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Specific Toxicologyشيرين
Specific Toxicologyشيرين
Specific Toxicology
Chapter 2
Corrosives
Scheme:
1- Effect of Poisoning.
2- F.D
3- F.P
4- Action
5- C/P
6- P.M.P
7- Ttt
(+/-)
8- Source & Uses
9- Kinetics
10-Diagnosis ( Investigations)
11- D.D
1
NMT 11
Specific Toxicology
4S
2- Swallow (Dysphagia) √
Speech (Dysarthria) √
Shock (Neurogenic) √
Stomach (Perforation) Rare
2
NMT 11
Specific Toxicology
3-Vomiting (Acidic Haematin) 3 Vomiting (Alkaline Haematin)
4-Constipation 4-Diarrhea
5- √
5-Dehydration
6-Shock 7-Oliguria
6- √ 7- √
-Temp Æ -Temp Æ √
-Pulse Æ Rapid weak -Pulse Æ √
-B.PÆ
-B.P Æ √
-Resp. Æ Shallow rapid
-Resp. Æ √
7-Cause of > In acids
Death & fatal
Period: S A D / P C > In alkalies
Stricture
+
Brain
3
NMT 11
Specific Toxicology
+
3- Internal & External signs
of asphyxia
PassagesÆ3- Internal &
External signs +
of asphyxia Narrowing of lower end of
esophagus
+
PM changes.
To prevent Stricture
2- E.C.G Æ XXX
3- Local Antidote Æ - Demulcent
-NeutralisationÆ XX due to…..
4- Dialysis, Diuresis & Heamoperfusion Æ XX
4
NMT 11
Specific Toxicology
-Cheap
2- Suicidal: -Easily Obtained Similar to Sugar & Salt crystals
-Local
Anaesthesia
1-Local: 1-Local:
Coagulative necrosis
1-Stomach Æ 1- Mild Corrosives +
Local anaesthesia Coagulative necrosis.
5
NMT 11
Specific Toxicology
2-Skin Æ Eschars (Brown) Æ2- White Eschars.
2-CVS(as before)ÆArrhythmia
Once exposed to airÆ Oxidation
3-Collecting TubesÆ + White
Hydroquinone Ca Oxalate Crystals
6
NMT 11
Specific Toxicology
8-ttt: 1-Supportive & Symptomatic 1-Supportive & Symptomatic
ttt: ttt:
As before + -RFÆResp.Failure as before
Met-hemoglobinanaemia -RFÆRenal Failure
Corrected by Diazepam
Vit C Or Methylene Blue 1mg/Kg
2mg
-Convulsion Æ as before
7
NMT 1
Specific Toxicology
10-P.M.P: SUSÆ1-Smell SUSÆ1- Sup.Ulcers
2-Sup.Ulcers + Thickened
Stomach
+ +
SES Æ3-Brown Eschars SES Æ2-White Eschars
+ +
Brain Æ 4-Brain Edema + Brain
Congestion
+ +
PassagesÆ 5-Int.& Ext. Signs of PassagesÆ 3-Int.& Ext. Signs
Asphyxia of Asphyxia
+ +
PM picture PM picture
+ +
C\P Æ 6-Kideny C/P Æ 4-Kideny
Affection
Congested Tense + Ca Oxalate Crystals
Enlarged Capsule 5-Dilated Heart
11-D.D: 3C In Stomach:
8
NMT 11
Specific Toxicology
Oral:
Role of Milk:-
Chapter : Corrosives
9
Plant poisons
Alkali+Acid
because
Plants are not called {Alkaloids} Salts
Alkalies because they don't turn litmus paper blue Plants+Acid
Salts
3V
OPIUM (Morphin)
5C
General↓
Characters of plants:
1)Alkaloids Doesn't turn litmus paper blue
1-Source
white
oxidation
in presence
of air ﺑﻨﻲ N.B. Derived from the capsule not the seeds
Opium Morphine
Smell (meconic.a) XXX
Ingested Injected
10
2-Uses
1-Pain killer
2-Shock
3-Morphin addicts
4-C.of poisoning
Children
Workers
Acc
Therapuetic √
Addicts √
Suc Addicts
Homicidal XXX
11
Action+ C/P
3V Action 5C C/P
↑ & ↓
1-↑Vagus ↓ BP, ↓Pulse, ↓Resp
12
P.M.P
SeS 3- Needle
+
Passages 5-Int&Ext
+Pulmonary edema
+
P.M.P XX
C/P XX
13
Coma
D.D. : 3 C Cyanosis
Constricted pupil
TTT :
1) S&S Resp.
2) ECG √√√ - even if injected
- cuffed endotracheal tube (v.imp.)
4) D & D & H
Competitors
Uses: 1) ophthalmology
2) GIT
3) Anaesthesia ↑ R.C
↓ Secretions
4) Toxicology Morphine
O.P. aconite
15
F.D.: Atropine & Hyoscyamine 100 mg
Hyoscine 30 mg
C.of poisoning:
Atropine Nutmeg
( hepatotoxic)
+ Jaur
16
Actions :
Clinical picture:
Plant Poison
1 Dry as bone
3 Hot as hare
4 Blind as bat
17
Peripheral actions :
(dysphagia,thirst&haorsness of voice)
2) V.D. Rush
3) ↑ Temp.
CNS : CHAIR
* Occupational Delirium
SUS 1-Seeds
+
SES
+
B 2-Brain edema & congestion
+
P 3-Int. & external signs of asphyxia
(dry air passages)
+
P 4-Putrefaction
**N.B.→ Resist putrefaction
1-Metal
2-O.P
3-Nicotine
4-Strychnine
18
TTT:
4×2
1- S& S→ Resp.
2- ECG + local antidote
3-D & D
4-physiological antidote A-Pilocarpine 10mg
(peripheral action only)
19
D.D.
2- Temp. ↑↑ ↓↓↓
3- Pupil Dilated & fixed Changeable (Mc Ewin′s sign)
Cocaine
3C 3S
Catecholamines Sympathomometic
CNS then
Cutaneous anathesia 30 mg ﺴﺎﻋﺘﻴﻥ
F.d F.p
20
Theraputic
5- Condition of poisoning: Accidental Addicts
Workers
Children
Suicidal
Homicidal
Action 3 C/P
Stimulation Depression
1. ↑. atecholamine release &
1. C.V.S: ↑. BP,
↓. uptake.
2. NS stimulation then ↑ pulse.
cardiac arrest
depression. (psychosis)
3. utaneous anaesthesia
2. Resp.: ↑. Rate &
depth. Coma, Cyanosis,
3. CNS: CHAIR + Central asphyxia.
psychosis +
Hallucination +
Delusions +
Illusions +
Euphoria +
Alertness
↑. Quality not
Cutaneous
Quantity
anaesthesia.
4. Cutaneous
anaesthetic
effect.
Cause of death:
21
P.M.P
S U S
+
S E S 1- Site of injection
+
B 2- Brain edema + congestion
+
P 3- Internal + External signs of asphyxia
+
P.M.P 4- Putrefaction
Rapidly destroyed after death.
22
Digitalis
Dysrhythmias
Dye vision
Diarrhea
Drowsiness
Dermatological
search for
5- Uses 1- CHF
2- Atrial arrythmias.
6- C. of poisoning Accidental Theraputic
Children
Suicidal √√
Homicidal
23
Action:
Ca K (chronic toxicity)
Yeast
C/P of Heart:
Tachycardia Bradycardia
24
P.M.P:
S U S 1- Tablets or leaves or seeds.
2- No ulcers Stomach irritant.
+
S E S
+
B
+
P
+
P.M.P 3- Putrefaction.
+ Dilated
C/P 4- Heart Hypertrophy
Pulmonary congestion
Treatment: of Digitalis toxicity
1- S & S Care of the heart
25
ashish ( Systems)
F.P
alf day 12 hrs
F.D 2-8 gm
(2 cigarettes)
A.P ∆9 T H C
2- Investigations As before
+ ∆9 THC
Psychoactive:
CNS &
1- Dose
2- Type
3- Personality (Mood)
4- Previous exposure
26
C/P
Psychological Eye Resp. C.V.S GIT Reproduction
&
Neurological
1- 25 mg/kg Red Eye ↑. HR ↑appetite ↓sperms +
THC (Conjunct. (specially ↓testosterone
cong.) sweets due to
ppt. to PPt. induced
Sense of well cough to hypoglycemia) ↓ovulation
being. angina (not marked as
(Euphoria) in males)
Inc. senses:
· Smell
· Sound
· Touch
· Colour
3->250 mg
(details later)
C/P (followed) :
27
Cause of death:
1- Central asphyxia.
2- Car accidents.
P.M.P:
S U S
+ 1- Smell.
S E S
+
B 2- Brain edema & congestion.
+
P 3- Int. & ext. signs of asphyxia.
+
P.M.P
+
C/P
Treatment:
1- S & S Care for respiration.
2- ECG √√√
28
Strychnine S
- ﺳﻢ ﻓﺮان
Children
5) Condition of poisoning: -Accidental Workers
Therapeutics
7) Action:
29
8) Clinical Picture:
2-Sympathatic Stimulation
- Bl.Pr.
- Pulse
- Resp. + Mydriasis + Bulging
- Temp.
9) P.M.P:
30
10) D.D:
1) Tetanus 2) Epilepsy
1-History of Wound 1-Loss of conscious
2-Bacterial à Cl. tetani 2-Bitten tongue + froth
3-Deathà Days 3-Normal face not cyanosed as in
4-Trisumus à Lock jaw strychnine + Rising
5-Gradual 4-One attack only (Not Several)
6-In state of relaxation, the
muscles are Tonic
11) TTT A B C
Charcoal
3-Local antidote kM2O4, H2O2
Tannic Acid
31
5-Physiological antidote à S M M
32
Metallic poisoning
Scheme:-
Distribution H,N,T,B
1- Kinetics ( Hair , Nail , Tooth , Bone )
Excretion Urine
GIT:
AS…….DS (descending colon)
HG…….Caecum
Antimony……..Stomach
Living
st
1
Dead
2– Diagnosis
Reinch test ( except lead )
2nd
Lead ( X-Ray )
Local ( GIT )
3- Action: Mixed
33
5- Fatality 1 Day (local) Dehydration & Shock
Period
(F.P) 1 week (Remote) Organ Failure
6- P.M.P superficial
A- Ulcer + Intact mucosa in between
B- Resist & Delay putrefaction (due to dehydration & bactericidal
effect of Metals)
7- Cause of Death:
A- Dehydration & Shock (1 Day)
B- Organ Failure (1 Week)
8- Treatment:
A- S&S
B- ECG
C- Local Antidote
D- D&D
1- BAL
2- EDTA
E- physiological antidote → Chelators 3-Penicillamine
4- Desferol
C- Local antidote:
Adsorption
Precipitation
Ph ﻧﺤﺎس
34
Blood Brain Black offensive Micturation Mucus ﻣﻴﻪ
stool
Plum bum Mercury
Kinetics: Distribution: H+N+T+B Distribution: H+N+T+B
Ca M
O
B
Ca Ca I
Vit. D Vit. D L Caecum (excreted)
Alkalies Acids I
Parathormon Z
Deposition T
E
Homocidal
Rare
Rare by Insecticide
Suicidal
Ingestion of Corrosives
F.P:
Local 1 Day 1 Day
35
F.D: - TEL (2 drops) ‘Two’ 1 gm ( Mercury Mono )
- Rest 10 gm ‘Ten’
Sources: 1- Environmental:
-Fluminate Colon of
children
Firearm
-Cyanide Pink
Disease
Cidal
1- Pink extremeties
2- Painful
3- ﻣﺶ ﻋﺎرف أﻗﺮأهﺎ
4- BP
5- Bald (alopecia)
Uses: 1- Bullets 1- Blood Pressure
2- Pencils 2- Batteries
3- Printers 3- Lamps
4- Pipes
36
Action : Local : (GIT) Local: GIT
Remote : Remote: Kidney
Brain
Blood haemolysis
a)Local: M N V M N V
S C D black &
Offensive stool
salivation S C D
+
Dehydration &Shock mucous
+
blood
b)Remote: (Merconial
1)Brain dysentery)
2)Blood Haemolysis
R.F
(as before)
P.M.P:
37
TTT:
1) Care of shock
1) S&S 2) Care of dehydration 1) Care of shock
3) Care of CNS 2) Care of Kidney
4) Care of Kidney
2) Precipitation 2) Precipitation:
Salt MgSO4 اﻷﺑﻴﺾ ﻟﻸﺑﻴﺾ
ﺑﻴﺎض اﻟﺒﻴﺾ
Not milk Death
4) D&D √√ 3) Mercuric
Mobilization followed by Mercurous
immobilization to allow
The chelators to work
efficiently Na Formaldehyde
5) Physiological √√ Sulfoxalate
antidote
C/P :
Convulsion
1)Brain Encephalopathy
Mental
Paralysis
Motor Muscle atrophy
2) Buccal Stomatitis
Blue line
38
3) Bowel Colics D.D Intestinal Obstruction
Constipation
Fragility
Punctate basophilia
Mature RBC
Ribosomal RNA
Lead
Treatment:
39
4) Symptomatic:
Brain Encephalopathy + Anticonvulsion
Paralysis Physiotherapy & Splint
Bowel relaxant Colics
?????? Purgative
Blood Iron or Blood Transfusion
ﻣﺘﺴﻮل Mercuralism
C/P:
1) Mercurialentis
+ Vomiting + Diarrhea
4) Oral Salivation
Gingivitis
Grey line (Mercury)
Cancrum Oris Gangrenous
7) Psychic shyness
loss of confidence
erytheism
TTT:
cloth
0) Prophylactic container
check up
40
1)Prevention
2)Physiological antidote
3)Symptomatic ttt:-
*psychological *BAL skin ointment
*Nervous *BAL eye drops
Metallic poisoning
Anti muscle of heat
Anti mansoni &
Ampoules
Arsenic Antimony
Diagnosis: Reinch test
powder
Kinetics: Ascending & descending colon Stomach
41
5)Arseine gas 5-Stibine gas haemolysis
ttt haemolysis RF
blood CNS
transf. renal failure irritation
+ dialysis
USES:
1-اﻟﺒﻴﻮت glass 1-Insecticide
2-Insecticide
3-war gases
C. of Therapeutic
Poisoning: overdosage
• Accidental Household • ACC.
Occupational Accumulation
in organs
• Suicidal Rare
hypersensitivity
• Homicidal Common
Industrial exposure
Advantages:
1) Colics (gastroenteritis)
2) Color • Hom.
3) Can escape (4hrs) Rare
4) No Characteristic • Suic
smell/odour
Disadvantage:
Detected after putrefaction
In ‘B, N, H’
42
Actions:
1)Local: GIT GIT
2)Remote: SH group enz SH group enz
Liver Heart
Heart Liver
Kidney Kidney
s C D Rice watery
stool The Same
D&S due to
toxic
capillarities
43
P
+
P.M putrefaction
+
C/P congested liver C/P: Sometimes complications
Kidney 8% toxic jaundice
Heart
TTT:
1) S & S • Care of shock • Shock
• Care of liver • Heart
2) ECG √√√ √√ Except antimony
Chloride
Corrosive
3) Local 1)Charcoal (Adsorp) 1)Tannic acid
antidote 2)Fe(OH)3 (percipt) 2)Charcoal
4) D & D √√ √√
5) Physiological BAL
antidote DMSA
EDTA
44
Chronic Arsenic
A R S E N I C
Coryza + perforated
-Alopecia nasal septum
زﻳﺎدﻩ
+ GIT manifestation
+ Organ Liver
Heart
Kidney
TTT:- clothes
1)Prophylactic containers
2)Prevention
45
Chronic Antimony
اﻟﻔﻼﺣﻴﻦ
(Pustules)
Heart
Kidney
Arsenic Cholera
1)Toxic √ x
2)Bacteria x √
3)Colics √ x
4)Vomiting & diarrhea Vomiting diarrhea Diarrhea vomiting
5)Temperature ↓ ↑
46
Phases
----------------
Ca
3) ( اﻷﺣﻤﺮRed) Matches
Smell
F.P 1d D&S
C.of poisoning:-
Children
• Acc workers
• Suic √
• Homicidal x smell
47
Action:-
1)Local GIT
Kidney
- Ca in blood
C/P:- n c
1)Local:- (GIT) v D
( Smoking stool
Recovery
2)Remote (liver) →
48
P.M.P:
SuS 1)Smell
+ 2)Ulcer + luminous
P.M
C/P
Kidney
↑↑ 2)ECG √√
1)Charcoal
↓↓3)L.A 2)CuSo4 (precipitate)
3)H2O2 (Oxidation) (O2 )ﻋﺪو
KMNO4 phosphate
↑↑ 4)D&D
49
ﺑﺎﻟﺘﺮﺗﻴﺐStages
IRON
C/P:
Intestinal (GIT) plasma loss
I ↑Capillary permeability ↓O2, ↓BP
CNS CVS
R Recovery (unkown reason Cellular hypovolemic
Hypoxia shock
Convulsions Tachycardia
Tachypnea
O ↓O2, ↓BP C.V.S
N Necrosis of liver
Diagnosis:-
+ X-ray
F.D: 200mg/kg
F.P: 1d
1w liver failure
Actions:
1)Local
2)Remote
3) Capillary permeability
50
C.of poisoning:- Mainly children
Acc Therapeutic (predisposed)
Suic √√
Homicidal XX
P.M.P:-
SUS 1)Ulcers
+ 2)Tablets
SES
+
B 3)Brain
+
P
+
P.M.P 4)Resist putrefaction
+
C/P 5)Liver (necrosis)
TTT:- Shock
1)S & S Liver
2)ECG
4)D & D √√
51
Chronic Iron Toxicity
Liver
+Brown
(Site of injection)
(As carbolic a.
But without IODINE
Gastic lavage)
F.d 2gm
52
Action:-
1)Local:- Corrosive (Coagulative necrosis)
Stomach Skin
2)Remote Renal failure
C/P:-
N V Brownish
+ corrosions
1)Local:- GIT C D
D&S
P.M.P:-
Sus 1)Ulcers
+ 2)Eschars
Ses 3)Renal failure
+ 4)Respiratory Failure
B
+
P
+
P.M.P
+
C/p
53
TTT:-
Shock
1)S& S RF
RF
Allergy (Cortisone + Anti histaminics )
3)L.A Demulcent
4)D & D √√
5)Physiological Antidote
54
Cytochrome oxidase - Na-nitro prusside
5Cs Coma Volatile ttt of HTN
B) ﺻﻨﺎﻋﺔ Cameras
Graphic arts
Metallurgy
Kinetics:
Smell: (bitter almond oil)
D.D: CN
Red Asphyxia CO
Cold
C. of Poisoning:
child
Acc. workers
Suic. Spies
Lab. workers
Homic. X (smell)
Execution USA
F.D.:
- Acid & drop.
- Salt 300 mg.
F.P.: 1 min
55
Action:
1) Cytochrome oxidaze enz.
Anoxia (Hisotoxic)
Asphyxia (Red)
Acidosis (Anaerobic)
2) Corrosives ( GIT)
C/P:
1) Large dose death
2) Small dose
56
P.M.P:
1) Smell.
2) Ulcers (slats).
3) Brain oedema &congestion.
4) Int. & Ext. signs of Asphyxia ( Except blue Æ Red)
Physiological Antidote
NT Kelo CT
Nitrite thiosulfate cyanor cobalamine
thiosulphate
1) NT Nitrite thiosulfate
c c Na Nitrite
a- Oxy Hb Met Hb
Amyl (inhalation)
+ Cyanide
b- Met Hb Cyanomet Hb
Cytochrome-oxidase
57
2) Dicobalt EDTA Kelacyanor
3) C T thiosulfate
oH
(cobalamine)
a- Vit B12a + Cyanide cytochrome Æ Vit B12 + Free Enzyme
Oxidaze (Cyanocobalamine)
Na thiosulfate
b- Vit B12 Vit B12a (Reduced)
58
Methanol MICC
(Wood alcohol)
Because it’s derived from wood
denaturated
Uses:
• In factories.
• Unfit for drinking
Kinetics:
• Absorb. GIT 5%
Lung 5%
Skin
• Distribution: organs with H2O content + Optic nerve
Alcohol Alcohol
Methanol formaldehyde formic acid
dehydrogenase dehydrogenase folic
more dengerous acid
than methanol
CO2 + H2O
59
F.D. 100 ml Æ death
15 ml Æ blindness
Action:
Methanol formaldehyde formic acid
C/P:
M Mydriasis
Metabolic acidosis (kaussmal respiration ) ﺟﻌﺎﻧﺔ ﻟﻠﻬﻮا
ﻗﺪام
I Intestinal n c ورا hge pancreatitis
Vd
C Convulsions
P.M.P:
1) Smell
2) Brain
3) Asphyxia
4) Optic n. Atrophy
5) Pancreatitis
pipe stem atrphy
TTT:
Phys. Antidote Æ Ethanol Æ compete with methanol
Dose ½ ml/kg 2hr 2days
Better : folic acid ( leucovorin Ca)
60
Ethanol EICC
EICC
D.D: Atropine
Diagnosis: Breath Analyzer or Drunkometer
C. of poisoning:
Children
▪ Accidental Workers
Addicts
Therapeutic
▪ Homicidal Expensive
Characteristic smell
Famous Rape
Robbery
F.D: 800 ml
F.P: 10 hrs.
61
Action:
Local Systemic
Skin cooling ﻳﻨﻴﻢ CNS
M.M irritation ﻳﻔﺘﺢ اﻟﺸﻬﻴﺔ secretion of
** Toxic dose** GIT
1- CNS depression ﻳﺪر اﻟﺒﻮل ADH
2- Acidosis ﻳﺪﻓﻰ cut. blood flow
3- NO Eye Manifestations ↓temp ↑sweat
V.D evaporation
C/P:
S&S
1- ◊ Feel happy (Euphoria).
◊ Fool behaviour (sexual crimes).
◊ Feeble reaction time.
3- ◊ Convulsion ◊ Hypoglycemia
◊ Conjugate eye deviation ◊ Hypothermia
62
PMP:
1- Smell.
2- Stomach congestion & irritation.
3- Brain oedema & congestion.
4- Int. & ext. signs of asphyxia.
5- Hypostasis blue
Flushed
TTT:
•Care of respiration
•ECG
•NaHCO3 (acidosis)
•D&D
•Vit. B6 (pyridoxine)
+ Alcohol metabolism
I.V NaHCO3 for Acidosis.
**** BICARBONATE
Brain edema
Bl.Glucose Glucose or Mannitol “Osmotic Agent”
63
Kerosene
Condition of poisoning:
Accidental Children
Workers
Suicidal – ♀
Homicidal
F.D: 20 ml
64
PMP:
• Smell
• Stomach congestion
• Brain edema
• Int. & ext. signs of asphyxia
• Lung consolidated patches
TTT:
• Care of respiration S&S
• Antibiotic after culture & sensitivity ECG
• No emesis LA
• Cuffed endotracheal D&D
• Charcoal Phys.Antidote
• D&D
• No physiological antidote
65
Toxic gases
Carbon monoxide
• Source : C + O → CO
1)Charcoal
2)Car fumes
3)Coal mines
4)Cigarettes
5)Fire
CO CN Cold
-Dilution test
-kunkels test
• C.of poisoning :
Ocupp.
-ACC. Children
adult
-Suic.
-Homi. Rare
66
• F.D. : 0.1 % in air → 50 % CoHb
• F.P. : 2 hrs.
• Action :
1)Co + Hb (300)
Red Asphyxia
Anaemic Anoxia
• C.P. :
0-10 %
20 % Two systems • CNSÆ headache
• CVS Æ Dyspnea(severe excercise )
30 % Three Systems • CNS Æ throbbing headache
• CVS Æ Dyspnea (more)
• Muscles >>> weakness
40 % Four systems • CNSÆ more &more
Fail to escape • CVSÆ dyspnea
• Muscles Æ incoordination
• GITÆ vomiting
50 % Flaring of • Shock
symptoms +
70 % Starting death • Convultions/coma/cheynestokes
resp.
>70 % Immediate death
67
• Complications :
Brain
Heart Affected
Kidney Necrosis
Liver Degeneration
Muscles
• Pm. Pic. :
1) Bed Rest
↓ O2 to ms.
2) Blanket
3- hyper baric O2
4) BL. Transfusion
6) Helthion
688
Carbon Dioxide Æ small dose Æ ↑ RC
69
2- Kinetics:
-Parathion Æ Paroxone ( Toxic).
-Smell Æ Garlic رﻳﺤﺔ اﻟﺜﻮم
3- D.D.
3 C
4- C. of poisons: Children
Acc Workers
Feed
Suicidal √
Homicidal X (Garlic smell)
5- F.P.: Parathion
Pair hours
70
7- Action:
Choline Choline
Ach O.P
Circulation
8- C/P:
1. Central: :
Broncho spasm
Bowel
Bladder
71
1. Central asphyxia.
2. Peripheral asphyxia.
3. Bronchospasm & Secretion of bronchi
( Mascarinic).
10- Diagnosis:
1. ﺑﻮل P.N.P. ( Para nitro phenol)
2. دم Choline estrase < 30%
72
12- TTT:
0. Prophylactic Clean
Clothes
Containers
Cholinesterase (Period examination of level in blood)
1. Care of respiration √
2. ECG√√√
O.P O.P
73
1. Phosphorylation ? Æ No
2. Prolonged action? Æ No (Because it’s reversible)
1. CNS +CVS
2. Cholemia + Uremia Chlorinated hydrocarbons
3. Cancer + Cutaneous inflammation
O.C (organo-choline)
Action C/P
1. CNS: then √
74
P.M.P
1) Asphyxia S U S
(External & internal signs) +
2) Brain edema S E S
+
3) Liver √B
+
4) Kidney √P
√P
√ C/P
TTT:
Resp
CNS
1) Case of CVS
Liver
Kidney
2) ECG
3) L.A
4) D & D
75
Synthetic Drugs
Aspirin
- Uses:
1) Analgesic
3) Anti-inflammatory Cortisone
- Diagnosis
X-ray (Aspirin cake)
- F.D. 1 day
Conditions of poisoning
Child
Mainly ACC Therapeutic
Hypersensitivity
76
Action C/P
1) GIT N C Ulcers
V D Bleeding
2) (-) Platelet aggregation - Bleeding
(-) Prothrombin synthesis
3) Allergy - Rash & urticaria
4) R.F - √√
5) Ear - Tinnitus / vertigo
6) CNS : - √√
7) Acid-base balance 1) Resp. hyperventilation
Respiratory alkalosis
(central action)
2) PH Neutral
(Kidney)
3) Metabolic acidosis Kidney
Kid of
Salicylic
Acid
X Kreb's
cycle
77
P.M.P:
SUS
1) Ulcers +
SES
2)Tablets +
3) Brain edema B
+
4)Internal & External P
Signs of asphyxia
+ +
Pulmonary edema P
Ttt:
1) Case of Kidney
Respiratory
Acidosis NaHco3
Allergy Antihistaminic
Bleeding Vit. K &
Blood
Transfusion
2) ECG
3) L.A NaHco3
4) D & D Forced alkaline diuresis
(Done to anything that causes acidosis)
5) Physiological antidote No!!
78
PARACETAMOL
N-Acetyl Cysteine
Physiologic antidote
N A C
II Ache III
I- Nausea in urine
ARF
Central
lobular
Necrosis
1) Source synthetic (Aniline)
2) F.d 10/10gm
Therapeutic
4) C.of poisoning Acc Child
Suic Rare
SH sulphate glucouronide
Toxic (NAPQI)
When there’s absence of SH
SH
Glutathione Centri-Lobular Necrosis
79
Action C/P
1)GIT I- n c
V d
P.M.P
SUS
1)Congestion (intestinal ulcer) +
2)Tablets SeS
+
3)Brain edema √B
+
4)liver (centri-lobular necrosis) X P
+
5)Kidney failure XP
+
√ C/p
80
Treatment:
liver
1)S&S care for Kidney
CNS
2)E.C.G √√√
3)L.A Charcoal
4)D& D √
3 letters 3days
NAC
1) Dose 140mg/kg loading dose 7hrs
For 3 days 70mg/kg/4hrs 14hrs
. centrilobular necrosis)
81
BARBITURATES
G A B A
ARF
1)Source:- Barbiturates
3)Types:
Long sleep
1)Long-acting (6-12hrs) Luminal (Phenobarbiton)
Lower elect.impulses (epileptic)
82
Action C/P
1)CNS ↓↓ Coma, Cyanosis, Central asphyxia
*Shock
*Muscle hypotonia
*Dilated reactive
pupil
- VMC
2)CVS ↓ - Myocardium ↓BP, ↓Pulse :- Arrest
-Vascular ms tone
3)Lung Hypostatic pneumonia
4)Skin Bullous
6)ARF √√ √
Cause of death:
G A B A
83
P.M.P:
SUS
1-Tablets +
2-Brain SeS
Oedema +
&congestion B
3-Asphyxia +
4-Pnumonia +
5-Kideny P.M
+
6-Blisters C/P
Treatment:-
Respiratory
1) S & S CVS
Bronchopneumonia (Antibiotics)
Renal
2)ECG √√ √
3)L.A Charcoal
NaHCo3
5)Physiological antidote X
82
Adrenaline
AMPHETAMINE
Alkaline
Forced acidic dieresis
2)Uses
a)Anorexia Anorexient
b)Dexidrine Depression
e)Hyperkinesis (ADHD)
C. of poisoning: Therapeutic
1)Accid Child
Addicts
2)Suic
Actions :
↑ CNS ↓ MAO I.
C/P :
1)CNS ↑↑↑
2)CVS ↑↑↑
3)Resp. ↑↑↑
85
Cause of death :
1)Resp. failure
P.M.P :
1) Tablets SUS
(site of inj) +
P.M + C/P
TTT:
1)S&S Resp.
Shock
2)ECG √√
3)L.A Charcoal
86
C. of Poisoning :
2)Glutathamide Child
3)meprobamate
5)Phenothiazine
TTT.:
1)TCA 1)S&S
2)Glutathamide 2)ECG
3)meprobamate 3)L.A
-Physostigmine Anti-cholienergic
TCA Glutathamide
87
CNS ↓↓ CVS ↓↓ Allergic Anticholinergic Extra pyramidal
(A & B) (A & G)
All cause ↓ All cause Rash e.g atropine Neck rigidity &
except TCA Arrythmia & Articaria (dry mouth, dry skin, tremors
cause CV↓↓ DF pupil, urine Parkinsonism
stimulation except TCA constipation.
then meprobimate Benzodiazepine Phenothiazine
depression have no TCA
arrhythmia Glutathamide
but cause
pulmonary
edmema
88
Addiction
Opium
5- C / P :
89
6- TTT:
1) اﻷهﻞ Æ Admit Addiction + Hospitalization (High secrecy)
3) اﻟﻨﻔﺴـــﻴﺔÆ Rehabilitation
A-Codiene B-Methadone
SC Mouth
M 30 mg 1 mg = 2 mg Heroin
= 4 mg Morphine
m 10 mg Tranquillizer
in Case
Dose : 1/3 : 1/10 :
m + C 10 mg + of
1/20
Convulsions
C 10 mg Then STOP
90
Alcohol
C / P:
1-Physical أﺻﻔﺮ+ أﺣﻤﺮ 2-Mental 3-Withdrawal 4-Nervous (3P)
‐Delusions of jealousy
-Pachymeningitis
( sexual desire +
N.B: Hagica
sexual potency )
Feotal Alcohol
Syndrome Chronic
-Delerium tremens
هﻼوس ﺑﺼﺮﻳﺔ Subdural He
(terrifying)
Tremors -Pain in Muscles
-Wernicks
Encephalopathy اﻟﻤﻬﺰوز
-Ataxia
-Nystagmus
-Tremors
91
TTT:
1- اﻻهــــــﻞ
2- اﻟﻤﻤﺮﺿــﺔ
3- اﻟﻨﻔﺴﻴـــﺔ
4- اﻟﺴﻤـــﻮمÆ A + P
1) Antabuse (Disulfiram) 3) Promazine
+ Diazepam
2 gm ( If Convulsions)
1 ½ gm
1 gm
½ gm Æ Year
Alcohol Acetaldehyde
(Acetaldehyde + Antabuse)
2) Temposil
92
Barbiturates
ﺑﻄﺊ وﻣﻬﺰوز
2-C / P:
-Drowsiness
3- TTT:
1) اﻷهـــﻞ
2) اﻟﻤﻤﺮﺿــﺔ
3) اﻟﻨﻔﺴﻴــﺔ
0.5 gm (1 × 2)
ﻳﺨﻠﺺ ﻋﻼﺟﻪ
0.1 gm (1 × 2) after 3 weeks
93
Cocaine
1-C / P:
VC
Adulterations
ﻣﻐﺸﻮش
-Needle pricks
2-TTT:
1) اﻷهـــﻞ
2) اﻟﻤﻤﺮﺿــﺔ
3) اﻟﻨﻔﺴﻴــﺔ
94
Amphetamine
2-TTT:
Syptomatic
(Antipsychotic, Antidepressant ,,,)
95
Animal Poisoning
Snake
Scorpion
Snake
Cobra (CNS) Horned
TTT:
1) A + B
2) S. + S.
VC Suck
Solid ice
Anaesthesia ineffective
3) H2O + KM2O4
96
4) Specific antidote + Supportive
Mono Poly
-Resp. –Bl.Transfusion
-Renal
97
Food poisoning
Atropa-belladonna
2)Food Allergy
3)Contaminated Food
Preservatives
BOTULISM
- Prevent ach.
Cl. Botulinium
Exotoxin A B C D E F G
98
Actions:
- Ach.
C/P:
10 (vagus) → dysphonia
12 (hypogloss.) → dysarthria
1 2 3 4
F.P.=1DAY antitoxin
99
TTT. :
3)L.A. Charcoal
100