POISONING.pptx
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The document discusses various aspects of poisoning, including definitions, classification of poisons, types of poisoning (acute and chronic), and their treatments. It elaborates on methods for removing poisons, the use of antidotes, and general treatments for symptoms caused by different poisons. Additionally, it addresses specific poisonings, such as insecticide, heavy metals, barbiturates, and narcotics, along with their symptoms and recommended treatments.
POISONING.pptx
- 1. ARCHANA CHAVHAN M.PHARM (QA) KYDSCT’S COLLEGE OF PHARMACY SAKEGAON
- 2. Poison ○ A poison is defined as any substance which when administered, inhaled or swallowed or applied locally causes detereoious effects on the body. ○ Under the following acts the poison can be purchased, stored or sold 1. Poison Act 1919 2. Pharmacy Act 1948 3. Drug Act 1940 4. Drug and Magic Remedies act 1954 5. NDPS Act 1985
- 3. Classificationof poisonous substances • HCl, H2SO4. • Carbolic acid, caustic soda • Sodium carbonate Corrosive substances • Inorganic: lead, mercury, bromine iodine, zinc etc • Organic: insects, snake, scorpion, aloe, capsicum, ergot etc. Irritant substances • Cerebral poison: opium, sedatives & hypnotics • Spinal poisons: nux vomica • Peripheral poison: corium Neurotic • Digitalis, aconite, tobacco Cardiac • Gases such as coal gas, carbon monoxide Pulmonary depressants • Analgesics, antipyretics, antihistamines Miscellaneous
- 4. TYPES OF POISONING ○ Acute poisoning ♥ Symptoms appear immediately ♥ Poison can be detected in the ingested subts., vomit, stool & urine ♥ Main symptoms are vomiting, diarrhea or coma ○ Chronic poisoning ♥ Symptoms appear gradually ♥ Poison can be detected in the ingested subts., vomit, stool & urine ♥ Main symptoms are chronic ill-health malaise, repeated attacks of GI irritation,
- 5. GENERAL TREATMENT OF POISONING ○ 5 Basic principles of general treatment of poisoning includes; Remove unabsorbed poison from the body To use antidotes To excrete absorbed poison To treat general symptoms of the victim To maintain the victims general condition
- 6. “ To remove unabsorbed poison from the body Poison enters the body by different routes. Following measures should be taken for the removal of unabsorbed poison 1. Poison entered through mouth: poison may be removed by inducing vomiting and washing the stomach(gastric lavage) 2. Poison entered through inhalation: victim immediately be taken to place where there is fresh air. Artificial respiration should be given immediately. 3. Poison entered through skin contact, eye or wound: wash out the poison with plain warm water and if antidote is available, neutralize the poison with it. 4. Poison entered through injection: remove poison by making incisions at the point of injection & causing it to bleed. After this poison may be removed by suction.
- 7. Vomiting: Emetics are given to induce vomiting. Emesis should not be done if poisoning is by strychnine, corrosives or patient in coma. Common household emetics are mustard powder(15g), salt, ipecac(2g). Dose of 6mg of Apomorphine by SC injection followed by 5-10g Naloxon hydrochgloride by IM or IV is widely used emetics. Vomiting is contraindicated in case of acid or alkali poisoning since it may cause stomach rupture.
- 8. Gastric lavage: This method is employed in case of ingestion of poison within 4-6hrs. This method is contraindicated in following cases: In corrosive poisoning In case of convulsion In children In case of COMA Gastric lavage is done by using specific tube referred as BOA’s Tube EWALD’s Tube.
- 10. “ To use antidotes Antidotes are substances which neutralizes the effects of poison.
- 11. PHYSICAL ANTIDOTE ♥ This are the substances which inhibits the absorption of poison ♥ E.g. demulcents such as egg albumin and fats, oil. ♥ Demulcents form a coat on the mucus membrane of GIT and thus, inhibit the absorption of poison. ♥ Fats and oils should not be used as an antidote in phosphorous since phosphorus is soluble in it. ♥ Banana is the best antidote is glass poisoning ♥ Charcoal is used to absorb alkaloidal poison.
- 12. CHEMICAL ANTIDOTE ○ These antidotes interact chemically with a poison to form an insoluble precipitate which is non toxic or it oxidize the poison to its non toxic form Poison Antidote Acids Calcium & Mg oxide Carbonic acid Magnesium sulphate Lead Sulphates of alkali Oxalic acid Lime Phosphorus Copper sulphate Alkaloids Tannins
- 13. PHYSIOLOGICAL ANTIDOTE ○ These antidotes produces the effect opposite to that of the poison without interacting chemically with it. ○ These are antagonists of poison. Poison Antagonist Morphine Caffeine, naloxone Arsenic BAL, EDTA Copper BAL, Penicillamine Lead BAL.EDTA, Penicillamine Organophosphorus Atropine Mercury BAL, Penicillamine Iron Desferrioxamine B
- 14. BAL (british anti-lewisite) (Dimercaprol): It is a chelating agent used in the treatment of heavy metal poisoning. The heavy metals have an affinity for thiol(-SH) group and combine with them in body tissues, displacing the hydrogen and depriving the body of these enzymes whose activities depends on a thiol group. BAL is administered in a dose of 3-5 mg/kg. IM at the interval of 4hours for first 2 days, interval of 4-6 hrs for additional 2 days and interval of 6- 12 hrs for additional 7 days EDTA(ethylene Diamine tetra acetate): It has great affinity for the lead. Chelated lead is excreted in urine. Dose: 75mg/kg 24 hrs IM or slow IV given in 3-6 divided dose for 5 days
- 15. Penicillamine: It has stable –SH group which confers the chelating action. It is less toxic than EDTA & can be given orally. Used in copper, lead, mercury poisoning Dose: 100mg/kg/day in divided doses for 5 days For long term therapy dose should not exceed 40mg/kg/day Desferrioxamine: It chelates iron in the stomach & binds iron in the blood. Thus, it is useful both orally & intravenously for avoiding systemic absorption & removing absorbed iron. Dose: oral 8-12g in 40-60ml distilled water IV 29 in 5% laevulose solution
- 16. Universal antidote: When the nature of poison is unknown the universal antidote is used, To neutralize the acids To absorb the alkaloidal poison To chelate the metals or certain glycosides Composition of unioversal antidote Magnesium: 1 part Activated charcoal: 2 parts Tannic acid: 1 part The mixture should be given in dose of 1 tbs in 200ml of water once or twice
- 17. To excrete absorbed poison After 6 hrs of ingestion of poison, emesis and gastric lavage are useless. The poison has entered the intestine and hence the following measures should be taken to excrete poison through urine & feces. 1. Forced diuresis: use IV chlorthiazide or mannitol 2. Use of cathartics 3. Use of hot packs: for increased sweating 4. Peritoneal dialysis: for salicylate poisoning in children 5. Hemodialysis: for excretion of barbiturates, bromides
- 18. To treat general symptoms of the victim When the poison is unknown symptoms provide the best clue for the treatment. Symptoms Treatment Pain Morphine Respiratory failure Artificial respiration Circulation failure Cardiac stimulants Dehydration Saline infusion Glucose leven abnormal Saline infusion + sodium bicarbonate
- 19. To maintain victims general condition In case of unconscious victim, maximum danger is of upper respiratory infection. To avoid this risk of infection the prophylactic antibiotic therapy must be given Also management of hypothermia, Intensive supporting treatment & Good nursing care Is required to maintain the general condition of victim
- 20. “ INSECTIOCIDE POISONING • Organophosphorus compounds The compounds of this class include; A. Alkyl phosphates B. Aryl phosphates • D.D.T • Endrin • Naphthalene
- 21. ORGANOPHOSPHORUS COMPOUNDS A. Alkyl phosphates: HETP (hexaethyl tetraphosphate) TEPP (tetraethyl pyrophosphate OMPA ( octamethyl pyrophosporamide) B. Aryl phosphates: Parathion Diazinon
- 22. Symptoms Fatal dose Treatment Poison first affects the smooth muscles and glands and then vital organs HETP IV/IM 160mg Oral 350mg Decontamination Initially headache, malaise, constriction of chest and pupil OMPA IV/IM80mg Oral 175mg Artificial respiration After a few hours nausea, vomiting, diarrhea, sweating TEPP IM/IV 45mg Oral 100mg Antidote therapy: atropine In severe poisoning, pulmonary odema, coma, convulsion Parathion: IV/IM 80mg Cholinestrase reactive therapy
- 23. D.D.T. Symptoms Fatal dose Treatment Oral route: salivation, nausea, vomiting 280mg/kg oral Poison must be removed from GIT by lavage Contact: irritation of eye, nose, throat, vision, dermatitis 150-1000mg/kg/body weight Adrenaline should not be used. Artificial respiration endrin Symptoms Fatal dose Treatment Vomiting, abdominal pain, convulsion 280mg/kg oral Poison must be removed from GIT by lavage
- 24. Naphthalene Symptoms Fatal dose Treatment Haemolytic anaemia, acute nephritis, optic neuritis, pain in urethra, nausea, vomiting. Approximately 2g Keep the patient warm. Stomach wash with saline water. Use mg. Sulphates to clear stomach and administer sodium bicarbonate to maintain urine alkaline Sever poisoning causes kidney damage or liver damage After inhalation it causes convulsion, headache, vomiting etc Blood transfusion may be necessary Hydrocortisone for haemolysis
- 25. “ HEAVY METAL POISONING Arsenic Symptoms Fatal dose Treatment Acute poisoning 100-200mg Stomach wash with warm water. Ppt. of hydrated ferric oxide as antidote. IV sodium thiosulfate 1g in 10ml sterile water every 4-6hrs for first day Morphine for controlling pain Chronic poisoning 100-200mg Remove patient from exposure IV sodium thiosulphate 1g in 10 ml sterile water WFI 2-3times/week
- 26. “ lead Symptoms Fatal dose Treatment Acute poisoning -- Stomach wash with 10% solution of mg.sulphate followed with plain water. Bowel should be washed at regular intervals Chronic poisoning 05g BAL is effective in excretion of lead. BAL 4mg/kg/body weight
- 27. “ MERCURY Symptoms Fatal dose Treatment Acute poisoning -- Removal by emetics or stomach wash with 5% solution of sodium formaldehyde or charcoal powder Chronic poisoning -- Remove patient from exposure. Promote elimination by bowels & kidney Dimercaprol or belladonna as antidote Symptoms Fatal dose Treatment Acute poisoning 30g Same as mercury poisoning 600ml of pot. Ferro cyanide in glass of water to be given before performing gastric lavage Chronic poisoning -- Same as for chronic mercury poisoning COPPER
- 28. “ BARBITURATES POISONING Symptoms Fatal dose Treatment Nausea, mental confusion, depression, drowsiness, decrease urine formation, contraction of pupil, muscle spasm. 3-5g • Gastric lavage with KmNO4. • Artificial respiration • 5% glucose saline IV • Coramine 5ml IV • Hemodialysis • Forced diuresis • Enema
- 29. “ NARCOTIC DRUG POISONING Symptoms Fatal dose Treatment Opium Excitement, Sopor,Narcosis, Increased heart rate, Deep coma, Loss of reflex, Cocaine Euphoria, mydriass, dry mouth, increase sweating, black tongue. Belladona Dry mouth, fever, blur vision, increased heart rate, abdominal pain. 2g or 200mg of morphine • Stomach wash with tepid water first & then with solution of KmNO4 • Enema • Antagonist therapy • Naloxone 04-0.8 mg IV every 15 minutes • 5% glucose saline 1g 125mg
- 30. Toxicovigilance • Toxicovigilance is the process of identifying and evaluating the risks of poisoning that exist within a community, and proposing and evaluating measures taken to reduce, eliminate or manage them. • It involves the analysis of poisons center enquiries to identify whether there are specific circumstances or agents giving rise to poisoning, or certain populations suffering a higher incidence of poisoning. • The practice of Toxicovigilance often involves the registration of cases of poisoning by health professionals, or the analysis of enquiries made to poison control centers. Because of this, practicing Toxicovigilance is often one of the core tasks of a poison control center.