo globinemia 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. |
| Nitrogen Dioxide (NO2) |
Air Pollutant |
Can cause pneumonitis by direct effects on lungs
upon inhalation. |
|
| 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. |
| 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. |
|
| Paraquat |
Herbicide
Bipyridyl |
Forms a superoxide radical ------> singlet O2 radical,
which attacks lipids in cell membranes ------> lipid
hydroperoxides which form lipid free radicals and do damage in
lungs.
Paraquat affects the lung, regardless of route of
exposure. Pneumonitis. |
Gastric lavage, cathartics, to prevent further GI absorption of
paraquat.
Hemodialysis and hemoperfusion may be helpful to detoxify. |
| Parathion |
Insecticide
Organo phosphate |
Biotransformed to Paraxon before it has its toxic
effect. |
2-PAM, Atropine (see above) |
| Parti culate Matter |
Air Pollutant |
Pneumoconiosis: 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. |
|
| Penta chloro phenol |
Fungicide
Wood preservative |
Thermogenic. Uncouples oxidative phosphorylation
from ATP production. Fatal fever. Similar to dinitrophenols. |
Ice baths, correct fluid and electrolytes, O2. |
| Phosphine |
Fumigant
From aluminum or zinc phosphide, in the presence of moisture. |
Severe pulmonary irritation, pulmonary edema. |
|
| Phos phorous
Zinc Phos phide |
Rodenticide |
GI irritation, vomiting. Vomitus is luminescent and
has a garlic odor. GI hemorrhage may ensue, with death within 24 hours.
Or, severe liver injury may ensue.
Chronic Compli cations: Anemia, bronchitis.
Phossy Jaw = Necrosis of the mandible. |
|
| Propy lene Glycol Mono methyl Ether |
Solvent
Glycol Ether |
It is not teratogenic and is a safe compound. |
|
| Propy lene Glycol |
Solvent
Glycol
Drug solvent |
It does not produce kidney injury. |
|
| Pyre thrum |
Insecticide
Botanical Insecticide
From chrysan themums |
Very safe. Some people may be allergic. At very high dose, they show
the same convulsant action as DDT. |
|
| Red Squill |
Rodenticide
From plant bulbs containing scillaren glycosides |
Scillaren glycosides act similar to Digitalis.
Cardiotoxicity, arrhythmias, convulsions. |
|
| Rote none |
Insecticide
Botanical Insecticide
Plant roots |
Rotenone blocks mitochondrial respiration.
Oral ingestion produces GI irritation, nausea, vomiting.
Conjunctivitis, dermatitis, pulmonary irritation. |
|
| Silver |
Metal |
Causes discoloration of skin known as argyria. |
|
| Sodium Fluoro acetate |
Rodenticide |
Metabolized to fluorocitrate, which then inhibits aconitase in the
citric acid cycle. CNS and CV toxicities. |
|
| Stry chnine |
Rodenticide |
It inhibits glycine receptors in the CNS, producing severe CNS
excitation. Glycine is primarily in the spinal cord.
Stiffness of face and neck muscles, convulsions.
Opisthotonos: Body hyperextended, arched backward,
with head and heals on ground. |
Prevent convulsions, respiratory support. Minimize sensory stimuli.
Diazepam for convulsions. May need to use general
anesthetics or neuromuscular blocking agents (tubocurarine). |
| Sulfur Dioxide (SO2) |
Air Pollutant
Fossil fuel combustion |
Forms sulfurous acid on contact with mucous membranes, irritating
membranes. Membrane irritation, bronchial constriction, especially in
asthmatics. |
|
| Thal lium |
Rodenticide
Metal |
Hazardous because it is not selectively toxic for rodents.
GI toxicity, brain, liver, kidney. Reddening of the skin,
neuropathy, alopecia are characteristic signs. May also see
psychoses, delirium. |
Prussian Blue (ferric ferrocyanide) interrupts the
enterohepatic circulation of Thallium, enhancing its excretion. |
| Tin |
Metal |
Lead Line along gingiva |
|
| Toluene |
Solvent
Aromatic Hydrocarbon
Glue Sniffing |
CNS Depression, but no hematologic abnormalities or
cancer. |
|
| 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. |
| Trio thocre sylphos -phate (TOCP)
Mipafox
Leptophos |
Insec ticide
Organo phosphate |
They may cause delayed neurotoxicity sequelae.
Residual paralysis and axonal degeneration, occurring weeks after an
episode of organo phosphate poisoning. |
|
| Vinyl Chloride
(CH2 = CHCl) |
Solvent
Halogenated Hydrocarbon |
CNS Depression and known carcinogen. |
|
| Warfarin |
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. |
| Zinc |
Metal |
|
CaNa2 EDTA |
