PHARMACOLOGY

Toxicology
Dra Dando
12 February 2008
Joyce “,.

POISONING  Carbon monoxide

 Opiates (Morphine, Novaine, Heroin, Codeine)
• Overdose of drugs, medicaments, chemicals  Quinine
and biological substances o Anti-protozoal
• “acute” poisoning versus “chronic’ poisoning
 Acute: 24 -48 hrs of exposure RECOMMENDED IV FLUIDS
 Chronic: weeks, months, years of  Hypotensive patients
exposure  NSS
• Father of toxicology: Paracelsus  Adult for maintenance
 NSS
GENERAL PRINCIPLES  D5 Acetated Ringer’s solution
 Emergency stabilization
o First thing to do  Pediatric for maintenance
 Clinical evaluation  D5 0.3% NaCl (hypo)
o Include good Hx taking & thorough PE
 Elimination of the poison POISON COMMONLY ASSOCIATED WITH
 Excretion of the absorbed substance CONVULSIONS
 Administration of antidotes  Aminophylline
o Important for certain specific poisons or  Amphetamines
drugs  Carbon monoxide
 Supportive therapy and observation  Cocaine
 Disposition  Cyanide
 Ethylene glycol
EMERGENCY STABILIZATION  Hypoglycemic agents
 Maintain adequate Airway  Isoniazid – triad of coma, metabolic acidosis,
o Remove obstructions intractable seizures
o Conditions wherein suction cannot be  Lead
done:  MAO inhibitors
- caustic substances (causes  Mefenamic Acid (usual side effect: GI
ulceration of GI mucosa) irritation; overdose: seizures)
- hydrocarbons (causes aspiration)  Opioids
 Ensure adequate Breathing/Ventilation  Organophosphates
o Nasal cannula, intubation  Phenothiazines
 Maintain adequate Circulation (put IV lines,  Salicylates (Aspirin)
fluids)  Strychnine
 Treat convulsions (e.g Diazepam)  Theophylline
o Diazepam: 1st line of Tx for active  Tricyclic antidepressants
seizures and status epilepticus  Withdrawal of narcotics, diazepam or ethanol
 Correct metabolic abnormalities (Electrolytes,  Signs of ethanol withdrawal
glucose, acid-base) o Irritable
o Base: used for severe metabolic o Agitated
acidosis (Tx: Na, bicarbonate) o Seizure
o Glucose: for hypoglycemia (Dextrose
50-50 concentration) CAUSES OF CONVULSION IN POISONED
PATIENTS
 Treat coma (e.g Flumazenil)
 Direct convulsant effect of the poisons
o Flumazenil:
 Cerebral hypoxia from respiratory or
1) Tx for BZD (diazepam) overdose
cardiovascular depressive effect of drugs
2) Tx for coma (but not as first line
agent)  Hypoglycemia
- coma due to overdose of valium  Severe muscle spasm due to spinal o
peripheral effects on the mechanism
COMMON CAUSE OF HYPOXIA controlling muscle tone
 Alcohol  Withdrawal reactions in patients with physical
 Cyanide dependence on abused drugs
o In silver jewelry cleaners  Decreased seizure threshold in an epileptic
patient
 Organophosphates
o In pesticies
TREATMENT OF CONVULSION
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jat bambi erika jen roche bam aLex anna sheen jam pau eagleman jeff toni
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 PHARMACOLOGY: Toxicology – Dra. Dando
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• Diazepam • Time exposure

o Adult: 5mg IV  Needs to be very specific
o Children:0.3mg/kg  e.g.: N-acetylcysteine, antidote for
o Only compatible fluid is blood (direct) paracetamol overdose; effective only
• Lorazepam (Ativan) in the first 6 hrs after ingestion
o Adult: 2.5-10mg IV  e.g. lavage of poison is only good for
o Children: 0.05-1 mg/dose the 1st 24hours
o Withdrawn from the marked d/t its • Mode exposure
associated side effects  Rectal
o Short acting, long duration  Transplacental
• Phenytoin  Oral
o LD: 15-20mg/kg IV  Etc
o Adult: 50mg/min • Intake of other substances
o Children: 1mg/kg/min • Circumstances prior to poisoning
o Inducer of CYP450
• Current medications
o Maintenance drug
• Past medical history
• Pyridoxine (B6)
• Any home remedies taken
o Adult: 5g IV
o Children: 80-120mg/kg
*Organophosphate/carbamate poisoning:
o For INH poisoning manifests with DUMBEL
o Tx of convulsions due to unknown
etiology POISONS WITH DELAYED MANIFESTAIONS
Ethylene glycol 6 hours
Hypothermia Hyperthermia o Present in anti-
 Alcohol  Antihistamines freeze 12 hours
 Barbiturates  Amphetamines Salicylates 36 hours
 Carbon monoxide  Isoniazid Paracetamol 48 hours
 General  Phenytoin Paraquat 48 hours
anesthetics  Salicylates Methanol
 Opioids o Toxic alcohol 4 weeks
 Xanthines
 Phenothiazenes Thyroxine
 Anticholinergics:
 Sedative-hypnotics Atropine
 Tricyclic *Vodka
 Cocaine - among alcohols, has the highest alcohol content
antidepressants
 Phenothiazines - converts ethylene glycol and methanol to less
 Quinidine toxic form
 Sulfonamides - amount to be given needs to be computed

TREATMENT OF COMA OF UNKNOWN ETIOLOGY COMPLETE CLINICAL EVALUATION

• Thiamine (vit B1) 100mg IV
o Tx of Wernicke Korsakoff Synd in
alcoholic px
• Glucose
o Adult: 50-100ml D50-50
o Children:2ml/kg d10
o Most pts present with hypoglycemia
esp. in alcoholic intoxication
o Wernicke-Korsakoff syndrome
 d/t sever B1 deficiency
 administer B1 first before
giving glucose
• Naloxone
o Adult: 2mg IV every 3-5mins
o Children: 10mcg/kg
o For opiate overdose (coma)
o Expensive
o Given to newborns whose mothers
underwent CS causing respiratory
difficult in their babies
COMPLETE CLINICAL EVALUATION
• Good history taking (d/t vulnerability of
children)
INFORMATION TO BE ELICITED DURING HISTORY
 Complete physical examination
 Evaluate general status
 Examine skin
 Characterize odor of patient’s breath
 Auscultate the lungs
 Listen to patient’s heart
 Check the abdomen
 Do a complete neurologic exam
 Skin changes in poisoning
 Bullae: barbiturates, CO
 Diaphoresis: OP, salicylate, amphetamine
 Jaundice: paracetamol
 Dry and warm: atropine, anticholinergic
 Flushed: anticholinergics, alcohol,
cyanide, atrophine odors
 Brerath odors
 Bitter: almonds, cyanide
 Fruity: DKA, isopropanol
 Oil of wintergreen: methylsalicylate
 Rotten eggs: sulfur dioxide, hydrogen
sulfide
 Pears: chloral hydrate
 Garlic: arsenic, OP
 Mothballs: camphor (like the one in vicks)
Bradycardia Tachycardia
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 Propranolol  Iron  Mydriasis  Miosis

 Anticholinesterase  CO, cyanide  Tachycardia  Bradycardia
 Hypertension  Hypotension
 Clonidine, codeine,  Organophocphate
 Hyperthermia  Hyperventilation
Ca-channel blocker  Phenothiazine  Seizures  Coma
 Ethanol  Ethanol, ethylene
 Digitalis glycol CONDITION OR AGENTS PREDISPOSING TO
 Free-base cocaine METABOLIC ACIDOSIS OR ELEVATED ANION GAP
 Anticholinergics • Methanol
 Antihistamines • Ethylene gycol
 Amphetamines • Theophylline, toluene
 Sympathomimetics • Alcoholic ketoacidosis
 Salicylates, • Lactic acidosis
solvents
• Aminoglycosides
 Theopylline
• Cyanide, CO
Mydriasis Miosis • Isoniazid, Iron
 Antihistamines  Cholinergics, • Diabetic ketoacidosis
 Antidepressants clonidine • Grand Mal seizures
 Sympathomimetics  Opiates, • Aspirin (salicylate)
Organophosphate
 Isoniazid • Paraldehyde, phenformin
 Phenothiazines,
 Anticholinergics pilocarpine,
ELIMINATION OF THE POISON
pontine bleed
• External Decontamination – bathing of pt with
 Sedative-hypnotics
alkaline soap e.g perla, ivory, dove
• Emptying the stomach
*Triad of opiate overdose:
o Emesis – only in adults
 Coma
*pediatrics have risk for aspiration
 Respiratory depression
 Pinpoint pupils
o Gastric lavage – H20, NSS, Na
Bicarbonate, activated charcoal
Clinical Evaluation: • Limiting GI absorption
Check for Toxidromes o Activated charcoal
 Signs and symptoms taken collectively can o Demulcents (watusi) / neutralizing
characterize a suspected toxicant agents (raw egg white: to prevent
 These groups of manifestations are observed absorption)
to occur consistently with particular poisons
o Intractable seizures + Coma + SUBSTANCES NOT ABSORBED BY ACTIVATED
Metabolic acidosis = INH Poisoning CHARCOAL
*Intractable seizures despite  Alcohol – rapid absorption
administration of diazepam  Cyanide
 Iron
o Lavage with NaHCO3
 Lithium - dialysis
Anticholinergic / Antidepressant Toxidrome  Petroleum distillates (hydrocarbons)
 Hyperthermia: “hot as a hare”  Caustic agents
 Dry mucosa: “dry as a bone”
 Flushed skin: “red as a beet” SUBSTANCES WITH EXTRAHEPATIC
 Dilated pupils: “blind as a bat” RECIRCULATION
 Confusion / delirium: “mad as a hatter” • Aspirin
• Cyclosporine
Cholinergic Toxidrome (S&Sx of organophosphate • Digoxin
and carbamate poisoning) • Meprobamate
 Diarrhea, diaphoresis • Paracetamol
 Urination • Phenothiazine
 Miosis, muscle fasciculations • Phenytoin
• Salicylate
 Bradycardia, bronchoconstriction
• TCAD
 Emesis • Anticoagulants
 Lacrimation • Carbamazepine
 Salivation • Dapsone
• Gluthetimide
Sympathomimetics Opiates / Narcotics • Methamphetamine
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• Phencyclidine (Fe3+) state, resulting in the

• Phenobarbital inability to transport oxygen and
• Piroxicam carbon dioxide)
o Sodium Thiosulfate: binds with
• Theophylline
cyanide-methemoglobin complex
• Organochlorines
to detoxify
*Formalin ingestion:
o Used in PGH, a raw material that
is compounded and prepared
 No antidote
whenever it is needed
 Give H2 blockers
 Reduction in conversion to more toxic
 Surgery (cut the part with ulceration) compounds
 Ethanol
ENHANCEMENT OF ELIMINATION OF ABSORBED o For tx of methanol and ethylene
SUBSTANCES glycol poisoning
• Forced diuresis  Competitive inhibition at receptor site
o Mannitol 20% - osmotic diuretic
o Furosemide – loop diuretic  Atropine (physiologic antidote) – for
organophosphate/carbamate poisoning;
• Alkalinization therapy
inhibits the enzyme acetylcholinesterase)
o Sodium bicarbonate – for weak acids:  Pralidoxime (pharmacologic antidote)
INH poisoning  Bypassing the effects of the poison
• Acidification therapy (for weak bases:  Oxygen for CN poisoning
Methamphetamine/shabu)  Pyridoxine for INH poisoning
o Ascorbic acid
 Antibody interacting with poison
o Ammonium chloride
• Dialysis and hemoperfusion  Digoxin antibody fragments (Digibind) –
not available locally
• Multiple dose activated charcoal
*Locally: nadia-nadia
INDICATIONS FOR DIALYSIS  Snake antivernin (available in RITM)
- species of Philippine cobra cause
• Amanita phalloides (mushroom) – very paralysis
dangerous and lethal causing renal failure - Tx: activated charcoal
• Antifreeze (glycol type)
o Tx: ethanol e.g. vodka via NGT; SUPPORTIVE THERAPY
prevents conversion to more toxic from • Essential for poisoning patients, especially for
• Heavy metals in soluble compounds critically ill
o Tx with EDTA or chelators • Problems in the critically ill poisoned patients
• Heavy metals after chelation o Depressed sensorium
• Methanol o Impaired ventilation
o Impaired cough reflexes
ANTIDOTES FOR PATIENTS WITH COMA OF o Prone to aspiration
UNKNOWN ETIOLOGY o Immobility
• Naloxone o Fluid, electrolyte and other ,metabolic
• Glucose problems
• Thiamine • Intravenous fluids: replacement and
maintenance
ANTIDOTE FOR PATIENTS WITH SEIZURE OF • Frequent blood and urine pH determination:
UNKNOWN ETIOLOGY acidification and alkalinization therapy
• Pyridoxine (Vitamin B6) • Prevention of aspiration
• Prevention of decubitus
USE OF ANTIDOTES • Ulcer
Mechanisms: • Treatment of electrolytes, metabolic and
 Inert Complex Formation temperature problems
 Chelating agents (DMSA, NAPA) • Monitoring of vital signs
o Tx of heavy metal poisoning • Monitoring of input and output
 DMSA: suximer?
GOOD SUPPORTIVE AND NURSING CARE IS
 NAPA: N-acetyl-penicillamic acid –
IMPORTANT
mercury, arsenic, lead
 Accelerated detoxification DISPOSITION
 Cyanide antidote kit – available in US • Observation at the emergency room: atleast
only 24hrs may be warranted
 Sodium nitrite and sodium thiosulfate • Frequent reevaluation
o Sodium nitrite: Induce • Psychiatric evaluation: suicidal patients and
methemoglobinemia (a condition substance abusing patients
in which the iron within
• Childhood poisoning: evaluate for possible
hemoglobin is oxidized from the
child abuse or neglect
ferrous (Fe2+) state to the ferric
• Family counseling and education
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• Physical or sexual abuse among women  Acetic acid

• Domestic violence  Benzalkonium chloride
Pathology: Coagulation necrosis
TOP TEN POISONS (All Ages) IN-PATIENT STATISTICS  Others
National Poison Control and Information Service UP-
PGH  Phenol (e.g. Lysol)
YEAR 2006 (N=847) NUMBER PERCENTAGE  Cyanide salts: Silver jewelry cleaner
1. Ethanol – alcohol 95 11.2 - mixed with Na Hydroxide
withdrawal pts
2. Kerosene (Gaas) 87 10.3 PHARMACEUTICAL AGENTS
3. Sodium Hypochlorite 62 7.3  Paracetamol
(Zonrox)
4. Mercury (thermometer) 45 5.3  Toxic dose: 150-200mg/kg
5. Jewelry Cleaner (Cyanide) 35 4.1  Toxic metabolite: NAPQI (N-acetyl-p-
6. Hydrochloric acid (Muriatic) 27 3.2 benzoquinone imine)
7. Methamphetamine (Shabu) 19 2.2  GI, liver and renal damage (4 stages)
8. Paracetamol 16 1.9  Antidote: N-Acetylcysteine
9. Mixed Pesticides (Baygon) 15 1.8
10. Jathropa seeds (cause 15 1.8  Preparation: IV – usual route (e.g.
hemorrhagic gastritis) Hydranap)
Oral – in sachet
*Na Hydroxide: Liquid sosa Inhalation
 Average 50-kh man who ingests 15-20 tablets
TOP TEN POISONS (All Ages) TELEPHONE REFERRALS (500 mg) causes toxic injury
National Poison Control and Information Service UP-
PGH
YEAR 2006 (N=2,682) NUMBER PERCENTAGE
1. Kerosene 192 7.2
2. Sodium Hypochlorite 131 4.9  Iron
3. Mixed Pesticides (Baygon) 118 4.4  Toxic Dose: 20mg/kg
4. Elemental Mercury 90 3.4  GI, CVS, CNS manifestations (4 stages)
5. Paracetamol 64 2.4  EGD
6. Silica gel (shoes) – 62 2.3
nontoxic, causes mild GI  Antidote: Deferroxamine
manifestation  Causes severe bleeding and hypotension
7. Jewelry Cleaner 57 2.1  e.g. Flintstones, Gummy bears – contains iron
8. Ferrous Sulfate 53 2.0 which can cause toxicity
9. Hydrochloric acid 48 1.7
10. Isoniazid 42 1.6  Isoniazid (INH)
 Toxic Dose: 80-100mg/kg
HYDROCARBONS
 Triad of INH toxicity: seizures, coma,
 Kerosene (Gaas) metabolic acidosis
 Chemical pneumonitis  Antidote: Pyridoxine (Vitamin B6)
o Presents with cough  cyanosis  seizures
 Aspiration pneumonia  Aspirin
 Treatment: Pen G or other beta-lactams (for  Acetylsalicylic acid: 100mg/kg (children),
pneumonia) 200mg/kg(adults)
 No antidote  Methylsalicylate: 50-500mg/kg or 4ml
 Easily absorbed (1.4mg/ml)
 Vomiting, tinnitus (first thing to manifest),
 Solvents metabolic acidosis, seizures, coma, renal
 Aliphatic hydrocarbons failure
 Aromatic hydrocarbons
 Activated charcoal / hemodialysis (causes
 Benzene (ADR: Leukemia) coma, seizure)
 Toluene (ADR: Kidney failure due to
chronic exposure)

CAUSTIC AGENTS PESTICIDES

 Alkali (ph > 7) Strong alkali: ph >10  Organophosphates
 No antidote (only supportive): H2 blockers, PPI  Malathione
 Sodium hypochlorite  Chlorpyrifos
 Sodium hydroxide (e.g liquid sosa)  SSx: DUMBELS
 “LIhiya” (pang-green ng suman)
 Main Tx: surgical  Carbamates
Pathology: liquefaction necrosis (esophagus and  SSx: DUMBELS
intestine)
 Pyrethroids
 Acids (ph < 7) Strong acid: ph <4  DEET (diethyltolbutamide)
 Hydrochloric acid - present in insect repellants (e.g. lotions)
 PHARMACOLOGY: Toxicology – Dra. Dando
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- causes seizures esp in children >2 y/o  Organic: contaminated waters from
 Permethrin industrial waste products, air, soil
- anti-pediculosis and scabies: cause seizure (methylmercury)

 Rodenticides Small-scale mining practices

 Zinc Phosphides = residue after panning operation where most of
 Coumatetralyl  bleeding (Tx: vitamin K) the water are removed
= no personal protective device is provided
 Herbicides = route of entry is skin
 Chemical pneumonitis
Mercury in Thermometer
“There is approximately 1 gram of mercury in a
MIIXED PESTICIDES (e.g. Baygon)
typical fever thermometer. This is enough mercury to
 Carbamates
contaminate a lake with a surface area of about 20
 Propoxur acres, to the degree that fish would be unsafe to eat”
 Pyrethroid *Mercury is not actually absorbed if GI is intact but
 Cyfluthrin can cross BBB after 24-48 hrs
 Transfluthrin *Tx: cathartics
 S/Sx: DUMBELS
 Treatment: Atropine, Activated Charcoal  Organic Chemicals: Methylmercury

Effects of Pesticides:
- Endocrine disruption (cause problems in
reproduction and immune system)
- Neurodevelopmental effects (e.g autism,
cerebral palsy, mental retardation)
- Immune system (can cause cancer)

NON-PHARMACEUTICALS
 Silica gel – gastric irritant
 Chinese herbal meds (e.g. Ma-Huang – has
pseudoephedrine and ephedrine: precursor of
methamphetamine)
 Button batteries
- in <7 y/o, the diameter of intestine is >1.5
cm
- can obstruct trachea, pyloric sphincter *Mercury vapor – amalgam fillings are chief sources
- endoscopy is done to get it manually of exposure to mercury vapor
 Watusi
 Yellow phosphorus – most dangerous Minamata Disease (d/t high levels of methyl
(protoplasmic: cause severe hypotension and mercury in big fishes, e.g. tuna)
hypoxia) In 1932, Nippon Chisso Hiyu started to operate an
acetaldehyde acetic venyl chloride manufacturing
 Trinitrotoluene (present in dynamite and
plant using mercury as a catalyst. The plant had
bombs)
been directly discharging its industrial waste into
 Potassium nitrate
Minamata Bay for 36 years with no adequate
 Potassium chlorate facilities.
 Moth balls
 Naphthalene – causes hemolytic anemia in In 1958, Chisso redirected the outlet drainage canal
G6PD deficiency pts from Minamata Bay into the tributary of the
 Camphor – most toxic Minamata River which resulted in the contamination
of a wider area of Yatshushiro Sea.
 Para-dichlorobenzene – deodorizer (e.g.
Albatross) Increase in number of vaccines
- least toxic, causes recommended for routine use in infants
slight gastric irritation

HEAVY METALS
 Mercury (a.k.a Asoge)
 Sources:
 Elemental: “quicksilver” metal, cinnabar
ore, dental amalgam, apparatus, Potential increased exposure of infants to mercury
thermometers from thimerosal in vaccines
 Inorganic: antiseptics, vaccines
(merthiolate) Ethyl Mercury
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= in children receiving thimerosal in vaccines, the

half-life of ethyl mercury in blood was 7-10 days or CYANIDE
1/7 to 1/5 as long as that of methyl mercury - inhibits cytochrome oxidase
= a WHO advisory committee recently concluded that - CNS Effects: shock, profound lactic acidosis
it is safe to continue using thimerosal in vaccine - Toxic blood level: >0.5 mcg/ml

Mercury (Pink Disease)  Cyanogen-containing plants

Acrodynia  Linamarin in cassava cake – associated Sxs:
- Acrodynia is a rare idiopathic chronic toxic DUMBELS
reaction to elemental or inorganic mercury
exposure, which occurs mainly in young  Cyanide salts
children. It is characterized by pain in the
extremities and oink discoloration with
 Metal polishing (jewelry cleaners)
desquamation of the skin
 Cyanide Antidote Kit
Uncommon Syndrome “Pink Disease”  Amyl nitrite, sodium nitrite, sodium
thiosulfate
 Pain in the extremities
 Pinkish discoloration and desquamation RED TIDE POISONING
 Hypertension  Diarrheic shellfish poisoning
 Sweating  Okadaic acid (OA) and its derivatives
 Insomnia, irritability, apathy
 Considered as idiosyncratic reaction  Amnesic or encephalopathic shellfish
poisoning
Adverse Effects of Mercury  Domoic acid
 Elemental
- acute necrotizing bronchitis pneumonitis,  Paralytic shellfish poisoning
insomnia, forgetfulness, loss of appetite,
tremor, erethism, renal toxicity  Saxitoxin and gonyautoxin (GTX)
 Inorganic
- corrosive effects: GI ulceration, perforation,  Neurotoxic shellfish poisoning (NSP)
hemorrhage, acrodynia, renal toxicity  Brevetoxin
 Organic
- CNS: paresthesia, ataxia, muscle spasticity Department of Health
- Infants: psychomotor retardation, blindness, Criteria for Detecting PSP
deafness, seizure, cerebral palsy  Ataxia +
- Behavioral and learning delays: deficits in  Additional 2 Motor Distrubances +
language, attention and memory - Dysphagia
- Inability to stand
- Vomiting
 Lead (a.k.a tingga) - Dyspnea
 Pregnant women and their developing - Paralysis
fetuses are at high-risk because lead readily
 Additional 2 Sensory Disturbances
crosses the placenta
- Dizziness
 For every 10mcg/dl increase in BLL, children’s - Headache
IQ dropped by 4-7 points - Lightheadedness
 A higher proportion of learning disabilities - Paresthesias
was found among school-aged children with - Dysthesia
biological parents who ere lead poisoned as - Hot flashes
children 50 years previously - Numbness
 Source: paints, lipstick, gasoline, hair dyes

 Arsenic Poisoning
 Keratotic lesions  cancerous
 Patients from Bangladesh dig a well

PLANT TOXINS
 Jathropa Seeds
 Contents: toxalbumins = ricin (toxic content
causing hemorrhagic gastritis), curcin, tannic
acid
 Effects: abdominal pain, nausea, vomiting,
hepatic injury, muscle twitching, weakness,
salvation, sweating, dehydration,
hemorrhagic gastritis
 Tx: activated charcoal Specific Treatment
 PHARMACOLOGY: Toxicology – Dra. Dando
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With known or suspected toxin

 Give raw egg whites in cases of corrosive

ingestion
(-) Respiratory Distress (+) Respi Distress 8-12 egg whites (adult)
4-6 egg whites (children)

Observe for 24 hrs  Give 1-5% baking soda solution in cases of

shellfish and iron poisoning
1 teaspoon + 100mL water
Asymptomatic (-) Respi Failure (+)
Respi Failure PREVENTIVE MEASURES
• Wash vegetables / fruits thoroughly
• Support integrated pest management
Discharge NaHCO3 q 5 hr NaHCO3 q 5 • Avoid use of mercury thermometers
hrs x 24h
• Flush cold water tap before use
• Dispose chemical containers properly
Observe x 24 hrs
Ventilatory support • Promote healthy lifestyle: “Say no to drugs”
• Do regular inventory of drugs and chemicals
in the house
Respi Distress Test dose of • Proper storage or labels
edrophonium
National Poison Management and Control
Center
UPCM – Philippine General Hospital
With Response Hotline Numbers: 5241078 or 5218450 loc.
2311
Public Health Issues
 Reporting to DOH
 Shellfish / Fish Advisory
 Monitoring of other possible patients
 Monitoring of levels of toxins in the area (BFAR)

SUBSTANCE ABUSE
Sedatives
 Diazepam (Valium)
 Lorazepam (Ativan)
 Flunitrazepam (Rohypnol)
 Sleeping Pills (Stinox, Unisom)

*Ecstasy
- side effect: bruxism
- causes seizure, severe dehydration
- more toxic than shabu

Smoking and Alcohol

FIRST AID MANAGEMENT OF POISONING CASES

GOAL OF TREATMENT:
- to limit absorption of poison
- remove from toxic environment
- decontamination Maneuvers

REMEMBER THE DONT’S:

 Do not induce vomiting in the following
situations:
- drowsy and comatose patients
- poor gag reflex
- ingestion of corrosive and hydrocarbon
- if the ingestion has occurred for more than
one hour
- late pregnancy (last 3 months of pregnancy)
- presence of heart disease

 Do not give milk or vinegar

:milk is not a universal antidote