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impaired judgment
More than 50% of persons are grossly intoxicated by a concentration of 150 mg/dl. In fatal cases, the average concentration is about 400 mg/dl, although alcohol-tolerant individuals often can withstand comparable blood alcohol levels.
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Ethanol
In the United States, most states set the ethanol level defined as intoxication at 80 mg/dl. There is increasing evidence that lowering the limit to 50 to 80 mg/dl can reduce motor vehicle injuries and fatalities significantly. Blood alcohol levels reduce at a rate of about 15 mg/dl per hour. measurement of levels in exhaled air remains the primary method
Ethanol
Concentrations of alcohol in blood will be higher in women than
in men consuming the same amount of alcohol because, on average, women are smaller than men women have less body water per unit of weight into which ethanol can distribute women have less gastric ADH activity than men. For individuals with normal hepatic function, ethanol is metabolized at a rate of one standard drink (12g) every 60 to 90 minutes.
Patients who are comatose and who exhibit evidence of respiratory depression should be intubated to protect the airway and to provide ventilatory assistance. The stomach may be lavaged, but care must be taken to prevent pulmonary aspiration of the return flow. Ethanol can be removed from blood by hemodialysis. Uses of alcohol Relieve the long-lasting pain related to trigeminal
Ethanol
ADH = Alcohol Dehydrogenase ALDH = Aldehyde Dehydrogenase
Ethanol perturbs the balance between excitatory and inhibitory influences (GABA, Glutamate, proteins) in the brain, resulting in anxiolysis, ataxia, and sedation.
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Methanol
Results in formation of formaldehyde and formic acid.
Formic acid causes nerve damage; its effects on the retina and optic nerve can cause blindness. Tachypnea, CNS depression, abdominal pain and multisystem organ failure Treatment sodium bicarbonate to combat acidosis Hemodialysis
the
administration
of
ethanol,
which
slows
formate
Methanol Metabolism
ADH: Alcohol Dehydrogenase ALDH: Aldehyde Dehydrogenase
H
H-C-OH H Methanol ADH
Cyanide Toxicity
Potent cellular toxin with nefarious (evil) history Poisoning can occur from Occupation, accidental ingestion of pre-metabolites Sodium nitroprusside infusion
Biochemical Toxicology
Inhibits final step of oxydative phosphorylation (cytochromes) Pyruvate lactate (anaerobically) severe metabolic
acidosis
Alters calcium homeostasis Constricts pulmonary and coronary vessels Clinical Features: CNS: Headache, Drowsiness, Seizures, Coma
Management
1. Decontamination (Reduce absorption) Nasogastric aspiration, Activated charcoal, Gastric lavage, Emesis 2. Enhanced cyanide metabolism
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3. Cyanide ion binding a. Cobalt containing drugs: Cyanide ions will bind to cobalt which can be supplied in the
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Hemoglobin occupied by CO is called carboxyhemoglobin Hb affinity for CO 250 times affinity for O2 Body systems most affected are the cardiovascular and central nervous systems Effects of Carbon Monoxide Oxygen cannot be transported because the CO binds more readily
Myocardial depression from CO exposure Dysrhythmias, myocardial ischemia, MI Vasodilation from increased release of nitric oxide;
Duration of exposure
Concentration of CO in the environment Concentration of O2 in the environment The lower the O2 concentration to begin with, the faster the symptoms will develop
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Pathophysiology - Neurovascular
CO in circulation associated with massive increase in NO in perivascular tissues NO released from vascular endothelial cells and platelets Production of oxygen radicals from impaired mitochondrial
function
Reaction of NO with oxygen radicals to form peroxynitrite ( ONOO- )
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Peroxynitrite binds to perivascular tissue proteins causing injury Increased capillary permeability in CNS and pulmonary
vascular beds
Endothelial injury causing expression of adherence molecules - beta 2 integrins
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Clinical manifestations
General headache, nausea, vomiting, weakness Cardiovascular chest pain, tachypnea, tachycardia, hypotension
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Snake bite
Snakes are strict carnivores & venomous at birth. Snakes are deaf & almost blind. Sense of smell is high Sensitive to vibration
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Types of snakes
Non Poisonous Snakes
Head-Rounded
Fangs-Not present
Pupils-Rounded Anal Plate-Double row Bite Mark-Row of small teeth.
Poisonous Snakes
Head Triangle Fangs Present
Snake Venom
Snake Venom is a Toxin (Hemotoxin, Neurotoxin, or Cytotoxin) It is excreted through a modified parotid salivary gland
hollow in the center to project the venom into the air or its prey
Though the venom is dangerous, since it is not inhaled it cannot be considered a Poison
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Varies widely between species and even within a species Geographic location ex. Mojave rattlesnake Age of snake
Last feeding
90% protein by dry weight and most of these are enzymes 25 different enzymes have been isolated from venoms and 10 of these occur frequently in most venoms Different venoms contain different combinations of enzymes
Snake Venom is primarily to attack prey Immobilize kill Digest 90% water Other 10% : Proteins : enzymatic & nonenzymatic
Polypeptides
Hyaluronidase All snake venom An enzyme that splits hyaluronic acid and so lowers its viscosity Facilitates spread of other toxins
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Clinical effects
Neurotoxicity Systemic toxicity including hypotension and shock
Coagulopathy
Renal failure Local tissue necrosis including cobra spit
Toxic Effects
Respitory paralysis, Fever, Rapid Pulse, Increased Thirst, Dizziness, Local Tissue Damage, Blurred vision, Nausea and vomiting, Diarrhea , Coma , Death
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Supportive treatment
Elevate limb Paralysis: neostigmine and atropine Hypotension: Crystalloid, fluids and ionotropic support Oliguria & renal failure: fluids, diuretics, dopamine, dialysis
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Antivenin
Antivenin is made by injecting horses with toxins from venomous snakes and then monitored to make sure they survive.
Bee Sting
Honey bee belong : Family- Hymenoptera ; Sub Family-Apidae Only the females have adapted a stinger from the ovipositor on the
Melittina
membrane
active
polypeptide
that
can
cause
degranulation of basophils and mast cells, constitutes more than 50 percent of the dry weight of bee venom Venom commonly causes pain, slight erythema, edema, and pruritus at the sting site Local reaction, Toxic manifestation and anaphylaxis, delayed reaction Serum sickness
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Treatment
Immediate removal is the important principle and the method of removal is irrelevant. Sting site should be washed thoroughly with soap and water to minimize the possibility of infection. Intermittent ice packs at the site- diminish swelling and delay the absorption of venom while limiting edema. Oral antihistamines and analgesics may limit discomfort and pruritus. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective in relieving pain. Severe case: Epinephrine Methylprednisolone :to limit ongoing urticaria and edema and may potentiate the effects of other measures.
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Scorpion sting Scorpions have a world-wide distribution. Highly toxic species are found in the Middle East, India, North Africa, South America, Mexico, and the Caribbean island of Trinidad.
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generalised
Cranial nerve- abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination and drooling and respiratory compromise. Excessive motor activity Nausea, vomiting, tachycardia, and severe agitation can also be present. Cardiac dysfunction, pulmonary edema, pancreatitis, bleeding disorders, skin necrosis, and occasionally death can occur.
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Treatment Pain Management Ice pack Immobilization of limb Local anesthetics are better than opiates
Tetanus prophylaxis
wound care and antibiotics, Benzodiazepines for motor activity.
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