class no.

3
SYMPTOMS RELEVANT TO THE TOXICOLOGICAL
DIAGNOSIS

 HYPOTENSION  MYOSIS

 HYPERTENSION  MYDRIASIS

 BRADYCARDIA  HYPERTHERMIA

 TACHYCARDIA  HYPOTHERMIA

 DELIRIUM, PSYCHOSIS  NISTAGMUS

 COMA  OPHTHALMOPLEGIA

 CONVULSIONS  OPTIC NEURITIS

 RETINAL HEMORRHAGE
 SYMPTOMS RELEVANT TO THE TOXICOLOGICAL
DIAGNOSIS

 SKIN:
CYANOSIS
ERYTHEMA
DIAPHORESIS
ACNE
DRY SKIN

 TASTE AND SMELL IMPAIRMENT

 MUSCLE SYNDROMES - RHABDOMYOLYSIS
 PERIPHERAL NEUROPATHY
 HEPATIC TOXICITY / NEPHROTOXICITY
 PULMONARY SYNDROMES
 HYPOTENSION

 TISSUE HYPOPERFUSION

CONSCIOUSNESS DEPRESSION

PERIPHERAL VASOCONSTRICTION
METABOLIC ACIDOSIS
OLIGURIA

 HYPOPERFUSION MECHANISM
↓ PRELOAD: NITRITES, NITRATES
HYPOVOLEMIA: HEAVY METALS, COLCHICINE, MUSHROOMS
↑ AFTERLOAD: COCAINE, AMPHETAMINE
↓ MYOCARDIAL CONTRACTILITY: CLONIDINE, BARBITURATES,
HYPNOTICS, NARCOTICS, TRICYCLIC ANTIDEPRESSANTS
 60/min
↑↓ CARDIAC FREQUENCY CARDIAC OUTPUT↓

150/min

CONDUCTION DISORDERS:
CO, CN, H2S
TRICYCLIC ANTIDEPRESSANTS, PHENOTHIAZINE
β-BLOCKERS, CALCIUM BLOCKERS
As, P, OP, CARBAMATES,
COCAINE, THEOPHYLLINE
DIGITALIS
 TOXIC NEUROPATHIES
 SENSITIVE NEUROPATHY
ETHIONAMIDE

 PARESTHESIA
STREPTOMICIN
NALIDIXIC ACID
 MIXT NEUROPATHY (S-M)
ISONIAZID

ETHAMBUTOL
 PREDOMINANTLY MOTOR
SULFONAMIDE
 OPTIC NEURITIS
METHANOL
 ORGANIC ARSENIC
 ETHAMBUTOL,
 ISONIAZID
 MYOSIS
1. CENTRAL MECHANISM – LOCUS COERULEUS
- lowers central sympathetic tonus
◦ α adrenergic agonist: CLONIDINE
◦ opiates: MORPHINE, HEROIN
◦ profound coma: CENTRAL DEPRESSANTS
BARBITURATES
BENZODIAZEPINE
◦ pons located hemorrhage

2. PERIPHERAL RECEPTOR ACTION

◦ peripheral α blockers: PRAZOSIN, PHENOTHIAZINE
◦ anticholinesterase: CARBAMATES, ORGANOPHOSPHORIC AGENTS
◦ muscarinic stimulation: MUSCARINE (AMANITA MUSCARIA)

3 . GANGLION SITE ACTION

◦ nicotinic stimulation: NICOTINE

4. LOCAL EFFECT: PILOCARPINE

 MYDRIASIS
DRUG INDUCED MYDRIASIS

Atropine Cocaine Pralidoxima

Cyclopentolate Ethanol Quinine
Glycopyrrolate Ethchlorvynol Reserpine
Antihistaminice Ether Succinimide
Aminophylline Glutethimide Ephedrine
Barium LSD Adrenaline
(compounds)
Carbamazepine Mescaline Phenylephrine

Cimetidine Nicotine Tricyclic

antidepressants
Barbiturates Phenytoin Amphetamines
(coma)
 MYDRIASIS
TOXIC INDUCED MYDRIASIS
ACONITINE FLUORINE AGENTS
BENZENE FLUOROACETATE
BOTULINUM TOXIN LOBELINE
CAMPHOR METHYL ALCOHOL
CARBON DIOXIDE METHYL BROMIDE
CARBON MONOXIDE PSILOCYBIN
CHLOROFORM SOLAMINE
CYANIDE ETHYLENE GLYCOL
ETHYL BROMIDE TOLUEN
 PUPILLARY LIGHT REFLEX

RESISTANT PATHWAYS TO THE TOXICOMETABOLIC

AGGRESSION

PRESERVATION OF THE PUPILLARY LIGHT RESPONSE

(DIFFERENTIAL DIAGNOSIS WITH STRUCTURAL COMA)

EXCEPTION:
ANTICHOLINERGICS
GLUTETHIMIDE
 HEPATIC TOXIC AGENTS

INDUSTRIAL DRUGS
(therapeutic doses)
BENZENE NARCOTICS
 HALOTHANE
BROMOFORM ORAL HYPOGLYCEMIC
AGENTS
CBr4 ANTIMICROBIALS
 HIN, RIFAMPICIN
CCL4 ACETAMINOPHEN
CHLOROFORM
ETHANOL
HYDRAZINE
TETRACHLOROETHANE
 NEPHROTOXIC AGENTS
INDUSTRIAL
METALS: Pb, Cr, As, Cd, Bi,
Fe, Ag, Mn, Be
SOLVENTS: methanol,
trichloroethane, CCl4,
methylcellulose
TETRACHLOROETHANE
ENVIRONMENTAL TOXIC
AGENTS:
 mushrooms, CO
DRUGS (THERAPEUTIC DOSES)
PROTEINURIA: penicillin, EDTA,
captopril
PROXIMAL TUBE: salicylates,
aminoglycosides
PAPILLARY NECROSIS:
analgesics
INTERSTITIAL NEPHRITIS
sulfonamide
ACUTE RENAL FAILURE
analgesics, aspirin, EAC
indomethacin, phenilbutazone
aminoglycosides, cephalosporin
HEMATURIA: cephalosporin, penicillin,
cyclophosphamide
 TOXIC INDUCED HYPERTHERMIA
USUAL OCCASIONAL
ANTIHISTAMINIC ALLOPURINOL

BLEOMYCIN CEPHALOSPORIN

METHYLDOPA CIMETIDINE

PENICILLIN COCAINE DERIVATE

PHENYTOIN HYDRALAZINE

PROCAINAMIDE ISONIAZID

QUINIDINE IODINE AGENTS

SALICYLATES NITROFURANTOIN

SULFONAMIDE PAS

STREPTOMYCIN RIFAMPICIN

STREPTOKINASE
 TOXIC INDUCED HYPERTHERMIA MECHANISM

1. OXIDATIVE METABOLISM INTERFERENCES:

SALICYLATES, DINITROPHENYL, WITHDRAWAL
SYNDROME, THYROID HORMONES
2. MUSCLE RIGIDITY INCREASE: STRYCHNINE,
PHENCYCLIDINE
3. HYPERACTIVITY S - A: AMPHETAMINE, LSD,
COCAINE
4. SWEATING IMPAIRMENT: ANTICHOLINERGIC
AGENTS, ANTIHISTAMINES, ADT, PHENOTHIAZINE
5. MALIGNANT HYPERTHERMIA: RARELY – THE
ASSOCIATION HALOTHANE – SUCCINYLCHOLINE
6. MALIGNANT NEUROLEPTIC SYNDROME - RARE
 Toxic hypothermia

 Peripheral vascular resistance increases

 CARDIAC INDEX DROPS

ETHANOL NARCOTICS
MORPHINE-LIKE NARCOTICS CARBON MONOXIDE
BARBITURATES INSULIN
GLUTETHIMIDE CHLORAL HYDRATE
 TOXIC INDUCED DIGESTIVE IMPAIRMENT

 IRON
 MERCURY
 LITHIUM
 PHOSPHORUS
 ARSENIC
 MUSHROOMS
 THEOPHYLLINE VOMITING, DIARRHEA OR BOTH

 COLCHICINE HEMORRHAGE (Fe)

 FLUORITES OP
 COMA
 TOXICOLOGY DIAGNOSTIC:
 DEPRESSING SUBSTANCES:
◦ NON SPECIFIC
ETHANOL, METHANOL
ISOPROPANOL
 RAPID ONSET: SEDATIVE-HYPNOTICS
CYANIDE BENZODIAZEPINE
HYDROGEN SULPHIDE ANTICHOLINERGIC (deliria)

CARBON MONOXIDE ANTICONVULSANTS

(PHENYTOIN, VALPROIC ACID)
OPIATES
ANTIDEPRESSANTS
BARBITURATES
(MAO I, TRICYCLIC AD)
ANTIHISTAMINES
 FLUCTUATING CONSCIOUSNESS: (DIPHENHYDRAMINE)
PHENCYCLIDINE BARBITURATES
GLUTETHIMIDE BROMIDES
OPIATES
TRANQUILIZERS: minor, major
 GLASGOW COMA SCALE (GCS)

SPONTANEOUSLY OPEN 4p
EYE ON VERBAL COMMAND 3p
PAIN INDUCED 2p
NO RESPONSE 1p
VERBAL COMMAND 6p
STIMULUS – LOCALIZATION 5p
MOTOR DUREROS - FLEXION 4p
- EXT. DECORTICATE 3p
- EXT. DECEREBRATE 2p
-NO RESPONSE 1p
COHERENT 5p
VERBAL DISORIENTED 4p
INAPPROPRIATE WORDS 3p
NON INTELLIGIBLE SOUNDS 2p
NO RESPONSE 1p
 REED COMA SCALE

Degree Consciousness Verbal Pain Reflex Breathing Circulation

level response response

0 stupor positive positive intact normal normal

I comatose negative positive intact normal normal

II comatose negative negative intact normal normal

III comatose negative negative absent normal normal

IV comatose negative negative absent cyanosis shock