6.Hypotonic hypohydration .Metabolic acidosis. Classification of acute poisoning.

Hypotonic hypohydration is loss of water associated with decreased effective osmolality of body
fluids.

Causes include loss of isotonic fluids via the kidneys or gastrointestinal tract that has been partially
compensated by drinking hypotonic fluids (eg, unsweetened tea). This results in a shift of water from the
extracellular fluid (ECF) to the intracellular fluid (ICF), which leads to cellular edema (particularly
affecting the central nervous system) and a further reduction of the extracellular compartment
(worsening of hypovolemia).

Metabolic acidosis is a condition in which there is too much acid in the body fluids.
Causes

Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the
kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis:

Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone
bodies (which are acidic) build up during uncontrolled diabetes.

Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which
can happen with severe diarrhea.

Kidney disease (uremia, distal renal tubular acidosis or proximal renal tubular acidosis).

Lactic acidosis.

Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol.

Severe dehydration.

Metabolic acidosis is commonly associated with many conditions within anaesthesia and critical care.
It is often unclear whether this is a primary abnormality, i.e. the patient is unwell because they have
accumulated H+, or an epiphenomenon reflecting the effects of an underlying process such as sepsis.

Acute toxicity describes the adverse effects of a substance that result either from a single exposure
or from multiple exposures in a short period of time (usually less than 24 hours). Acute toxicity tests in
animals (i.e, rat) use mortality as the main observational endpoint in order to derive a LD50 or LC50.
Acute toxicity studies usually include 3 routes: oral, dermal and inhalation.
GHS Classification Criteria for Acute Toxicity

There are 5 acute toxicity categories under GHS although some jurisdictions (i.e, EU) have not
implemented category 5. The table below shows GHS classification criteria for acute toxicity for different
routes. LD50 and LC50 values are needed for GHS classification. Acute toxicity category 1 represents the
most severe toxicity.

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