Clinical J¥L.Acknowledgment Parfection ic arly for GOD, What we do is to fallow HS steps & try to prae HS cane i our Gives, Tavicolagy is beaatifal but difficalt/// So we tried to sinphfy it ie the form of tables to be vasior for study, These tables are the fruit of comoporations of Dr. Didi & De. Dandan who did extra-ordwary effort ie uniting these tables on the compater, Alco au cioabd bike to thak De, Sara for her great hardnade tables that were the light that led as in the dark road of toxicology, Fivally we hepe that you fired these notes valuable & worth readig. Please pray for as. Bala6y.orgBarbnarater Benzodiazepine Weprobamave Teer Manscione T Seaeaves 1 Minor Trangulfzer (anéoryse) T, Rypnotcs (xcept thiopental 2. Anxialyties (Minor tranquilizer) 2. Muscle relaxant 2. Antepilepsic [phenobarbital 2 Hypnotee 3, auction of aneshes's (thiopental 4. Musce relaxants Mined with other madicstons 5 Andepileptc 1, Sympathatorimetce(Antcold) 68 Anesthetics 2. Theaphyline (Antasthmati) 2, ErgotominelAntimisraine) 4, Bhenytoin Antepilaptie synergistic etext) 5. Antispasmodies & Antiyretis Mataboliem | tong acting > minimally metsbolzcd aver & oarered > Upophitc> sbsarpuon Te unchanged a utine larger urasen of action. delayed (peak 4-5 hours} Short ating > hiehiymetabalze in Iver & only + Ferms coneretion in stomach > metabolites wil appear fn urine further delaying itsabsorption Pathophysiology + 5 bind to GABA, eceptarianopharecanplex > | Trevacton GAGA, recaptas) redure | © Fuctuosions ct absorption > Increase duration of cpening atc channels> potential ference across cellmembrane | fuctuatons of nicl pietre potentiate & prolong the inhibitory action of GABA | block el ability te conduct nerve + Acton pert for several days Innibiten af neurana! dapcarizaton. Irmpulses + Direct GABA mimetic effect Asa rasult of theve nwo mechanians E, Sedation & hypnosis 2. Anesthesia 83, Dspresion ot brain stern center 3) RCD RD b]_VMc > hypotension Mode oftoraity_| 7 Overdose by dspandant subject 7 Overdose 2, Suicide 2 sucide 2. Accidental sin children o BB automatin 3. Accidental eldarty with ow Onset 315 mia in shortacting B12 hoursialong seting | tolerance ta CNS depresssnts 45. Criminal ro facitate ronbery& pe “Cinical Pickus TE Pree cus + Confusion, dutred speech ataxia & memory iswroances + Decrensed deep tendon reflexes Git > cecrossed bowel sounds ‘Acoma Maier sien) 1 Geadingiscorrelated with blood evel of 88 ‘Confusion, slurred mecch, atone & = Nysagrnus & postural hypo + Depression + Hotty & aggressive behovior + Paranaidresctlons Depressen as 5 Hallucinations & canfuslon on swskering ‘small sosse-> hypotension ve + Lange doses > eardlogenie shock with cardiogenic pulmonary Bala6y.org‘HLespiiaion Deprenion ‘= Inleacstohypoventiation & Asnes © maybe ofrepid onset (1/2 hour) > fatalif the potentiate in reaching the howita. ‘Litypotension = Especially with short acting B81 Reversible unless compilated by shock due to protonged hypcsie or delayed CPR) iio ‘AlMendelon’s androme Deeply comatose patients > snontaneous vomiting regurgitation of acsicgasiriccontentintolungs > sve destruction of slvealar membranes Irleads to ARDS & NCPE 1 Rhabgomvolyaie © lnchemve ysis of compressed muscles & overlying skin in deep prolonged coma, ‘CLutensous Baters * Bulls Found on hands, buttocks & knees D1 Respiratory Arrest [8162051 hyponie encephalopathy > irravesble brain damage death 1Benalinsutfidency + Due torenal hypoperfusion (rypotension, severe dehydration or shock) + 85lare not nephrotoxic ‘A} Com 1 Respiratory Depression Hypotension D] Hypothermia E]Hypotonia ‘edema Sisto dapresrion oh ‘yocardalcontraclty + Arrhythmias le Same as 88» cardiogenic shock B arrhythmias Investigations ARG (hype, metabo eae ‘BL dectrovtes & glucose ‘Lgenalprafle@UN, creatinine) ‘DL Serum barbiturate concentrations + Todetermine vestments ffcacy + Ges chromatogrophy o- immunoessay + For phenoberbital LUtine dug sereen * Thin layer chromatography + To.detect poisoning by other drugs Bala6y.orgTreatment {A} Emesie > patients conscious & wal signs are stable Bl Lavage + E17 erento delayed lovage con be done a3 des ClAetivated Charcoal > almovsh MOSS cacy of adsor enelitin £6 hours but eluggieh bows! movernents & gastric emptying on but may be more harmful especially A} Emesie win yup ipecse Bi Lavage ‘Con be repeated several nes Fumazenf 1-2mg lV slowly under ‘monitoring over the frst few days esecially it gome 1s prolonged or erica! picture is uctuating Lactivated Charcoal > M0 more bencfici $8204 camaisraversedin | AlHemoperfusion (ipohile dru) minutes 3] Hemodialysis less fezive FAD 1D Teemofitration 2, opiclone intoxication > RD ey + tiohiomiatas |" 3. Pulmedema (WW Rulds NaHCO) stecive tan reversed ‘care cl come 3] 1V Fluid for hypotension Clinetroples (Oepsmine & Dobutamine) fr earcogenic shock expecially with high VP Bala6y.org“anipyehation ] Antdepremants(TEA) | S38 Thm Fhenvain Garbamanepine (wesroleptie {Dipheny! regetal dane) Mambers | Fen iferenicises J antipyine 1 Fooremne rs 1. Feces Depron Thee mane Fomanaan) | Frapaied ona 2 Sedat 2 enweas, Zane depresive 2 Stauseateptcas | 2 Phanngealewape 5. orueintaced eerer tatariytnnc | 3 arma fewepe Saatcnatons sso grin hatin se sheen cet] nde hen is Mode offonely [1 aera Tn cy I en |) Seas |e a 4. Dopamine Rs (Limbic system, | As antipsychotics but © Delayed tissue © som metobohzed proteins 186, hypothalamus) BeDas blockade, setae ar ¢ Hepatic metabolism: 2 aphons Gmimiocteater | + teveynarow | 1 Mepmemetivte 5 Mean por mage ace Shree aerate 2 tocreared capiry = efecttne ort | ne troll Deect myocar Inacio eerie section > deceased { Doprestonatemiatvaa |” dren + Kaew Gitmestiy ‘hee \quniane seen = Veoneretont + Deect myocardial charms 4 ldnaphonelac Ui 1+ Strong enterohepatie deprenion P1sinidine ation * impaired conduction charinythmia(v 8S) piece’ ¢ Widening ef 085 complex ecvscoxery of fherapevticuse& ofter Sessile, NSH or both Gr reabaerbedin Dehydration, HE RED duete Dluretiea > de 1 Nadesleton water reabseration > reduce aM rate of ring of + tevetion of HY decrees tumover of casa Bala6y.orgEe — a es Sieaerapyramidal 1 Follewedby browdnem; | ‘sinsiaa © (Gara aia Tin ioameunes Sontusa tama. | "nner Pom alerssiminten |" >oraverda «Hypothermia “antipsychotics plas: + Convulsions, 4] Hyperglycemia due | degree er even 2 omer ey eco cs woot comin | uecaa’ | 2am ‘Condon stnemalie Seco chenees | geen | Serine 3 Aas tamu puma oe ' ——— attaoudbeohe “Comeruan aston | arent The previous Preonegea sce, |lowermasence ot 1 Moyen EEE, 9 weemed tert ® myoehinata Grrontetonety | Sposa heats Tigtaman ae inne a Bcroceincrisi Maen | arwaneya sted S-cingivelhyprpisin Bala6y.orgTaka paaeeT (disturbed vain Teaeepenia 5-H slevtion of er raymes but foal oie aie ferme |e. Con sonurion Seren stapes om as a Terepaehats | FRE a = a E Sat «| Beam. | Maes | ase Sa +. nestectns | _sesopae = Enercaey Mose oe << homamoon | «mone SE» occ eects ec * infusion of absorption) ko Sams > penyon, | sna secre ai Claw denn uieaea shove ed iturin >| trees Per txty Shoes [Shea teeters Titearontematennt | tnense oc ceck Scivener arena |aiecmen Se A Aloevesei nore: [esters non [dopamine goes) ool the | Ne ovoid plyzosigming potent ® dazesam verapamil proernatl in Wo Sow dicbuton of Bala6y.orgaphihatene| ‘Coumarine|[Warlatn) ‘Suayehnine Tine phosphide Toes 5 Mom repelent TRosenseiss T fesertide Rodentide 2 Tolet bowel deodrzers 2 aohros 2 haves. Soares coal ar Hard seeds of Seychnes Ni NB now contains gaa: orice (contin obi tirotenzene (eas ti Pathophysiology [+ tsreisecltsalphe + Desrass hepatic wntheaisof |» lracsby blocking the | » Onis vontectwith water ar dius sede napithoquinone cuse RBCs | vitamin Kdependantclotng | glycine receptors {i stamach) 9 phosphine ga erated hamalysis sy acre sean | factors (2072) enseily sompativay. «+ Phoephine gsinhibitseytochrome cndnive agent. prothrrn et + Giycineiss postanaptic. | oxidase erayne > [of serie « Racecantmeet demand | Increase permesbittyet al |” iohbrtory metabotm due tocaidatve deariaton | explain the body. reuotranariteri he | « Testeadst oblentory aneerble of e> nemoiyie + Aearendt widasprend | rain spinal cord smatabota > oct acdows cll sTisecaursinpasentswih |” inaral hemorrhage sSoanyaight sensory — | death Gero deiineyrapiy & simulation may induce ‘wth ematrdoves convalons, Mode oftoxey [Accidents in children PT Tsiceal 2 noniceal a] Route of ingestion {Reel sensinpton ingestion ingetion tom nha ofits vperincthes | connie ood sree dy al ‘orblankets by infants, 2 Ingestion of a very large amount 3S entanination, ‘trader bat ines pure | cir NV pan increase protivarbin te 2S dahon =) > headache, restesaess& convulions + (1 fthoray& coma {ony ce) 2opte neue “atemetyts > hemohtic nema & hematria SHepatocalala inary 25 dors postingeston Hacmoglobinura > olguria 3 anvria ever > fusing 8 Hemoltic anemia ofthe rnawborn taken ding 48 hourslendng to 1-Fechymess 2 picts S-cirgival bleeding “Hematemes S-Hematuria Nv {Stfinesr offal mus (tlemus& Rist sardenius) 2-Arcned back opisthotonus) 2:-Convulsions ofall muscles of the body inciudrs ‘PPostictal depression (ine patientisexnausted & stoops ater convulsion) 2Aactie cides, 2 Hyperthermia. ‘Tachycardia & hypertension S-Rhabdomvolsis 1 GlTssevere V &D (garlic odor & Fuarescent)> dehydration within ins. + CNS lethogy, restlessness italy lest symptoms) 1+ Metabolic ackosis with respiatory compensation + Toxic cardiomyopathy wit frequent arrhythmias > shock out of prozertion tothe fui os. ‘Inhalation of tues > dyepnaa & cough = Risk of death [rom OV compliestions or sebyaration) disap + may lat fw hrs only or may be absent (overlapoed by 1" & 3 phases) ar & the pationtis Bala6y.orgNB The cour of doathir resphratory fore uring “fight ypachondiel pin, 2-Enirges tender Iver, jaundice NB Elcwated prothrombin ne & bina fare mare confident prognostic markers or development of hve cel fours encephalopathy & coma 9] Renal tubular damage > onuria, Tevestigations | 1-C8C (ar hemalys eT 1 ECG ding the 1" 48 hours even the P-verfunetons. * Detectable reduction in 24 patient sppears normel $-Kidney functions 48hrs 2. ABG ,elecvalytes glucose + Maximum in 36 7208 2 Kidney function tos (cretiins) * ersiaing for 1-3 weeks 4 Liver function test (PT & blrubin 2ewcsilv, level 3-H & hematoert every hoursif Pris very prolonged to detect hidden being Urine fo nematurs Tenet | Ta | a + AED + Slo transfusion it svere Ty innalaben > remove fo ech air Biigate eye with copious water if afecta, 2, logsesion = acsem\ig ATITT af hemolysis + Blood trensusion + Cortcortercis (apport wal of blood w DB] Liver suppor [NB W okaline fd may be Considered the gotidote Leetimination mess cr GL flowed by AC oe ‘Al Unknown smountot peo © Orally (n0 rae or pacien) + Adult > 15-25 mg + <12 years > 510mg lage amounts or PT >2 Himesnoimal NZ) +M + Adulte > S10me + <12 years > 15 me litblesding, * Infusion (ropsatin 24 brit stil blessing) + Adults > 20mg = <12 yeors > Se GURAC aeration conte) ot convulsions. 2-059 pauentin quiet dark » Anticonvulsant <. Anesthesia with mechanical ventilation. <:cold compresses & fan for hyperthermia nto! thabdomyolyse *= Good hydration ‘Using alklination + Contra of hyperkoineria (NaHCO, Gluccee/inaun cor) + luretice nen loos volumeisexpanded Blrasfusion rsh eran plana TAR 1 severe dehyésation 3 MV fuids — daeesaiot ermine Walsnan erro + Bole dene sthorverat Rant af inoncoytosaeos tbeson eosin on nace cicrote art aye Sars. Powopt for tone voccis wie Sock anor foci ra burn rosherd senoya Bala6y.orgaT a Read ra FoeetiOUN| ser wie ene oa nn arate wes Gamo, mar &vemnoub > Paboph ear exe *Ethandl is dose dependant CHS depressant + ieaffacts () & (+) peurowrarsmiters as dopamine & secoroni. + Effect on crtenrasches speak while blood + Inlerger quantiles > {) of medullary RC RE & respiratory acidosis + lsmetabalism affects NAD/ NADH ratio hypoglycemia (decrossec! NAD} and metabolic lacie aedosi (blocking of Conversion of ncic acid toglocore) + VDincreasescutsneousbiood How with impaired cantral thermal autoregulation leads tohypothermia NB thy! akohol fs oxidized to geetoldehyde then to acetic ocd then to H.0 & CO: by alcohol dehydroaenase If this enzyme is inhibited (eg. by antabuse ehsufram,) “accumulation of intermediate products producing ther own effects + Well absorbea rom GI, evenly istibuted in whale body water including astric secretions + Metabolized inthe liver, arc excreted in the urine as toxicmetabaltes {Slowly matabalized inte iver By slechal ehyoogenase preferentially use sthano)) formaldehyde thon formle sad ethanol ent available ‘+ Metabolic aekosis suc 10 seeumulation| + Laetie acidosis due tention of ceytoehrome oidese > obligatory fonserobie metabolism + Laeslsesurnuaton lesdain CNS & opt herve leads © opte atrophy & central Low volatility & ow viscosty > aspiration A spread of theliqudin the lung down to terminal broneriles & sive 4+ Triswill causa destraction o ning ctant in the avea (eather than direct acne Bie) > weiner preumonit + Indirectly > seconcerytohypexia wii 1+ Severe arhythias (duet ether Sensitization ofthe hear 0 circulating catecholamines cr hypoxia) “> sudden death ce To Dustoiteiritant effect & fat solubty neurological sequel Bala6y.orglineal Pezure tiveness > becomes noisy 1] Conjunctival injection Clincreased appetite non addicts ‘Alcona Carsbal I deoressn: 9 Atana (Stapgerira galt Tremors — Surred spe + Slow respiration + Diplopia 3] Vomiting & hiecough, C)utaneous VO > flushing & sweating > fase si i a ‘Soars ONS depression 3 come with + Hypothermia + Mypotonia & Hyporeienia + Hypotension + leregularacdotic breathing oder th scala ease AJCNS depression (ssaventaton stiper & coma) > caused by mersbalic acide fccumuation of ferric aid in CSF 18] CWS stimulation > cor CLencephalopethy D] Delayed necrosis ofthe basal ganglia > spostcity & dyekinetic movements, ns eto) Al Cerdiogenie > custo 30 { byperkaloenis inoveed depression ot myocardial contract B] Vesoplegie > () 1c Zy to brain edema dus C]Hypovolemie > due to dabysatio NB symptoms eppearofter a latentporiod of 12:35 bys due to slow metabesism 4-Gherical pneumonitis with + Dyspnes & achypnes «Ronen de wheazen ‘-Bronchopr wii Pe escescal ET craaspsy SE ont area 2Sudaen enh Tern to broshopneumeni Seman Tnvestigations > (hypoetyeemia) Eectalytes (High anlon gap high ‘osmolarity gap, ketoseidors) TABGS clecwolvies 2- Random blood sigar (RBS), ures 3- Methanal blood level (200v2 25 m/e! indicate antidote & hernocalyss) 5-Fundus examination & VEP TABGe 2 £06 monitoring S-chest x-ray 4 Laboratory investigation of tone additives Balaby.orgTreatment ‘stupor & come may benef from Gt + Acisnt use = Avoid emesie cama due ta Wernicke'sencepholopathy + ABC separ foc enalsion # Contra acidosis (fp H<7.15) & hhyperkalaas by slow infusion of 1V bicarbonate + Staroids(cerly for opt neurtls late for srebralecerna) (Geovic lavage n fet ze ours AY Ethy alcohol g/g followed by 2.5marka/# hours to meintsin blood thancl 100ma/él 1] 4-Methy1 Pyrazole Both compete with methanol jor alohe! ddebydrogenase enzyme excretion of ‘methanol as patent compound. Folin aid helps ondatiano sccumulatad Frrnates inseatea + Methanol level > 25-90 mg/l + Aegrossive acidosis refractory to tt + recitation of renal failure No emesis or GL fe fear of aspiration. # Observation & fellow up. Severe cases showire ONS manifestations, systemic manifestations cr combination with Insecticides A Geral expose * Remove contaminate slotne 1 Wash kin with water and sop. 8] Oeslor expoare = Irigation with ste eline or with tap CLingestion + In sovera cases (more than 2 ml/kg dangerous addlives > Gt efter introduction of cued endotracheal tube to prevent aspiration cis no efieeive & may dehorry ‘Al Comticostaroids fr chemical pneumonitis, Dinteaton By Antibiotics it hacterial pneumonia Bala6y.orgemergencies specilly in dren > Accidental in ciliren * Irie common becouse available at home, presontin attractive colored gar coated reparations + Scverty deperds upon amount of ‘slementa iron ingested, + Amountiegasted = Naf tablets x percentage of elemental Fin salt aaa aaa Tropes | = Roccrsh eric € noone rs caer pra oe Sere] ce BE «ce ron onc poesorsonegntance | Dever orayer gs bermemeas eS = ros core ner tores rd ehyrvororemta Uhre toe rpatme by citen + Toy only aerial roxy nasotcrtaesedacseh aavesesinciien |” wren aslanes wary ebred, icon asd TN | «ses cer once Srerireritaacasurstertsrcet | © tact tranny apie Se te weree esas Sreoecnteercemenerce 2 Step met werary puters unt fod arantrg narnia ih SSE SRE Geers ip oe rare 7 a a aT aaa ‘rw igand with SH group isa target ayanemia * More in children + Uncommon in inorganic aod poisoning “Defective Hb syminesie Aystancton > F) eholine acety! transferase enzyme ch deficiency > SfS.of motoe dstunetion 2. lmmune mechanisn-> Membranous GN, aerodynia ee Sareeinenciomericenenne VGcen ee isertethonialtonn > isuonceinenety meabotim ne sem tock on orn predng |. () conversion of BALA to porphobiinogen 6. (conversion of eoproporphysingen Ill > protoporphyrin, ©. ()incerpecaton o Fe into protoperphyrin 2 for NB ‘+ DALA end Coproporphyrn accurulste im urine > used 2s text markers © Proxoporphyrin accurate in RBC chelates ine + Enthroorte protoporphyrin) reflect chronic led exposure 2 Increased RBC frailty + nterereswith Na-K ATPate pump + attace RBC membrane a Exythopoietn deficiency = Due to toni effects on renal tubules heme Bala6y.org18} Barophili stippling of RBC * Due to ably RBC togatria cf RNA degradation products flowed by aggregation of ribotomes 1 Retieuleeyeos AA] Aosta toxtety > direct tubular damage (Fanconi 1B] Chronic toxilty“>ohone interstitial nephritis (LAltersrennin-anglotensin system hypertension D] Alters uric acid excretion > Iyperuicoemia nd gout a | A] Direct aflect on CHS * Lead encepholopathy (oecalychiléren) * Delayed or reversed development + Dermanentlescring sister 1B Developing brain isthe most rky organ tobe offected 8] DALA is neurotoxic interfore with G chronic teed exposure + ects perigheral nervesimotor)-> wrist ond foot drops [A] Crosses tha placenta > abortion, si bh, neuro-developmental problems BLL sperm count & numberof abnormal sperms paren syndrome) sesalyin dren cn metaphysial and growth plate densities NB Closes Lead Lines on radiographs elect hone growth arest not deposition their wid i ‘elated 10 duration of expozu 3] [-) eanversin of vitamin D into the active form ‘Ginicl Picture of acute toncty cares Tiina a 1 pens rom acdrtl or ulealingetin of ws cv SAY thenstemess > dehyeraton, a Seen «Severe ramps, uring sensation & ccmansun mest rionin salva > stomatitis, -ingits & inereased salvation + Exceahalopathy, suet SI AlGIT eration ‘+ NVD &GIT Bleeding [may be sa shock + Abdominal pain + Necross may be savere > perforation and Pertonitis B]NS depression fn scvere cases) Bala6y.org« Hamatura, caste eee taeered ST torer nthe blood ceuetonery | asco mc + Ivrfernce with Rebs led LS || oes emesis c GU gee mens GL 1 Shock & ln aidot Eh fever and eucooytone See irate Penclamine BAL Avr ata Dus olmvanon of damaged testinal SS | oe cs Devyraton 3 NV fide sDehysraton > W fds citepati neces {Lande ce laconata {rent fare hemes ‘iver celflure> junc, hypaalcenia 1 encephloosthy Dear of coma, convulsions | © Mouth hygene tccideton slat 3 Mannie radeon cr Renal fare SiNen spatter verve Dodyashen anctns, | GIT Sscading ttatitonSinng cory or "= Recurrent stomatil, palm (ft BGLin soft tissue blue line onthe gums preotatesiond |” sivoton-ais f Coma and cs alps sulde duc to bocerl von + Rocurentverstr, SS & 2 Peripheral eure wrist and foot rope waentoss ternal searing wher witout ‘Nope neue ny ec 2.6rey neon gums sbarction Stas cogate deurbances headache, | Sree > tnt htnton encehalostncrer) tremors > intreue ent .Homtalglal ane, eticlceto al) ren hand fenelyie Mal corer flection > concn of Renal mpalrent vaults ‘tony aces se gouty artis s.Paycelogeal > Etiam ® ntyceri f shyes ear oss fel canidence + reborn Bret Renal fection > toxic oN Jleutaneusaffeaton > ders Ne Mode of eos is Insti > Inhalation of mercy mes Teatmentot | WProphyeate TT Prophet [os lead SAT Ghronletatty | + Decrease exposure: masts gloves EE + Pevosic medica! eeminstion of workers ASD Bala6y.orgCurative «Stop further exposure = Symptomatic Ancmia blood transfusion ena offection >hemodialysis Wrist ond oot drop - splint & physiotherapy 0} = Upld sluble cross Ba reply fst chelator used In encephalopathe individuals + Remove \Cand EC lead 1M only UW cause fa embatsn) ere = Alow EC [cas t2 6 renally eliminated + Not metabolized, few toe effects + Once started, should be given in full-day + 1" dove removes lead from ECF in bone, i not Followed by next doce" free lead wil redistribute > neurotoxicity + Inlexciencephalopathy > give BAL frst to avcidresisiution lead mabilized by NagEDTA YO = Eective orally, few acversecfects = Elective orl chelator = Oral form & water-based parenteral 077 + Antidote for most heavy metal intoxication Ty carative + Sg further ppoeure + Symptomatic ‘Renal afecton -Dhemodialysis + Chakstion > Pentailamine cr DMSA = Emer GL Pano ng nee Fe-deferoxamine complex in + Doesn't bind Fein Mb, avoalobin or other fe corrying proteins 1 Serum Fe > SOOhe/Al or existed dose > 6omg/ke of slemental Fe 2.shock 2.Altered mental status 4 Persistent GIT symptoms S.Metabolie acidosis 6.Serum Felevel nat available with presence of symptoms + Dialysis + Correction of acids Investigations TBlood level ct teed more than 30ug/lis abnormal E> more than SOyg/dlis senccrna 5-Urinary DALA, use os screening tst Renal functions Sve functions 6 Serum ure acid “kay on long bones to reves Jeod lines TORE 2 ecrralytes Renal function taste 7 Serum Fe INSBO-TOORe7A, >500j/d) Electrolytes Renal function ests BUN, creatinine Hepatie profile transaminase, bilrabin, coagulation profile X-ray abdomen to detect radiopaque shadows Bala6y.orgDigialie Bata Blockers Nitrates & Nites Theophyling Teer T Hypertension Tange Darina Di ertore “Management of migraine Source sn the most cersmonly sed eights Pathophysiology S inheart > Pintraealor ts + nskeletalns 9 extreaile > hyperalaems ‘+ Mayinereese iotropy in therapeu doses reston of efractrypeiod in AVN i Sodtam ntrat sed preven tector of meat ime PEKIN 2. Silver nitrate, used forts eausties and dontectant properties. Its aee soa fo burn toeduce infection, Sih concentrations cur maturly in spnach beet, carats and (abboge. The tds nites form after th substonce rdthen T Nkrogheern 2. userbie dinitrate (ord Distrate) a ‘muemucn erremly seed gearug of abuse ietreetname Mama Poopers) 2. Sodium nite se forthe teat 2. inbuty nities used at 0m dodorcer i ayay be abved by. math ebritrete contaminated ella may be converied By of crane sotoning 2.Nirates in contaminated water in the presence of Baan sbi spores in ded mile ponder or warsared to nies reparations aminophyiine fs Dayne of coMP > oronarie peripheral arteries, nd veins Leardine preload, tnd output 4 Compansatory fin pularate and sealer vareconsrition Auduecneuledeseancither Inotapy ner ehronowopy i= lected sian, bat her dose the myocardium is +b sdenylte clase ensyme 3 Venue ovesion of msccard Dusto Nipidsalabty> Nene eeneuationat dn Talat oT oeath (rainy bronchi muscles 4 Taerum etecholaminer 5: entra of lea 6. Parr secretions MeL and FVD escapees Bala6by.org3. 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