CC- TOXICITY OF HOUSEHOLD PRODUCTS - Decreased sensitivity to airway foreign

body
ALCOHOLS - Diuresis
- Exposure causes disorientation, - Loss of behaviour inhibitions
confusion, and euphoria which can - Hypoglycaemia
progress to unconsciousness, paralysis - Loss of fine motor control
- Have depressant effects on the CNS
HIGH DOSES OF ETHANOL CAN CAUSE:
ETHANOL OR ETHYL ALCOHOL (CH2CH3OH)
- Leading cause of morbidity across - Loss of gross muscle control (ataxia,
cultures slurred speech)
- Most common psychoactive drug used - Acute pancreatitis
by children and adolescents in the US - Severe myocardial depression
and is one of the most commonly - Hypotension
abused drugs in the world - Atrial fibrillation
- Has a volume distribution (0.6 L/kg) - Lactic acidosis
and is readily distributed throughout - Congestive heart failure
the body - Pulmonary edema
- The primary route of absorption is oral, - Arrhythmias
although it can be absorbed by - Cardiovascular collapse
inhalation and even percutaneously - Sudden death

ETHANOL CONCENTRATIONS CHRONIC ETHANOL USE CAN LEAD TO THE

- Liquid cold remedies, 2-25%; FOLLOWING:
mouthwashes, 7-27%; rubbing alcohol, - Fetal alcohol syndrome
usually 70% (although most commonly, - Chronic pancreatitis
rubbing alcohol contains isopropanol); - Hepatic dysfunction
aftershave lotions, 15-80%; and - Hematologic disorders
perfumes and colognes, 25-95% - Numerous electrolyte abnormalities
- Ethanol concentrations in some - Hypertension
common alcoholic beverages are as - Cardiomyopathy
follows: whiskey, 40-60%; liqueurs, 22- - Malnutrition
50%; wine, 8-16%; and beer, 3-7% - Obesity

ACUTE ETHANOL INTOXICATION CAN CAUSE: ACTIONS

- CNS depression - It binds directly to the gamma-
- Mild vasodilation leading to a modest aminobutyric acid (GABA) receptor in
decrease in blood pressure the CNS and causes sedative effects
- Flushed skin similar to those of benzodiazepines
- Urticarial - An N-Methyl-D-aspartate (NMDA)
- Inhibition of spermatogenesis glutamate antagonist in the CNS
- Hypothermia - Has direct effects on cardiac muscle,
- Tachycardia thyroid tissue, and hepatic tissue
- Myocardial depression - Peak serum concentrations typically
- Variable pupillary response occur 30-60 mins after ingestion
- Respiratory depression - Primarily metabolized in the liver. 90%
- Decreased pulmonary secretion of ethanol load is broken down in the
clearance
 liver; into acetaldehyde by alcohol
dehydrogenase (ADH)
ETHYLENE GLYCOL
- Similar in structure with ethyl alcohol
with addition of hydroxyl group on
each carbon
- Used in preparation of car radiators,
de-icers, and coolants
- Colorless, odourless liquid with
pleasant and bittersweet taste
- Non-volatile and miscible with water
- Can be ingested with peak levels of 1-4
hours
- Major product of metabolism is formic
acid
- Hallmark of toxicity is a severe anion
gap- metabolic acidosis
- Minimum lethal level is 21 mg/dl
METHANOL
- Common component of gasoline,
gasohol, antifreeze, windshield washer
fluid, photocopying fluid, perfume,
wood alcohol, paint solvents,
household cleaners
- Colorless liquid and metabolism gives
formaldehyde- formic acid (ocular
toxicity)
- Metabolites are toxic, when ingested
peak levels is 30-60 mins, and plasma
half-life of 12 hours
ISOPROPYL ALCOHOL
- Includes rubbing alcohol, skin lotion,
hair tonics, aftershave lotion, and
window cleaning fluids.
- Other names: isopropanol, secondary
propyl alcohol, propan-1-ol and 2-
propanol
- Readily absorbed with peak levels after
1 hr of ingestion
- More toxic than ethyl but less toxic
than methanol
- Lethal dose- 240 ml, intoxication in
20ml
- Intoxicated patients: odor of acetone or
rubbing alcohol breath
ACETONE (2-PROPANONE)
- Primary ingredient in finger nail polish
remover
- Volatile solvent widely used in various
glue, varnishes, and rubber cements
- Colorless, volatile, and flammable
- Has a characteristic sweet odor
- Signs of intoxication is the same with
ethyl alcohol but quicker onset and
shorter duration
HYDROCARBON AND PETROLEUM DISTILLATE
- Hydrocarbon
o Organic compounds that
contain hydrogen and carbon
atoms only
o Used in lighter fluid, paint
thinners, and removers,
furniture polishers, clearing
agents, solvents, automotive
products
- Petroleum distillates
o Mixtures of various aliphatic
and aromatic hydrocarbons
(gasoline, kerosene, mineral oil,
and heavy lubricating oil)
o Intoxication results in
pulmonary toxicity
- Toxicity
o Related to pulmonary toxicity
o Pulmonary injury is reflected by
the development of chemical
pneumonitis
NITRATES AND NITRITES
- Inorganic nitrates
o Potassium nitrate- formerly
used as diuretic when taken in
dilute solution
o Sodium nitrate- used to
preserve the color of the meat
in pickling or salting process
o Bismuth subnitrate- used as
anti-diarrheal agent, antacid.
Paste form used to treat
radiation burns
o Silver nitrate- used for its
caustic, astringent, and
 disinfectant properties. Acid and Alkalines
Destroys warts and other skin Alkalines are present in many
growth household preparation
- Organic nitrates 1. Household bleaches (sodium
o Antianginal drugs hypochlorite)
(nitroglycerin, Isorbide 2. Detergents (sodium tripolyphosphate)
dinitrate nitroglycerin 3. Thermal burns - NaOH, sodium
Isordil) bicarbonate (Clinitest tablet)
- Inorganic Nitrites 4. Drain cleaners (NaOH)
o Amyl nitrite- used to treat 5. Ammonia compounds
industrial cyanide poisoning (NH4OH/ammonium hydroxide)
and diagnose cardiac murmur,
and used as drug of abuse Acids
(Mama Poppers) Household acid Major acid ingredients
o Isobutyl nitrite- room products (%)
deodorizer, sold as aphrodisiac,
used to relax anal sphincter Automobile Battery 25-30% H2SO4
(Rush, Bolt, hardware, Satans Toilet bowl cleaner 9.55% Hydrochloric
scent, quick silver, Snappers, (liquid) Acid
Flash, Sweat) Lysol toilet cleaner 8.5 HCl
o Sodium nitrite- used for the Metal cleaner anti rust 5-80% Phosphoric
treatment of cyanide poisoning compound Acid, 5-25% HCl
- TOXICITY
o Ingestion of 10ml of amyl nitrite Mister Plumber 99.5% H2SO4
or isobutyl nitrite can cause (Liquid)
methemoglobinemia Soldering Fluxes Zinc Chloride,
o Ingestion of 2-10g silver nitrate 10-35% HCl
is fatal Swimming pool Ca or 70% NaClO
sanitizer
CYANIDE Vanish toilet bowl Sodium bisulfate
- Plants may contain high quantities of cleaner
amygladin- which is converted to
cyanide to small intestine Toxicity
- Oral absorption of cyanide is rapid and
Alkaline reagent produce tissue injury
the toxic effects can present within
by liquefaction necrosis
minutes
Acid cause damage to tissue by
- Supertoxic substance, component of
coagulation necrosis
insecticides
- They bind to heme iron, and binding
result in uncoupling of oxidative Insecticides and pesticides
phosphorylation
- Expresses its toxicity by binding to Organophosphates - poisoning depend
heme iron on the balance on the stimulation of
- At low level of exposure, patients muscarinic and nicotinic receptors in
experience headache dizziness and neuroreceptors
respiratory depression which
progresses to seizure , coma and death
at slightly greater doses
 Most abundant pesticide and
responsible for 1/3 of pesticide
poisoning
Muscarinic receptor signs(DUMBELS)
Defecation
Urination
Miosis
Bradycardia, bronchospasm
Emesis
Lacrimation
Salivation
Signs And Symptoms Of Nicotinic Receptors
(MATCH)
Muscle weakness and fasciculation
Adrenal medullar cavity
Tachycardia
Cramping of skeletal muscle
Hypertension
Carbamate Insecticide
Carbamylate and inactive
cholinesterase leading to excessive
accumulation of acetylcholine with
muscarinic and receptor stimulation
Carbamate poisoning is short-lived,
produce no CNS toxicity due to inability
to penetrate blood-brain barrier
Organophosphates and carbamates
both function by inhibition of
acetylcholinesterease
Acetylcholine is a neurotransmitter
found in both central and peripheral
nerve, responsible for stimulation of
muscle cells and several endocrine and
exocrine glands
Serum pseudocholinesterase (SChE)
activity - for organophosphate levels
N,N-diethyltoluamide(DEET)
Contain in many insect repellants and
readily absorbed after dermal
application
Toxicity is associated with toxic
encelopalopathy, especially in young
girls and female infants
Ingestion of 50ml insect repellants
containing DEET have resulted to coma,
hypotension and seizure within 1 hour
TOXICITY OF METALS
Arsenic
Bound to or primary constituent of
different organic and inorganic
compound
Acquire through environmental and
occupational exposure
Analysis by AAS
Anti-GAIA
Cadmium
Found in many industrial processes
(intoxication by inhalation)
Main used in electroplating and
galvanizing (mining industry)
Pigment found in paints and plastics
and is the cathodal material of nickel-
cadmium batteries
Significant environmental pollutant
Toxicity is manifested by renal tubular
dysfunction (proteinuria, glycosuria and
amino aciduria)
Chemical Soup
Carbon monoxide
Reduces the ability of the blood to carry
oxygen to human tissue
NH3
Added to tobacco to help absorb more
nicotine- keeping you hooked on
tobacco
Toluene
Highly toxic, causes tremors, destroys
nervous system
Lead
Causes serious damage to the brain,
kidneys, nervous system and red blood
cells. Absorbed very quickly into
children causing severe damage
Butane
Affects nervous system
Formaldehyde
Causes cancer, and can damage your
lungs, skin and digestive tract; used to
preserve dead bodies
Cadmium
Damages liver, kidneys and stays in the
body for years; excreted in breast milk
Lead
Lead is a common environmental
contaminant
Constituent of household paints and
residual in automobile exhaust
Ingestion accounts to major toxicity
Adult absorbs 5-15%, children higher
than adult, infant 30-40%
Causes encephalopathy characterized
by cerebral edema and hypoxia
Severe lead poisoning result in stupor,
convulsions and coma
Potent inhibitor of enzyme, result to
change in bone and calcium metabolism
and anemia- most common finding
(normochromic and normocytic)
Decrease serum concentration of both
25-hydroxy and 1-25-dihydroxyl vitamin
D in excessive lead exposure
Increased aminolevulinic acid and
photoporphyrin, and basophilic
stippling of erythrocytes which is
indicator of lead toxicity
Excessive lead exposure is associated
with hypertension, carcinogenesis, birth
defects and compromised immunity
Treatment involves removal from
exposure and treatment with
therapeutic chelaters (EDTA and
dimercaptosuccinic acid (DMSA) or
dimecaprol. BAL- British anti-Lewisite
compound
Half-Life, 32 years in bones, 7 years in
kidney
CNS toxicity is caused by edema and
direct cytotoxic mechanism, peripheral
neuropathies are caused by leads
effect to myelin sheath
Ingestion of moderate amounts may
result in severe bloody gastrointestinal
tract
Mercury
Metal that exist in 3 forms, elemental
liquid, inorganic salts or component of
organic compounds
Exposure occurs primarily by inhalation
and ingestion common reasons for
toxic levels
A. Elemental Mercury (HgO) can be
ingested without significant effects
B. Cationic Mercury (Hg2+) is
moderately toxic
C. Organic Mercury (methyl mercury
CH3Hg+) is very toxic
Ingestion of moderate amounts may
result in severe bloody diarrhea owing
to ulceration and necrosis of the
gastrointestinal tract
Arsenic
Metallic element found in nature, use
as pesticides rodenticides, wood
preservatives, herbicides
Arsine gas is the most toxic form of
arsenic
Iron intoxication
Serious form of intoxication in children-
easy accessibility thru over the counter
medicines, attractive preparations and
readily available in children at home
Most abundant and most important
metal used in clinical biochemical
reactions
TOXICOLOGY OF THERAPEUTIC DRUGS
Cardiotropics
Used to treat congestive heart failure
and cardiac arrhythmias
1. Digitalis glycosides- for CHF, atrial
fibrillation and flutter
2. Digoxin
3. Procainamide anti-arrhythmic drug,
for supraventricular or ventricular
arrhythmias
4. Quinidine- prevention of ventricular
contractions and the maintenance of
sinus rhythm after conversion of atrial
flutter
Propranolol - for angina pectoris,
hypertension symptomatic coronary
artery disease, after acute myocardial
infarction, arrhythmias
Lidocaine(xyclocaine) - used as an anti-
arrythmic drug and as a local anesthetic
Anticonvulsants
Used in the treatment of seizure
disorders, in particular, grand mal, petit
mal, and psychomotor seizures and
other specialized seizure disorders such
as trigeminal neuralgia
1. Primidone (mysoline) - treatment of
generalized tonic-clonic simle and
complex seizures
2. Ethosuximide (zarontin) - drug of choice
for absence of (petit mal) seizures
unaccompanied by other types
3. Valproic acid - (depatene) for
generalized tonic clonic seizure,
absence seizure, myoclonic seizure
Anti-asthmatics
Theophylline (aminophylline) used as
bronchodilartor
Salicylates
Aspirin (acetylsalicylic acid) w/c is used
as analgesic, antipyretic and anti-
inflammatory
Functions by decreasing thromboxane
and prostaglandin formation through
inhibition of cyclooxygenase
Side effects includes interference with
platelet aggregation and
gastrointestinal disturbances
Also associated with Reyes syndrome
Excessive ingestion is associated with
metabolic acidosis
Gas or liquid chromatography provide
the highest analytic sensitivity and
specificity
Chromogenic assay. Trinder reaction
which reacts salicylate with ferric
nitrate to form a colored complex
Rapid qualitative test is done by adding
several drops of 10% ferric chloride to
1ml of boiled urine (purple color)
Acetaminophen(N-acetyl-p-aminophenol)
Major active metabolite of phenacetin
and acetanilide
Used as analgesic
Toxicity is associated with
hepatotoxicity
The action of the drug is the
interference with prostaglandin
synthesis through prostaglandin
synthetase in the arachidonic acid
cascade in the CNS
Recommended as prophylaxis to DPT
Therapeutic plasma concentration 5-20
ug/ml
Non-steroidal anti-inflammatory drugs
(NSAIDs)
Ibuprofen, fenoprofen, naproxen,
Tylenol
Therapy for arthritis, for common
sprain and strains
Therapeutic dose 400-2400 mg/kg/day
for adult and 20-50 in children
They inhibit cyclooxygenase, the
enzyme that mediates the initial step of
the synthesis of prostaglandins
Anti-infective agents (commonly used)
Cephalosporins - free of severe, acute
toxicity. Adverse reaction may include
renal dysfunction
Erythromycin - considered safest among
antibiotics
Metronidazole - inhibits alcohol
dehydrogenase
Quinolones - ciprofloxacin and
norfloxacin are known representatives.
Absolutely contraindicated in children
and pregnant women(relatively in small
doses(100mg/day) have caused erosion
of cartilage in immature animals leading
to permanent disability
Tetracycline- chronic ingestion is
associated with intracranial
hypertension and Fanconi-like
syndrome (polyuria, polydipsia,
glycosuria and hypokalemia)
Drugs causing fatalities in overdose
Chloramphenicol- includes capsules,
suspension, topical application and
parenteral forms
Originally discovered in Streptomyces
venezuelae - an actinomycete
Most common form of toxicity gray
baby syndrome
Side effects includes aplastic anemia
and bone marrow depression
Chloroquine (malaria) - 4 aminoquinolone
derivatives
Acts by attacking the asexual form
of malarial parasite by inhibiting
both DNA and RNA polymerase
Dapsone - synthetic sulfone that is
treatment for leprosy and
dermatitis herpetiformis
Known as 4 ,4` diaminodiphenyl
sulfone
Toxic effect is due to interaction
with hemoglobin to produce both
methmoglobin and sulfhemoglobin,
on erythrocytes - hemolytic anemia
Rifampin
Semisynthetic antibiotic derived from
streptomyces mediterranei
Use for treatment of antibiotic and as
prophylaxis for N. meningitides
Also used with dapsone to treat leprosy
Acute toxicity is associated with red
man syndrome deep orange-red
staining of skin, mucous membranes
and urine
Immunosuppressive
Used in the treatment of autoimmune
disease to reduce inflammation and
include prednisone, a steroid and
cyclophosphamide (cytotaxan) a toxic
drug
Used in organ transplant, these are
essential for graft survival
1. Closporine (CsA) - prevent rejection in
kidney, heart and liver allogenic
transplant
 2. Tacrolimus (FK-506) - macrolide
lactone, they are utilized in transplant
surgery to prevent rejection
3. Sirolimus (rapamycin, RAP) - GI
symptom and thrombocytopenia
4. Mycophenolate - used to decrease the
rate of renal allograft rejection
5. Mizorbine(MZ) an imidazole nucleoside,
inhibit inosine monophosphate
dehydrogenase
6. Deoxyspergmalin - has potent
monocytic effects and appears to
interfere with MHC antigen expression.
Side effect is bone-marrow suppression
and GI symptoms
7. Leflunomide (LFM) - isoxasole
derivatives, which inhibit lymphocyte
proliferation. Used in treatment of
rheumatoid arthritis and in animal
allograft survival
Drug used for manic depression
Lithium - antimanic agents and
prophylaxis and treatment of bipolar
disorder(manic depressive disorder)
used also in prevention of chronic
headache
Tricyclic antidepressants - treatment of
symptomatic and supportive care
The neuroleptics, anti-psychotic major
tranquilizers
Used in the treatment of acute
schizophrenia and result in suppression
of agitate
1. Haldol
2. Chlorpromazine
Chemotherapeutic agents
1. Methotrexate - immunosuppressive
agent used in the treatment of
psoriasis, rheumatoid arthritis and
some collagen vascular disease
2. Bisulfran - an alkylating agent- used in
the treatment of leukemias and
lymphomas prior to bone marrow
treatment
Environmental carcinogen
Carcinogen binds to DNA leading to
mutation of genetic code, resulting in
synthesis of mutated protein involved
in control of life cycle
Benzpyrene
Found in cigarette and exhaust of
engines and causing lung cancer
Nitrites
Preservation of red meat and could
cause lung cancer
Aflatoxin - produce by the fungus
Aspergillus which cause hepatocellular
carcinoma
Aromatic hydrocarbons such as
benzene and ionizing radiation is
implicated to cause anemia
Benzidine dyes, B- napththylamine,
dimethyl benzaantracene and other
aromatic compounds have been linked
to multiple malignancies
Asbestos is associated with lung cancer
Polychloride biphenyls (PCB) and dioxin
are implicated to cause cancers
Chemotherapeutic agents
1. Methotrexate immunosuppressive
agent used in the treatment of
psoriasis, rheumatoid arthritis and
some collagen vascular diseases
2. Bisulfran an alkylating agent used in
the treatment of leukemias and
lymphomas prior to bone marrow
treatment