1. Toxicologic
Emergencies
(Poisoning & Antidotes)

2. Introduction
• Poison
− Substance that is
toxic by nature, no
matter how it gets
into the body or
how much is taken
• Drug
− Substance that
has a therapeutic
effect when given
in the appropriate:
• Circumstances
• Dose

3. Definition:
 A poison is any substance solid, liquid or gas
that tends to impair health or cause death
when introduced in to the body.

4. Types of poisons
 Man-made poisons, such as chemicals
and drugs- and this are found in the home.
 Poisons that occur in nature such as,
plants that produce poisons that may
irritate the skin.
 Food poisoning: Contamination of food by
bacteria.

5. Causes:
 Many products can poison people
including gases (carbon monoxide),
food, medication, chemicals,
pesticides, or venom (a poisonous
substance secreted by snakes,
spiders) .

6. Frequent causes of poisoning
 Aspirin overdose especially in children.
 Poisons transferred from original containers to
other containers or soft drink bottles.
 Carelessness of the parents in leaving dangerous
substance and medicines within reach of
children.
 Improper storage and disposal of poisonous
substances.

7. Frequent causes of poisoning
 Improper handling of spray equipment including
the mixing of pesticides, insecticides and weed
killers.
 Inhalation or swallowing of poisonous substance.
 Over doses of drugs taken either accidentally or
with suicidal intent.
 Combining some drugs

8. Examples of poisons
around the home
 A few typical household poisons are listed below:
• Cosmetics and hair preparations
• Gasoline, kerosene and other petroleum products.
• Paint
• Strong detergents
• Bleaches
• Cleaning solutions
• Acids

9. Other examples of poisoning:
– Anticholinergics
– Sympathomimetics
– Sedative/hypnotics
– Opiates
– Alcohol intoxication
– Carbon monoxide
– Illegal drugs (drug abuse)
– Herbal preparations
– Any medication over-dose

10. Ways in which poisoning may occur
• Through the mouth (by ingestion)
• Through the skin (by absorption)
• Through the lung (by inhalation)
• By injection

11. Swallowed(ingested):
Signs and Symptoms of poisoning vary according to the type
of poison, and root of enter of the body
 Signs and Symptoms:
 Nausea and vomiting;
 abdominal pain;
 seizures;
 irregular, or fast or slow heartbeat;
 Impaired consciousness
Caused by drugs, contaminated foods, chemical solutions

12. Absorbed through the skin
(can cause burn):
 Signs and Symptoms:
 Pain; swelling;
 rash; redness; blisters
 Itching.
Caused by bleaches, cosmetic preparation, acids.. etc
Poisonings by pesticides are often the most serious.

13. Inhaled:
 Signs and Symptoms:
 Difficulty in breathing;
 Hypoxia;
 Cyanosis (blue skin coloration)
 Nausea vomiting
Caused by carbon monoxide, paints, gasoline vapor

14. Injected through the skin:
Caused by:
 Stings or bites from insects and animals
 Abuse of intravenously administered drugs
(Morphine, valium, Dolosal, etc..)
Signs and Symptoms:
Blurred vision;
Nausea and vomiting;
Difficulty in breathing;
Seizures;
Impaired consciousness;
Anaphylactic shock
Redness, itching on the site.

19. Management Modalities

20. Preventing absorption
(ingested poisoning)
Gastric lavage
 Not in unconscious patient unless intubated (risk aspiration)
 Flexible tube is inserted through the nose into the stomach
 Stomach contents are then suctioned via the tube
 A solution of saline is injected into the tube

21. Preventing absorption
(ingested poisoning)
Activated charcoal
 Adsorbs toxic substances or irritants, thus inhibiting GI
absorption
 Addition of sorbitol →laxative effect
 Oral: 25-100 g as a single dose
 repetitive doses useful to enhance the elimination of certain
drugs (eg, theophylline, phenobarbital, carbamazepine,
aspirin, sustained-release products)
 not effective for cyanide, mineral acids, caustic alkalis, organic
solvents, iron, ethanol, methanol poisoning, lithium

22. Elimination of poisons
(ingested and injected poisoning)
Renal elimination
 Medication to stimulate urination or defecation may be given to try to
flush the excess drug out of the body faster.
Forced alkaline diuresis
 Infusion of large amount of NS+NAHCO3
 Used to eliminate acidic drug that mainly excreted by the kidney eg
salicylates
 Serious fluid and electrolytes disturbance may occur
 Need expert monitoring
Hemodialysis or haemoperfusion:
 Reserved for severe poisoning
 Drug should be dialyzable i.e. protein bound with low volume of
distribution
 may also be used temporarily or as long term if the kidneys are
damaged due to the overdose.

23. Antidotes
(ingested and injected poisoning)
 Does an antidote exist?
 Does actual or predicted severity of
poisoning warrant its use?
 Do expected benefits of therapy
outweigh its associated risk?
 Are there contraindications?

24. Wernicke–Korsakoff syndrome is a chronic neurologic disorder results from
thiamine (vitamin B ) deficiency.

29. (Paracetamol)

30. n

31. Most common Antidotes
Demol Contrathion (Pralidoxine), Atropine
Aspirin Sodium Bicarbonate
Magnesium sulfate Calcium gluconate

32. THANK YOU