SlideShare una empresa de Scribd logo
1 de 55
Descargar para leer sin conexión
:Prepared by
       .Dr.Mohamed Shekhani
.References: Davidson PP of Medicine
:Introduction
• Poisoning is a major cause of death in young adults& 10% of
  hospital admissions.
• Most deaths occur before patients reach medical attention&
  mortality is much <1% in those admitted to hospital.
Introduction: In developed countries
• The most frequent cause is intentional drug overdose in the context
  of self-harm& usually involves prescribed or ‘over-the-counter’
  OTC medicines.
• Accidental poisoning is also common, esp in children& elderly.
• Household /agricultural products such as pesticides/ herbicides are
  common sources of poisoning &associated with a much higher case
  fatality.
• Toxicity also may occur as a result of alcohol or recreational
  substance use, or following occupational or enviro exposure.
General approach:Triage/resuscitation:
• Those seriously poisoned must be identified early so that
  appropriate management is not delayed.
• Vital signs:
• Identifying the poison(s) by obtaining adequate information.
• Prevent reattempt by identifying those at risk.
• Those with external contamination with chemical or environmental
  toxins should undergo appropriate decontamination.
• Critically ill patients must be resuscitated(abc).
• (GCS) is commonly employed to assess conscious level or AVPU
  (alert/verbal/painful/unresponsive).
General approach:Triage/resuscitation:
General approach: Triage/resuscitation:
• An (ECG) should be performed & cardiac monitoring instituted in
  all patients with CV features or where exposure to potentially
  cardiotoxic substances is suspected.
• Those who need antidotes given according to weight.
• Benzodiazepine/flumazenil
• Opiods/Nalorphine.
• Paracetamol/N-Acetyl cysteine.
• Substances that are unlikely to be toxic in humans should be
  identified so that inappropriate admission & intervention are
  avoided
General approach: Triage/resuscitation:
General approach: Triage/resuscitation:
:Clinical assessment
• History &examination .
• Patients may be unaware or confused about what they have
  taken, or may exaggerate (or less commonly underestimate) the
  size of the overdose, &rarely mislead medical staff deliberately.
• Toxic causes of abnormal physical signs SHOULBE BE KNOWN.
• Cluster of clinical features (‘toxidrome’) suggestive of poisoning
  with a particular drug type IDENTIFIED.
• Poisoning is a common cause of coma, especially in younger people,
  but it is important to exclude other potential causes, unless the
  aetiology is certain.
• Anticholinergic
  – Hot As Hades
  – Blind As A Bat
  – Dry As A Bone
  – Red As A Beet
  – Mad As A Hatter
:Investigations
• Urea, electrolytes, creatinine should be measured in most patients.
• Arterial blood gases should be checked in those with significant
  respiratory or circulatory compromise, or when poisoning with
  substances likely to affect acid–base status is suspected.
• Calculation of anion and osmolar gaps may help to inform diagnosis
  for a limited number of specific substances.
• Management may be facilitated by measurement of the amount of
  toxin in the blood.
• Qualitative urine screens or potential toxins including near-
  patient testing kits have a limited clinical role.
• Occasionally, for medicoegal reasons, it is useful to save blood
  and urine for subsequent measurement of drug concentrations.
psychiatric assessment
• All patients presenting with deliberate drug overdose should
  undergo psychosocial evaluation by a health professional with
  appropriate training prior to discharge ,once the patient has
  recovered from any features of poisoning, unless there is an urgent
  issue such as uncertainty about his or her capacity to decline
  medical treatment.
General management
• Patients presenting with eye or skin contamination should
  undergo appropriate local decontamination procedures.
Gastrointestinal decontamination
• Patients who have ingested potentially life- threatening
  quantities of toxins may be considered for GIT decontamination if
  poisoning has been recent.
• Induction of emesis using ipecacuanha is now never recommended.
Activated charcoal
• Given orally as slurry, activated charcoal absorbs toxins in the
  bowel as a result of its large surface area.
• If given sufficiently early, it can prevent absorption of an
  important proportion of the ingested dose of toxin.
• The efficacy decreases with time.
• Current guidelines do not advocate use >1 hour after overdose in
  most circumstances,EXCEPT when delayed-release preparation has
   been taken or when gastric emptying may be delayed.
Activated charcoal
• Some toxins do not bind to activated charcoal so it will not affect
  their absorption.
• In patients with an impaired swallow or a reduced level of
  consciousness, the use of activated charcoal, even via a nasogastric
  tube, carries a risk of aspiration pneumonitis.
• This risk can be reduced but not completely removed by
  protecting the airway with a cuffed endotracheal tube.
• Multiple doses of oral activated charcoal (50 g every 4 hours) may
  enhance the elimination of some drugs at any time after
  poisoning and are recommended for serious poisoning with some
  substances .
Activated charcoal
• They achieve their effect by interrupting enterohepatic circulation
  or by reducing the concentration of free drug in the gut lumen, to
  the extent that drug diffuses from the blood back into the bowel to
  be absorbed on to the charcoal: so-called ‘GIT dialysis’. A laxa-
  tive is generally given with the charcoal to reduce the risk of
  constipation or intestinal obstruction by charcoal ‘briquette’
  formation in the gut lumen.
• Recent evidence suggests that single or multiple doses of
  activated charcoal do not improve clinical outcomes after poisoning
  with pesticides or oleander.
SUBSTANCES NOT BOUND BY
            CHARCOAL
• Alcohols And        • Heavy Metals
  Glycols               – Iron
• Corrosives            – Lead
  – Alkalis             – Lithium
  – Acids               – Mercury
• Cyanide             • Hydrocarbons
• Saline Cathartics
Gastric aspiration & lavage
• Gastric aspiration and/or lavage is now very infrequently
  indicated in acute poisoning, as it is no more effective than
  activated charcoal, and complications are common, especially
  aspiration.
• Use may be justified for life-threatening overdoses of some
  substances that are not absorbed by activated charcoal
Whole bowel irrigation
• This is occasionally indicated to enhance the elimination of ingested
  packets or slow-release tablets that are not absorbed by activated
  charcoal (e.g. iron, lithium), but use is controversial.
• It is performed by administration of large quantities of
  polyethylene glycol and electrolyte solution (1–2 L/hr for an adult),
  often via a nasogastric tube, until the rectal effluent is clear.
• Contraindications include inadequate airway protection,
  haemodynamic instability, gastrointestinal haemorrhage,
  obstruction or ileus.
• Whole bowel irrigation does not cause osmotic changes but may
  precipitate nausea and vomiting, abdominal pain and electrolyte
  disturbances
Urinary alkalinisation
• Urinary excretion of weak acids& bases is affected by urinary pH,
  which changes the extent to which they are ionised.
• Highly ionised molecules pass poorly through lipid membranes and
  therefore little tubular reabsorption occurs and urinary excretion
  is increased.
• If the urine is alkalinised (pH > 7.5) by the administration of
  sodium bicarbonate (e.g. 1.5 L of 1.26% sodium bicar-bonate over 2
  hrs), weak acids (e.g. salicylates, methotrexate , herbicides 2,4-
  dichlorophenoxyacetic acid and mecoprop) are highly ionised and
  so their uri-nary excretion is enhanced.
• This technique should be distinguished from forced alkaline
  diuresis, in which large volumes of fluid with diuretic are given in
  addi-tion to alkalinisation(no longer used because of the risk of
  fluid overload).
Urinary alkalinisation
• Urinary alkalinisation is currently recommended for patients
  with clinically significant salicylate poi-soning when the criteria
  for haemodialysis are not met
• It is also sometimes used for poisoning with methotrexate.
• Complications include alkalaemia, hypokalaemia, occasionally
  alkalotic tetany.
• Hypocalcaemia is rare.
Haemodialysis & haemoperfusion
• These can enhance the elimination of poisons that have a small
  volume of distribution & a long half-life after overdose, useful when
  the episode of poisoning is sufficiently severe to justify invasive
  elimination methods.
• The toxin must be small enough to cross the dialysis membrane
  (haemodialysis) or must bind to activated charcoal
  (haemoperfusion) .
• Haemodialysis may also correct acid–base and metabolic
  disturbances associated with poisoning
Antidotes
• Are available for some poisons
• Work by a variety of mechanisms: for example:
• Specific antagonism (e.g. isoproterenol for β–blockers) or
  Pharmacological antagonism( flumazenil for benzodiazepines &
  nalorphine for opoids)
• Chelation (e.g. desferrioxamine for iron)
• Reduction (e.g. methylene blue for dapsone).
Supportive care
• For most poisons, antidotes & methods to accelerate elimination
  are inappropriate, unavailable or incompletely effective.
• Outcome is dependent on appropriate nursing & supportive care,
  & on treatment of complications.
• Patients should be monitored carefully until the effects of any
  toxins have dissipated.
:Study SCQs
•   1. In Poisoning all are true except::
•   A. The most common cause of death in young adults.
•   B. The most common cause of hospital admissions.
•   C. Most die before reaching hospital.
•   D. In-Hospital Mortality should be less than 1%.
•   E.The most common cause of death in elderly persons.
:Study SCQs
•   2.The most way of poisoning is:
•   A.Accidental.
•   B.Intentional.
•   C. Agricultural products intake.
•   D. Alcolol.
•   E. Opoid intake.
:Study SCQs
•   3.Common drugs involved in poisoning include all except:
•   A.NSAIDs.
•   B.Acetaminophen.
•   C. Antidepresants.
•   D.Lead.
•   E.Alcohol.
:Study SCQs
• 4. Poisons with serious effects requiring urgent actions
  include all except:
• A.Acetaminophen.
• B.Ethylene glycol.
• C.Oral contraceptives.
• E. CO.
:Study SCQs
• 5.Poisoning is recognized by the following toxidromes
  except:
• A.Anticholinergic.
• B. Adrenergic.
• C.Cholinergic.
• D.Stimulants.
• E.Opoid.
:Study SCQs
• 6.Regarding poisoning in elderly,all are true except:
• A. Commonly caused by intentional poisoning.
• B. Mortality in higher.
• C. Psychiatric disease as a cause is less than in the young.
• D. Higher risk of recurrent attempts if due to chronic
  illnesses.
• E. Toxic prescriptions are common.
:Study SCQs
• 7. Drug level as part of management of poisoning is
  indicated in all except:
• A.Acetaminophen.
• B. Oral hypoglycemic.
• C.CO.
• D.Iron.
• E.Digoxin.
:Study SCQs
• 9.All these poisons cause acidosis with normal lactate
  except:
• A.Aspirin.
• B.Methanol.
• C. Ethelene glycol.
• D.Paraldehyde.
• E.Iron.
:Study SCQs
• 10.The following are not adsorbed by activated charcoal
  except:
• A.Cyanide.
• B.Glycols.
• C.Aspirin.
• D.Lead.
• E.Lithium.
:Study SCQs
• 11.The best management of drug-poisoned patient
  presenting within 1 hour is:
• A.Whole bowel irrigation.
• B.Tincher ipecan vomint induction.
• C.Activated charcoal.
• D.Hemodialysis.
• E.Hemofiltration.
:Study SCQs
• 12.The antidote that acts by direct pharmacological
  antagonism is:
• A.Deferoxamine for iron.
• B.Nalorphine for opoids.
• C.Alkaline diuresis for salycylates.
• D.Praladoxime for organophosphorous poisoning.
• E.Methylene blue for Dapson.
:Study SCQs
• 13.The most urgent treatment of organophosphorous
  poisonig is:
• A.Atropin injection.
• B.Praladoxime.
• C.Mechanical ventilation.
• D.O2.
• E.Bronchial lavage.

Más contenido relacionado

La actualidad más candente

Poison AND treatment
Poison AND treatmentPoison AND treatment
Poison AND treatmentSuvarta Maru
 
Management of poison(Emergency Medicine)
Management of poison(Emergency Medicine)Management of poison(Emergency Medicine)
Management of poison(Emergency Medicine)kalyan ram
 
Principles of Management of Acute Poisoning
Principles of Management of Acute PoisoningPrinciples of Management of Acute Poisoning
Principles of Management of Acute PoisoningTahar Abdulaziz Suliman
 
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...RxVichuZ
 
Medical emergency on paracetamol poisoning
Medical emergency on paracetamol poisoningMedical emergency on paracetamol poisoning
Medical emergency on paracetamol poisoningIndhu Reddy
 
Kerosene oil poisoning by dr kalpana chetia
Kerosene oil poisoning by dr kalpana chetiaKerosene oil poisoning by dr kalpana chetia
Kerosene oil poisoning by dr kalpana chetiaKalpana Gogoi
 
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)Muavia Sarwar
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonDr.Ashwin Menon
 
Ethanol: Pharmacology (Alcohol)
Ethanol: Pharmacology (Alcohol)Ethanol: Pharmacology (Alcohol)
Ethanol: Pharmacology (Alcohol)Pravin Prasad
 
Organophosphorus poisoning
Organophosphorus poisoningOrganophosphorus poisoning
Organophosphorus poisoningAbhishek Yadav
 
General principles involved in management of poisoning- by rxvichu!!
General principles involved in management of poisoning- by rxvichu!!General principles involved in management of poisoning- by rxvichu!!
General principles involved in management of poisoning- by rxvichu!!RxVichuZ
 

La actualidad más candente (20)

Poison AND treatment
Poison AND treatmentPoison AND treatment
Poison AND treatment
 
Management of poison(Emergency Medicine)
Management of poison(Emergency Medicine)Management of poison(Emergency Medicine)
Management of poison(Emergency Medicine)
 
Poisoning
PoisoningPoisoning
Poisoning
 
Salicylate poisoning
Salicylate poisoningSalicylate poisoning
Salicylate poisoning
 
Nephrotoxic drugs
Nephrotoxic drugsNephrotoxic drugs
Nephrotoxic drugs
 
Principles of Management of Acute Poisoning
Principles of Management of Acute PoisoningPrinciples of Management of Acute Poisoning
Principles of Management of Acute Poisoning
 
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...
NAC, Physostigmine & Neostigmine: Their efficacy as antidote - By RxVichu!!! ...
 
Poisoning
PoisoningPoisoning
Poisoning
 
Medical emergency on paracetamol poisoning
Medical emergency on paracetamol poisoningMedical emergency on paracetamol poisoning
Medical emergency on paracetamol poisoning
 
Organophosphorus poisoning final
Organophosphorus poisoning finalOrganophosphorus poisoning final
Organophosphorus poisoning final
 
Drug overdose poisoning
Drug overdose poisoningDrug overdose poisoning
Drug overdose poisoning
 
Kerosene oil poisoning by dr kalpana chetia
Kerosene oil poisoning by dr kalpana chetiaKerosene oil poisoning by dr kalpana chetia
Kerosene oil poisoning by dr kalpana chetia
 
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
Poisoning Management.(What is poisoning and How to manage poisoning cases..?)
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin Menon
 
Ethanol: Pharmacology (Alcohol)
Ethanol: Pharmacology (Alcohol)Ethanol: Pharmacology (Alcohol)
Ethanol: Pharmacology (Alcohol)
 
Organophosphorus poisoning
Organophosphorus poisoningOrganophosphorus poisoning
Organophosphorus poisoning
 
Poisoning
PoisoningPoisoning
Poisoning
 
Snakebite
SnakebiteSnakebite
Snakebite
 
General principles involved in management of poisoning- by rxvichu!!
General principles involved in management of poisoning- by rxvichu!!General principles involved in management of poisoning- by rxvichu!!
General principles involved in management of poisoning- by rxvichu!!
 
Poisoning ppt
Poisoning pptPoisoning ppt
Poisoning ppt
 

Destacado

Mcq 1060 questions
Mcq 1060 questionsMcq 1060 questions
Mcq 1060 questionsadrioz
 
WICM 2014 Toxicology Quiz
WICM 2014 Toxicology QuizWICM 2014 Toxicology Quiz
WICM 2014 Toxicology Quizprecordialthump
 
Forensic MCQs for NTS Test Solved Past Papers Sample
Forensic MCQs for NTS Test Solved Past Papers SampleForensic MCQs for NTS Test Solved Past Papers Sample
Forensic MCQs for NTS Test Solved Past Papers SamplePaksights
 
Treatment of poisoning
Treatment of poisoningTreatment of poisoning
Treatment of poisoningvisheshrohatgi
 
Acute poisoning guidelines for initial management
Acute poisoning   guidelines for initial managementAcute poisoning   guidelines for initial management
Acute poisoning guidelines for initial managementDr. Saad Saleh Al Ani
 
Pmdc forensic
Pmdc forensicPmdc forensic
Pmdc forensicshobejee
 
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)College of Medicine, Sulaymaniyah
 
Pharmacology MCQ with Solution
Pharmacology MCQ with SolutionPharmacology MCQ with Solution
Pharmacology MCQ with SolutionNiraj Bartaula
 
Management protocol for opiates & opiods intoxication
Management protocol for opiates & opiods intoxicationManagement protocol for opiates & opiods intoxication
Management protocol for opiates & opiods intoxicationKerolus Shehata
 
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...Previous year question on poisoninig part i and ii based on neet pg, usmle, p...
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...Abhishek Gupta
 
Paraquat poisoning
Paraquat poisoningParaquat poisoning
Paraquat poisoningchinju achu
 
Paraquat Toxicity
Paraquat ToxicityParaquat Toxicity
Paraquat Toxicitykkrimetz
 
Laboratory tests in psychiatry
Laboratory tests in psychiatryLaboratory tests in psychiatry
Laboratory tests in psychiatryMonirul Islam
 
Mc qs in pharmacology
Mc qs in pharmacologyMc qs in pharmacology
Mc qs in pharmacologyjolly zh
 

Destacado (20)

MCQs in TOXICOLOGY
MCQs in TOXICOLOGY  MCQs in TOXICOLOGY
MCQs in TOXICOLOGY
 
Mcq 1060 questions
Mcq 1060 questionsMcq 1060 questions
Mcq 1060 questions
 
WICM 2014 Toxicology Quiz
WICM 2014 Toxicology QuizWICM 2014 Toxicology Quiz
WICM 2014 Toxicology Quiz
 
Forensic MCQs for NTS Test Solved Past Papers Sample
Forensic MCQs for NTS Test Solved Past Papers SampleForensic MCQs for NTS Test Solved Past Papers Sample
Forensic MCQs for NTS Test Solved Past Papers Sample
 
Treatment of poisoning
Treatment of poisoningTreatment of poisoning
Treatment of poisoning
 
Acute poisoning guidelines for initial management
Acute poisoning   guidelines for initial managementAcute poisoning   guidelines for initial management
Acute poisoning guidelines for initial management
 
Pmdc forensic
Pmdc forensicPmdc forensic
Pmdc forensic
 
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)
Medicine 5th year, all lectures/drug poisoning (Dr. Mohammad Shaikhani)
 
Poison
PoisonPoison
Poison
 
Pharmacology MCQ with Solution
Pharmacology MCQ with SolutionPharmacology MCQ with Solution
Pharmacology MCQ with Solution
 
INTRODUCTION TO TOXICOLOGY
INTRODUCTION TO TOXICOLOGYINTRODUCTION TO TOXICOLOGY
INTRODUCTION TO TOXICOLOGY
 
Poison sileshi-3
Poison sileshi-3Poison sileshi-3
Poison sileshi-3
 
Management protocol for opiates & opiods intoxication
Management protocol for opiates & opiods intoxicationManagement protocol for opiates & opiods intoxication
Management protocol for opiates & opiods intoxication
 
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...Previous year question on poisoninig part i and ii based on neet pg, usmle, p...
Previous year question on poisoninig part i and ii based on neet pg, usmle, p...
 
MCQ Pharmacology
MCQ PharmacologyMCQ Pharmacology
MCQ Pharmacology
 
Paraquat poisoning
Paraquat poisoningParaquat poisoning
Paraquat poisoning
 
Paraquat Toxicity
Paraquat ToxicityParaquat Toxicity
Paraquat Toxicity
 
Paraquat 2014
Paraquat 2014Paraquat 2014
Paraquat 2014
 
Laboratory tests in psychiatry
Laboratory tests in psychiatryLaboratory tests in psychiatry
Laboratory tests in psychiatry
 
Mc qs in pharmacology
Mc qs in pharmacologyMc qs in pharmacology
Mc qs in pharmacology
 

Similar a Poisoning plus MCQs 2012.

Poisoning introduction plus MCQs2012.
Poisoning introduction  plus MCQs2012.Poisoning introduction  plus MCQs2012.
Poisoning introduction plus MCQs2012.Shaikhani.
 
Therapy and management of toxicosis
Therapy and management of toxicosis Therapy and management of toxicosis
Therapy and management of toxicosis Muhammad Amir Sohail
 
Treating poison and overdose overview
Treating poison and overdose  overviewTreating poison and overdose  overview
Treating poison and overdose overviewPravin Prasad
 
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)medicine.Poisoningbyspecificdrugs.(dr.shaikhani)
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)student
 
Poisoning by specific drugs.
Poisoning by specific drugs.Poisoning by specific drugs.
Poisoning by specific drugs.Shaikhani.
 
ALCOHOLIC LIVER DISEASE
ALCOHOLIC LIVER DISEASEALCOHOLIC LIVER DISEASE
ALCOHOLIC LIVER DISEASEZeelNaik2
 
Pediatrics drug poisoning
Pediatrics drug poisoning Pediatrics drug poisoning
Pediatrics drug poisoning 7AFH
 
Toxico overdose-lec07-1223099219105884-9
Toxico overdose-lec07-1223099219105884-9Toxico overdose-lec07-1223099219105884-9
Toxico overdose-lec07-1223099219105884-9Gordhan Das asani
 
Poisoning in Pediatrics
Poisoning in PediatricsPoisoning in Pediatrics
Poisoning in PediatricsAhmad shu
 
Approach to a case of poisoning arif
Approach to a case of poisoning arifApproach to a case of poisoning arif
Approach to a case of poisoning arifArif Khan
 
Gout (drug and treatment )
Gout (drug and treatment )Gout (drug and treatment )
Gout (drug and treatment )Ravish Yadav
 
Paraquat toxicity explained.pptx
Paraquat toxicity explained.pptxParaquat toxicity explained.pptx
Paraquat toxicity explained.pptxMOPHCHOLAVANAHALLY
 
Chapter 35 tumor lysis syndrome
Chapter 35 tumor lysis syndromeChapter 35 tumor lysis syndrome
Chapter 35 tumor lysis syndromeNilesh Kucha
 
1. hepatic coma converted
1. hepatic coma converted1. hepatic coma converted
1. hepatic coma convertedDaisy Thomas
 

Similar a Poisoning plus MCQs 2012. (20)

Poisoning introduction plus MCQs2012.
Poisoning introduction  plus MCQs2012.Poisoning introduction  plus MCQs2012.
Poisoning introduction plus MCQs2012.
 
Therapy and management of toxicosis
Therapy and management of toxicosis Therapy and management of toxicosis
Therapy and management of toxicosis
 
Treating poison and overdose overview
Treating poison and overdose  overviewTreating poison and overdose  overview
Treating poison and overdose overview
 
POISONING.pptx
POISONING.pptxPOISONING.pptx
POISONING.pptx
 
Drug overdose in general
Drug overdose in generalDrug overdose in general
Drug overdose in general
 
POISONING - PDF.pdf
POISONING - PDF.pdfPOISONING - PDF.pdf
POISONING - PDF.pdf
 
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)medicine.Poisoningbyspecificdrugs.(dr.shaikhani)
medicine.Poisoningbyspecificdrugs.(dr.shaikhani)
 
Poisoning by specific drugs.
Poisoning by specific drugs.Poisoning by specific drugs.
Poisoning by specific drugs.
 
ALCOHOLIC LIVER DISEASE
ALCOHOLIC LIVER DISEASEALCOHOLIC LIVER DISEASE
ALCOHOLIC LIVER DISEASE
 
Acute poisoning
Acute poisoningAcute poisoning
Acute poisoning
 
Pediatrics drug poisoning
Pediatrics drug poisoning Pediatrics drug poisoning
Pediatrics drug poisoning
 
Toxico overdose-lec07-1223099219105884-9
Toxico overdose-lec07-1223099219105884-9Toxico overdose-lec07-1223099219105884-9
Toxico overdose-lec07-1223099219105884-9
 
Poisoning in Pediatrics
Poisoning in PediatricsPoisoning in Pediatrics
Poisoning in Pediatrics
 
Approach to a case of poisoning arif
Approach to a case of poisoning arifApproach to a case of poisoning arif
Approach to a case of poisoning arif
 
Gout (drug and treatment )
Gout (drug and treatment )Gout (drug and treatment )
Gout (drug and treatment )
 
Paraquat toxicity explained.pptx
Paraquat toxicity explained.pptxParaquat toxicity explained.pptx
Paraquat toxicity explained.pptx
 
Clinical pharmacology of management of poisoning
Clinical pharmacology of management of poisoningClinical pharmacology of management of poisoning
Clinical pharmacology of management of poisoning
 
Chapter 35 tumor lysis syndrome
Chapter 35 tumor lysis syndromeChapter 35 tumor lysis syndrome
Chapter 35 tumor lysis syndrome
 
1. hepatic coma converted
1. hepatic coma converted1. hepatic coma converted
1. hepatic coma converted
 
Poisoning & Drug overdose
Poisoning & Drug overdosePoisoning & Drug overdose
Poisoning & Drug overdose
 

Más de Shaikhani.

Git j club fiber in git20
Git j club fiber in git20Git j club fiber in git20
Git j club fiber in git20Shaikhani.
 
Med j club mm covid20
Med j  club mm covid20Med j  club mm covid20
Med j club mm covid20Shaikhani.
 
GIT J Club IBD- sexual dysfunction20.
GIT J Club IBD- sexual dysfunction20.GIT J Club IBD- sexual dysfunction20.
GIT J Club IBD- sexual dysfunction20.Shaikhani.
 
GIT J Club IBD- pregnancy2020
GIT J Club IBD- pregnancy2020GIT J Club IBD- pregnancy2020
GIT J Club IBD- pregnancy2020Shaikhani.
 
Med 5th geriatrics20
Med 5th geriatrics20Med 5th geriatrics20
Med 5th geriatrics20Shaikhani.
 
GIT 4th abd wall pain
GIT 4th abd wall painGIT 4th abd wall pain
GIT 4th abd wall painShaikhani.
 
GIT 4th endoscopy indications20
GIT 4th endoscopy indications20GIT 4th endoscopy indications20
GIT 4th endoscopy indications20Shaikhani.
 
GIT J Club from UEG Week 2018.
GIT J Club from UEG Week 2018.GIT J Club from UEG Week 2018.
GIT J Club from UEG Week 2018.Shaikhani.
 
Med j club dm antithrombosis19
Med j club dm antithrombosis19Med j club dm antithrombosis19
Med j club dm antithrombosis19Shaikhani.
 
GIT J Club IBS NEJM17.
GIT J Club IBS NEJM17.GIT J Club IBS NEJM17.
GIT J Club IBS NEJM17.Shaikhani.
 
GIT 4th indication for upper GI endoscopy.
GIT 4th indication for upper GI endoscopy.GIT 4th indication for upper GI endoscopy.
GIT 4th indication for upper GI endoscopy.Shaikhani.
 
GIT Cholestatic AI HBD 17
GIT Cholestatic AI HBD 17 GIT Cholestatic AI HBD 17
GIT Cholestatic AI HBD 17 Shaikhani.
 
GiIT 4th CRC 2017.
GiIT 4th CRC 2017.GiIT 4th CRC 2017.
GiIT 4th CRC 2017.Shaikhani.
 
Git j club colonoscopy mistakes.
Git j club colonoscopy mistakes.Git j club colonoscopy mistakes.
Git j club colonoscopy mistakes.Shaikhani.
 
GIT 4th ibd 2017
GIT 4th ibd 2017GIT 4th ibd 2017
GIT 4th ibd 2017Shaikhani.
 
GIT 4th IBS 2017
GIT 4th IBS 2017GIT 4th IBS 2017
GIT 4th IBS 2017Shaikhani.
 
Ppi seminar hiwa.
Ppi seminar hiwa.Ppi seminar hiwa.
Ppi seminar hiwa.Shaikhani.
 
Ppi symposium araz.
Ppi symposium araz.Ppi symposium araz.
Ppi symposium araz.Shaikhani.
 
Ppi symposium muhsin
Ppi symposium muhsinPpi symposium muhsin
Ppi symposium muhsinShaikhani.
 

Más de Shaikhani. (20)

Git j club fiber in git20
Git j club fiber in git20Git j club fiber in git20
Git j club fiber in git20
 
Med j club mm covid20
Med j  club mm covid20Med j  club mm covid20
Med j club mm covid20
 
GIT J Club IBD- sexual dysfunction20.
GIT J Club IBD- sexual dysfunction20.GIT J Club IBD- sexual dysfunction20.
GIT J Club IBD- sexual dysfunction20.
 
GIT J Club IBD- pregnancy2020
GIT J Club IBD- pregnancy2020GIT J Club IBD- pregnancy2020
GIT J Club IBD- pregnancy2020
 
Med 5th geriatrics20
Med 5th geriatrics20Med 5th geriatrics20
Med 5th geriatrics20
 
GIT 4th abd wall pain
GIT 4th abd wall painGIT 4th abd wall pain
GIT 4th abd wall pain
 
GIT 4th endoscopy indications20
GIT 4th endoscopy indications20GIT 4th endoscopy indications20
GIT 4th endoscopy indications20
 
GIT J Club from UEG Week 2018.
GIT J Club from UEG Week 2018.GIT J Club from UEG Week 2018.
GIT J Club from UEG Week 2018.
 
Med j club dm antithrombosis19
Med j club dm antithrombosis19Med j club dm antithrombosis19
Med j club dm antithrombosis19
 
Git 4th GC18.
Git 4th GC18.Git 4th GC18.
Git 4th GC18.
 
GIT J Club IBS NEJM17.
GIT J Club IBS NEJM17.GIT J Club IBS NEJM17.
GIT J Club IBS NEJM17.
 
GIT 4th indication for upper GI endoscopy.
GIT 4th indication for upper GI endoscopy.GIT 4th indication for upper GI endoscopy.
GIT 4th indication for upper GI endoscopy.
 
GIT Cholestatic AI HBD 17
GIT Cholestatic AI HBD 17 GIT Cholestatic AI HBD 17
GIT Cholestatic AI HBD 17
 
GiIT 4th CRC 2017.
GiIT 4th CRC 2017.GiIT 4th CRC 2017.
GiIT 4th CRC 2017.
 
Git j club colonoscopy mistakes.
Git j club colonoscopy mistakes.Git j club colonoscopy mistakes.
Git j club colonoscopy mistakes.
 
GIT 4th ibd 2017
GIT 4th ibd 2017GIT 4th ibd 2017
GIT 4th ibd 2017
 
GIT 4th IBS 2017
GIT 4th IBS 2017GIT 4th IBS 2017
GIT 4th IBS 2017
 
Ppi seminar hiwa.
Ppi seminar hiwa.Ppi seminar hiwa.
Ppi seminar hiwa.
 
Ppi symposium araz.
Ppi symposium araz.Ppi symposium araz.
Ppi symposium araz.
 
Ppi symposium muhsin
Ppi symposium muhsinPpi symposium muhsin
Ppi symposium muhsin
 

Último

Statistics and Probability Testing Hypothesis.pptx
Statistics and Probability Testing Hypothesis.pptxStatistics and Probability Testing Hypothesis.pptx
Statistics and Probability Testing Hypothesis.pptxClarizaJaneMetro1
 
Jason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentJason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentInMediaRes1
 
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSIS
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSISSUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSIS
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSISTRIDIP BORUAH
 
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...EduSkills OECD
 
What are the Basic Fields in the Odoo 17 ERP
What are the Basic Fields in the Odoo 17 ERPWhat are the Basic Fields in the Odoo 17 ERP
What are the Basic Fields in the Odoo 17 ERPCeline George
 
4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptxmary850239
 
How to create _name_search function in odoo 17
How to create _name_search function in odoo 17How to create _name_search function in odoo 17
How to create _name_search function in odoo 17Celine George
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxryandux83rd
 
What is Property Fields in Odoo 17 ERP Module
What is Property Fields in Odoo 17 ERP ModuleWhat is Property Fields in Odoo 17 ERP Module
What is Property Fields in Odoo 17 ERP ModuleCeline George
 
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdfMJDuyan
 
Objectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxObjectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxMadhavi Dharankar
 
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFE
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFEPART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFE
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFEMISSRITIMABIOLOGYEXP
 
Oxidative phosphorylation and energy calculation of aerobic respiration
Oxidative phosphorylation and energy calculation of aerobic respirationOxidative phosphorylation and energy calculation of aerobic respiration
Oxidative phosphorylation and energy calculation of aerobic respirationTRIDIP BORUAH
 
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...kumarpriyanshu81
 
Jordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentJordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentInMediaRes1
 
Calendar, Budget, Evaluation of a PR Campaign
Calendar, Budget, Evaluation of a PR CampaignCalendar, Budget, Evaluation of a PR Campaign
Calendar, Budget, Evaluation of a PR CampaignCorinne Weisgerber
 
4.2.24 The Black Panther Party for Self-Defense.pptx
4.2.24 The Black Panther Party for Self-Defense.pptx4.2.24 The Black Panther Party for Self-Defense.pptx
4.2.24 The Black Panther Party for Self-Defense.pptxmary850239
 
Air Quality Presentation - EEH Chapter 10
Air Quality Presentation - EEH Chapter 10Air Quality Presentation - EEH Chapter 10
Air Quality Presentation - EEH Chapter 10misteraugie
 

Último (20)

Statistics and Probability Testing Hypothesis.pptx
Statistics and Probability Testing Hypothesis.pptxStatistics and Probability Testing Hypothesis.pptx
Statistics and Probability Testing Hypothesis.pptx
 
Jason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentJason Potel In Media Res Media Component
Jason Potel In Media Res Media Component
 
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSIS
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSISSUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSIS
SUBSTRATE LEVEL PHOSPHORYLATION IN GLYCOLYSIS
 
CARNAVAL COM MAGIA E EUFORIA _
CARNAVAL COM MAGIA E EUFORIA            _CARNAVAL COM MAGIA E EUFORIA            _
CARNAVAL COM MAGIA E EUFORIA _
 
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...
Advancing Gender Equality The Crucial Role of Science and Technology 4 April ...
 
What are the Basic Fields in the Odoo 17 ERP
What are the Basic Fields in the Odoo 17 ERPWhat are the Basic Fields in the Odoo 17 ERP
What are the Basic Fields in the Odoo 17 ERP
 
4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx
 
How to create _name_search function in odoo 17
How to create _name_search function in odoo 17How to create _name_search function in odoo 17
How to create _name_search function in odoo 17
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptx
 
What is Property Fields in Odoo 17 ERP Module
What is Property Fields in Odoo 17 ERP ModuleWhat is Property Fields in Odoo 17 ERP Module
What is Property Fields in Odoo 17 ERP Module
 
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf
(Part 2) CHILDREN'S DISABILITIES AND EXCEPTIONALITIES.pdf
 
Objectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptxObjectives n learning outcoms - MD 20240404.pptx
Objectives n learning outcoms - MD 20240404.pptx
 
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFE
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFEPART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFE
PART 1 - CHAPTER 1 - CELL THE FUNDAMENTAL UNIT OF LIFE
 
Oxidative phosphorylation and energy calculation of aerobic respiration
Oxidative phosphorylation and energy calculation of aerobic respirationOxidative phosphorylation and energy calculation of aerobic respiration
Oxidative phosphorylation and energy calculation of aerobic respiration
 
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
 
Jordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentJordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media Component
 
Calendar, Budget, Evaluation of a PR Campaign
Calendar, Budget, Evaluation of a PR CampaignCalendar, Budget, Evaluation of a PR Campaign
Calendar, Budget, Evaluation of a PR Campaign
 
4.2.24 The Black Panther Party for Self-Defense.pptx
4.2.24 The Black Panther Party for Self-Defense.pptx4.2.24 The Black Panther Party for Self-Defense.pptx
4.2.24 The Black Panther Party for Self-Defense.pptx
 
Air Quality Presentation - EEH Chapter 10
Air Quality Presentation - EEH Chapter 10Air Quality Presentation - EEH Chapter 10
Air Quality Presentation - EEH Chapter 10
 
Herbal Cosmetics , Industries involved in the production of Herbal/natural co...
Herbal Cosmetics , Industries involved in the production of Herbal/natural co...Herbal Cosmetics , Industries involved in the production of Herbal/natural co...
Herbal Cosmetics , Industries involved in the production of Herbal/natural co...
 

Poisoning plus MCQs 2012.

  • 1. :Prepared by .Dr.Mohamed Shekhani .References: Davidson PP of Medicine
  • 2. :Introduction • Poisoning is a major cause of death in young adults& 10% of hospital admissions. • Most deaths occur before patients reach medical attention& mortality is much <1% in those admitted to hospital.
  • 3. Introduction: In developed countries • The most frequent cause is intentional drug overdose in the context of self-harm& usually involves prescribed or ‘over-the-counter’ OTC medicines. • Accidental poisoning is also common, esp in children& elderly. • Household /agricultural products such as pesticides/ herbicides are common sources of poisoning &associated with a much higher case fatality. • Toxicity also may occur as a result of alcohol or recreational substance use, or following occupational or enviro exposure.
  • 4. General approach:Triage/resuscitation: • Those seriously poisoned must be identified early so that appropriate management is not delayed. • Vital signs: • Identifying the poison(s) by obtaining adequate information. • Prevent reattempt by identifying those at risk. • Those with external contamination with chemical or environmental toxins should undergo appropriate decontamination. • Critically ill patients must be resuscitated(abc). • (GCS) is commonly employed to assess conscious level or AVPU (alert/verbal/painful/unresponsive).
  • 6. General approach: Triage/resuscitation: • An (ECG) should be performed & cardiac monitoring instituted in all patients with CV features or where exposure to potentially cardiotoxic substances is suspected. • Those who need antidotes given according to weight. • Benzodiazepine/flumazenil • Opiods/Nalorphine. • Paracetamol/N-Acetyl cysteine. • Substances that are unlikely to be toxic in humans should be identified so that inappropriate admission & intervention are avoided
  • 8.
  • 9.
  • 10.
  • 12. :Clinical assessment • History &examination . • Patients may be unaware or confused about what they have taken, or may exaggerate (or less commonly underestimate) the size of the overdose, &rarely mislead medical staff deliberately. • Toxic causes of abnormal physical signs SHOULBE BE KNOWN. • Cluster of clinical features (‘toxidrome’) suggestive of poisoning with a particular drug type IDENTIFIED. • Poisoning is a common cause of coma, especially in younger people, but it is important to exclude other potential causes, unless the aetiology is certain.
  • 13.
  • 14.
  • 15.
  • 16. • Anticholinergic – Hot As Hades – Blind As A Bat – Dry As A Bone – Red As A Beet – Mad As A Hatter
  • 17.
  • 18.
  • 19.
  • 20. :Investigations • Urea, electrolytes, creatinine should be measured in most patients. • Arterial blood gases should be checked in those with significant respiratory or circulatory compromise, or when poisoning with substances likely to affect acid–base status is suspected. • Calculation of anion and osmolar gaps may help to inform diagnosis for a limited number of specific substances. • Management may be facilitated by measurement of the amount of toxin in the blood. • Qualitative urine screens or potential toxins including near- patient testing kits have a limited clinical role. • Occasionally, for medicoegal reasons, it is useful to save blood and urine for subsequent measurement of drug concentrations.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25. psychiatric assessment • All patients presenting with deliberate drug overdose should undergo psychosocial evaluation by a health professional with appropriate training prior to discharge ,once the patient has recovered from any features of poisoning, unless there is an urgent issue such as uncertainty about his or her capacity to decline medical treatment.
  • 26. General management • Patients presenting with eye or skin contamination should undergo appropriate local decontamination procedures.
  • 27. Gastrointestinal decontamination • Patients who have ingested potentially life- threatening quantities of toxins may be considered for GIT decontamination if poisoning has been recent. • Induction of emesis using ipecacuanha is now never recommended.
  • 28. Activated charcoal • Given orally as slurry, activated charcoal absorbs toxins in the bowel as a result of its large surface area. • If given sufficiently early, it can prevent absorption of an important proportion of the ingested dose of toxin. • The efficacy decreases with time. • Current guidelines do not advocate use >1 hour after overdose in most circumstances,EXCEPT when delayed-release preparation has been taken or when gastric emptying may be delayed.
  • 29. Activated charcoal • Some toxins do not bind to activated charcoal so it will not affect their absorption. • In patients with an impaired swallow or a reduced level of consciousness, the use of activated charcoal, even via a nasogastric tube, carries a risk of aspiration pneumonitis. • This risk can be reduced but not completely removed by protecting the airway with a cuffed endotracheal tube. • Multiple doses of oral activated charcoal (50 g every 4 hours) may enhance the elimination of some drugs at any time after poisoning and are recommended for serious poisoning with some substances .
  • 30. Activated charcoal • They achieve their effect by interrupting enterohepatic circulation or by reducing the concentration of free drug in the gut lumen, to the extent that drug diffuses from the blood back into the bowel to be absorbed on to the charcoal: so-called ‘GIT dialysis’. A laxa- tive is generally given with the charcoal to reduce the risk of constipation or intestinal obstruction by charcoal ‘briquette’ formation in the gut lumen. • Recent evidence suggests that single or multiple doses of activated charcoal do not improve clinical outcomes after poisoning with pesticides or oleander.
  • 31.
  • 32.
  • 33. SUBSTANCES NOT BOUND BY CHARCOAL • Alcohols And • Heavy Metals Glycols – Iron • Corrosives – Lead – Alkalis – Lithium – Acids – Mercury • Cyanide • Hydrocarbons • Saline Cathartics
  • 34. Gastric aspiration & lavage • Gastric aspiration and/or lavage is now very infrequently indicated in acute poisoning, as it is no more effective than activated charcoal, and complications are common, especially aspiration. • Use may be justified for life-threatening overdoses of some substances that are not absorbed by activated charcoal
  • 35. Whole bowel irrigation • This is occasionally indicated to enhance the elimination of ingested packets or slow-release tablets that are not absorbed by activated charcoal (e.g. iron, lithium), but use is controversial. • It is performed by administration of large quantities of polyethylene glycol and electrolyte solution (1–2 L/hr for an adult), often via a nasogastric tube, until the rectal effluent is clear. • Contraindications include inadequate airway protection, haemodynamic instability, gastrointestinal haemorrhage, obstruction or ileus. • Whole bowel irrigation does not cause osmotic changes but may precipitate nausea and vomiting, abdominal pain and electrolyte disturbances
  • 36. Urinary alkalinisation • Urinary excretion of weak acids& bases is affected by urinary pH, which changes the extent to which they are ionised. • Highly ionised molecules pass poorly through lipid membranes and therefore little tubular reabsorption occurs and urinary excretion is increased. • If the urine is alkalinised (pH > 7.5) by the administration of sodium bicarbonate (e.g. 1.5 L of 1.26% sodium bicar-bonate over 2 hrs), weak acids (e.g. salicylates, methotrexate , herbicides 2,4- dichlorophenoxyacetic acid and mecoprop) are highly ionised and so their uri-nary excretion is enhanced. • This technique should be distinguished from forced alkaline diuresis, in which large volumes of fluid with diuretic are given in addi-tion to alkalinisation(no longer used because of the risk of fluid overload).
  • 37. Urinary alkalinisation • Urinary alkalinisation is currently recommended for patients with clinically significant salicylate poi-soning when the criteria for haemodialysis are not met • It is also sometimes used for poisoning with methotrexate. • Complications include alkalaemia, hypokalaemia, occasionally alkalotic tetany. • Hypocalcaemia is rare.
  • 38. Haemodialysis & haemoperfusion • These can enhance the elimination of poisons that have a small volume of distribution & a long half-life after overdose, useful when the episode of poisoning is sufficiently severe to justify invasive elimination methods. • The toxin must be small enough to cross the dialysis membrane (haemodialysis) or must bind to activated charcoal (haemoperfusion) . • Haemodialysis may also correct acid–base and metabolic disturbances associated with poisoning
  • 39.
  • 40. Antidotes • Are available for some poisons • Work by a variety of mechanisms: for example: • Specific antagonism (e.g. isoproterenol for β–blockers) or Pharmacological antagonism( flumazenil for benzodiazepines & nalorphine for opoids) • Chelation (e.g. desferrioxamine for iron) • Reduction (e.g. methylene blue for dapsone).
  • 41. Supportive care • For most poisons, antidotes & methods to accelerate elimination are inappropriate, unavailable or incompletely effective. • Outcome is dependent on appropriate nursing & supportive care, & on treatment of complications. • Patients should be monitored carefully until the effects of any toxins have dissipated.
  • 42.
  • 43.
  • 44. :Study SCQs • 1. In Poisoning all are true except:: • A. The most common cause of death in young adults. • B. The most common cause of hospital admissions. • C. Most die before reaching hospital. • D. In-Hospital Mortality should be less than 1%. • E.The most common cause of death in elderly persons.
  • 45. :Study SCQs • 2.The most way of poisoning is: • A.Accidental. • B.Intentional. • C. Agricultural products intake. • D. Alcolol. • E. Opoid intake.
  • 46. :Study SCQs • 3.Common drugs involved in poisoning include all except: • A.NSAIDs. • B.Acetaminophen. • C. Antidepresants. • D.Lead. • E.Alcohol.
  • 47. :Study SCQs • 4. Poisons with serious effects requiring urgent actions include all except: • A.Acetaminophen. • B.Ethylene glycol. • C.Oral contraceptives. • E. CO.
  • 48. :Study SCQs • 5.Poisoning is recognized by the following toxidromes except: • A.Anticholinergic. • B. Adrenergic. • C.Cholinergic. • D.Stimulants. • E.Opoid.
  • 49. :Study SCQs • 6.Regarding poisoning in elderly,all are true except: • A. Commonly caused by intentional poisoning. • B. Mortality in higher. • C. Psychiatric disease as a cause is less than in the young. • D. Higher risk of recurrent attempts if due to chronic illnesses. • E. Toxic prescriptions are common.
  • 50. :Study SCQs • 7. Drug level as part of management of poisoning is indicated in all except: • A.Acetaminophen. • B. Oral hypoglycemic. • C.CO. • D.Iron. • E.Digoxin.
  • 51. :Study SCQs • 9.All these poisons cause acidosis with normal lactate except: • A.Aspirin. • B.Methanol. • C. Ethelene glycol. • D.Paraldehyde. • E.Iron.
  • 52. :Study SCQs • 10.The following are not adsorbed by activated charcoal except: • A.Cyanide. • B.Glycols. • C.Aspirin. • D.Lead. • E.Lithium.
  • 53. :Study SCQs • 11.The best management of drug-poisoned patient presenting within 1 hour is: • A.Whole bowel irrigation. • B.Tincher ipecan vomint induction. • C.Activated charcoal. • D.Hemodialysis. • E.Hemofiltration.
  • 54. :Study SCQs • 12.The antidote that acts by direct pharmacological antagonism is: • A.Deferoxamine for iron. • B.Nalorphine for opoids. • C.Alkaline diuresis for salycylates. • D.Praladoxime for organophosphorous poisoning. • E.Methylene blue for Dapson.
  • 55. :Study SCQs • 13.The most urgent treatment of organophosphorous poisonig is: • A.Atropin injection. • B.Praladoxime. • C.Mechanical ventilation. • D.O2. • E.Bronchial lavage.