This document discusses toxicologic emergencies and poisonings. It defines poisons as substances that impair health or cause death when introduced to the body. Poisons can be man-made like chemicals and drugs, or natural like toxic plants. Common causes of poisoning include accidental or intentional overdoses of medications, chemicals, and illegal drugs. Poisonings can occur through ingestion, skin absorption, inhalation, or injection. Signs and symptoms vary depending on the poison and route of exposure but can include nausea, vomiting, breathing difficulties, and impaired consciousness. Management involves preventing further absorption using gastric lavage or activated charcoal. Eliminating the poison may involve stimulating urination, forced alkaline diuresis, or dial

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)

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

32. THANK YOU