2. Group Members
 1 Tamirat Bekele
 2 Tarekagn Genale
 3 Tekalign Hailu
 4 Teketel Desta
 5 Yemisrach Dubale
 6 Yosef Wondyifraw

3. Poisoning
Introduction
•Poisoning represents the harmful effects of accidental or intentional exposure
to toxic amounts of any substance. The exposure can be by ingestion,
inhalation, injection, or through skin.
•The effects may occur immediately or several hours or even days after the
exposure.
•The damage could be local or systemic .
• Poisoning can be from household substances (e.g. bleach), industrial (e.g.
methanol), pesticides e.g. organophosphates), therapeutic medicine overdose
(e.g. phenobarbitone, Amitriptyline), toxic plants (e.g. poisonous mushrooms,
toxic herbal medications), bites and stings of venomous animals (e.g. snakes,
bees).

4. Quote
Poison is in everything, and no
thing is without poison. The
dosage(dose) makes it either
a poison or a remedy.
Paracelsus
(1493–1541)
‘’the father of toxicology”

5. Clinical features
• Clinical presentation is variable depending on the type of
poison/medicine, route and dose.
• Many of the manifestation are nonspecific.
• Toxidromes are sets of clinical findings which could help in guiding
the possible class of the poison/medicine
• It is very helpful to have a sample of the substance or the container in
which it was stored as only few poisons can be identified instantly

6. Investigations
• Random blood sugar
• CBC
• BUN and creatinine,
• Electrolytes
• Liver function tests
• Chest X-ray for possible aspiration pneumonia
Treatment
Objectives
• Maintain airway, breathing and circulation
• Reduce absorption and enhance elimination
• Antagonize or neutralize the effects
• Relieve symptoms
• Prevent organ damage or impairment

7. Non-pharmacologic
Supportive care
• Airway protection • Treatment of hypoxia
• correct hypotension/arrhythmia • Treatment of seizures
• Correction of T◦ abnormalities • Correction of metabolic
derangements.
Pharmacologic and other cares
• Prevention of further poison absorption
o Gastric lavage
− Should be done within an hour of ingestion
o Decontamination of eye
o Skin decontamination
o Activated charcoal
• Enhancement of elimination
o Multiple-dose activated charcoal
o Hemodialysis
o Urinary pH alkalization

8. Specific poisons and overdoses
Organophosphate poisoning
• Poisoning due to parathion, malathion and other organophosphates.
• Absorption occurs through the skin or the agent is taken orally.
• Patients present with muscarinic and nicotinic manifestations of
intoxication.
Clinical features
• The killer signs are the 3B’s: bradycardia, bronchospasm and
bronchorrhea
• Muscarinic overstimulation causes salivation, lacrimation, vomiting,
diarrhea and increased bronchial secretions.
• Nicotinic overstimulation causes muscle fasciculations and paralysis.
Investigations
• Clinical -there is no lap results. diagnosis is based on Patient Hx and s/s.
• Toxicological analysis – pin pointed pupils, confusion.

9. Treatment
• For all poisoning patients the principles of management are
o ABC’s of life comes first,
o Give coma cocktail (Naloxone, thiamine, dextrose and oxygen),
o decontamination,
o Antidote and, Supportive care
Objectives
• Support physiological function
• Treat symptoms
• Remove the poison from the body
Non pharmacologic
• Supportive treatment
Pharmacologic
• Atropine, IV, 1-3 mg, every 3-5 minutes, until pulmonary secretions are dry
• Do not stop atropine therapy abruptly.
• Our goal in atropinazation is chest clearance and not tachycardia

10. Carbon monoxide poisoning
• Poisoning with carbon monoxide is common where there is incomplete
combustion of charcoal.
Investigations
• Clinical – an elevated level of carboxy-hemoglobin (Co-Hb).
• Toxicological analysis
• Acute poisoning results in headache, nausea and vomiting, mental
confusion and agitation.
• Severe toxicity causes confusion, impaired thinking, and may progress to
coma, convulsions, and death.
Treatment
Non pharmacologic
• Supportive treatment
• Take the patient out to open air.
Pharmacologic
• Oxygen, 100% via face mask

11. Warfarin
Warfarin is an anticoagulant used for treatment and prevention of a variety of
coagulopathic and thromboembolic disorders. While it was initially marketed as a
rodenticide, it has been used as a medication for more than a half- century.
Despite its common use, warfarin therapy can be associated with significant
bleeding complications. Achieving a safe therapeutic response can be difficult
because of warfarin’s narrow therapeutic index and great individual variability in
the dose required,
Acute overdose of warfarin has been noted to have a potential delay of PT/INR
elevation for 12 hours following ingestion. At the level of 100mg/m3, warfarin is
immediately dangerous to life and health.
Investigations
• Clinical- evaluation of the patient’s PT(prothrombin time) 11-13 sec INR 0.8-
1.1.

12. • Toxicological analysis
- Red spots on the skin that’s look like a rash.
- Sever head ache or dizziness
- Heavy bleeding after an injury.
- Sever stomach pain or vomiting blood.
- Pink, red, or dark brown urine.
Treatment
Activated charcoal can be considered in patients who are awake and alert and
present within 1 hour of ingestion.
Any patient with a coagulopathy due to a warfarin and life threatening
bleeding should receive the following treatment:
intravenous vitamin K 10mg.

13. Heavy metal poisoning
Heavy metal poisoning occurs when microscopic molecules of metals
accumulate within a body after exposure. Heavy metals attach to cells
and prevent them from performing their functions, which causes
symptoms that could be life threatening without treatment.
Type of metal Where it can be found
♦Several metals can be toxic to the body. The most common toxic
metals are:
Type of metal Where it can be found
Lead
Contaminated water from lead pipes, batteries, paint,
gasoline, construction materials.
Mercury
Liquid in thermometers, lightbulbs, batteries, seafood,
topical antiseptics.
Arsenic
Topical creams, herbicides, insecticides, pesticides,
fungicides, paints, enamels, glass, contaminated water,
seafood, algae.
Cadmium Cigarette smoke, metal plating, batteries.

14. • Mental disorders
• Pain in muscle
and joints
• Gastro intestinal
disorders
• Vision problems
• Chronic fatigue
• Susceptibility to
fungal infections
The Symptoms

15. 1. Lead is number 2 on the "Top 20 List."
2. Lead accounts for most of the cases of pediatric heavy metal
poisoning
3. It is a very soft metal and was used in pipes, drains, and
soldering materials for many years.
4. Lead poisoning occurs when lead builds up in the body, often
over a period of months or years
5. blood lead level of 10 μg/dL or above is toxic
SOME FACTS ABOUT LEAD

16. SYMPTOMPS
• High blood pressure
• Abdominal pain
• Constipation
• Joint pains
• Muscle pain
• Declines in mental functioning
• Headache, Memory loss, Mood disorders
• Reduced sperm count, abnormal sperm
• premature birth in pregnant women

17. • Number 3 on "Top 20 List" is mercury.
• Mercury is generated naturally in the environment from the
degassing of the earth's crust, from volcanic emissions.
SOME FACTS ABOUT MERCURY

18. SYMPTOMPS
• Damage to the brain, kidneys and lungs.
• The limit of mercury is 0.1mg/m3 in the
occupational exposure.

19. 1. Arsenic

20. 1. Arsenic is the most common cause of acute heavy metal
poisoning in adults and is number 1 on the "Top 20 List.“
2. People can be exposed to arsenic by inhaling it, by consuming
contaminated foods, water, or beverages, or by skin contact.
3. People may be exposed to higher levels if they live near
industrial areas.
SOME FACTS ABOUT ARSENIC

21. SYMPTOMPS
• Vomiting
• Abdominal Pain
• Diarrhea
• Dark urine
• Dehydration
• Cardiac problems
• Hemolysis
• Dizziness
• Disorientation
• Shock
• Death

23. Management of poisoning
I/ Emesis:
 Used for oral poisoning.
 Contraindicated in case of corrosives and
pesticides for the fear of gastric perforation
• Ipecac syrup, which causes vomiting in order to
empty the stomach.

24. Con….
II/ Gastric lavage:
 is the administration of a tube into the stomach to
wash it with water, normal saline or half normal
saline before the absorption of poisons.
 This need experts for the fear of gastric injury, but
its contraindications are similar to those of emesis.
III/ Chemical adsorption of many chemicals to the
surface of activated charcoal to reduce the absorption
of the drug and enhance its excretion.

25. Con….
IV. Purgation:
 The rationale for using osmotic harmless cathartic is
to minimize absorption by speeding up the passage
of toxicants through the GIT, usually after the
ingestion of enteric coated tablets by more than
one hour.
E.g. Cathartics, laxatives

26. Treatments
 Removal of the patient from the source of exposure
 Decontamination
Treatment may include whole-bowel irrigation with polyethylene
glycol electrolyte solution if radiographic evidence of retained
metal (coins, paint chips) is present.
 Resuscitation:
 Ensure airway opening, provide mechanical ventilation where
necessary,
 correct dysrhythmia
 replace fluid and electrolytes (significant fluid losses generally
occur and require aggressive rehydration), and monitor and treat
any organ dysfunction.

27. Dimercaptol (BAL)
 Drug of Choice in the treatment of lead, arsenic, and mercury
toxicity.
 Administered via deep IM injection only, q4h, mixed in a peanut oil
base.
 Enhances fecal and urinary elimination
 Diffuses into brain and RBC's
 Chelates intracellular and extracellular lead and is excreted in urine
and bile.
 May be given to patients with renal failure.

28. EDTA
 Second-line for lead toxicity.
 Chelates only extracellular lead and may induce CNS toxicity if BAL
therapy not initiated first.
 Begin therapy 4 h after BAL is given. Only given IV, and continuous
infusion is recommended.
 Not recommended with renal failure. Because of potential for renal
toxicity, patient should be well hydrated.

29. Succimer/Dimercaptosuccinic acid (DMSA)
 More effective than BAL
 Can be used to chelate Hg, As, and Pb
 Wider therapeutic index than BAL
 Does not re-distribute Pb to brain

30. Penicillamine
 Metal chelate used for treatment of copper, mercury, arsenic, lead
and zinc poisoning.
 Forms soluble complexes with metals that are subsequently
excreted in urine.
Desferrioxamine (DFO)
 used for Iron poisoning, and aluminum poisoning.

32. Antidote
1. Atropine sulphate - organophosphorus poisoning
 Atropine will reverse the muscarinic effects of acetylcholine and is
given in a dose of 2 mg as atropine sulphate (intramuscularly or
intravenously according to the severity of poisoning) every 20 to 30
minutes until the skin becomes flushed and dry, the pupils dilate,
and tachycardia develops.

33. Antidote
2. Acetylcysteine used in paracetamol poisoning.
3. Sodium nitrite is used in the treatment of cyanide poisoning in
conjunction with sodium thiosulphate.
4. Flumazenil, a benzodiazepine antagonist, is used in anesthesia and
intensive care to reverse benzodiazepine induced sedation; it is also
used to treat benzodiazepine over dosage.

36. References
 STG 2020
 Poisoning and Toxicology Handbook Fourth Edition
jerrold B.Leikin and Frank P. Paloucck
 Some Internet used

37.  Thank
you