TOXICOLOGY HAND-OUTS PART 1 INSTRUCTOR: RALPH EPHRAIM S.

PALABRICA

Toxicology is an important science. It provides a sound basis for formulating measures to

protect the health of workers against toxicants in factories, farms, mines, and other occupational
environments. It is also valuable in the protection of public health hazards associated with toxic
substances in food, air, and water. Toxicology has played and will continue to play a significant
role in the health and welfare of the world.

It is the study of the nature and mechanisms underlying toxic effects exerted by substances on
living organisms and other biologic systems. Toxicology also deals with quantitative assessment
of the adverse effects in relation to the concentration or dosage, duration, and frequency of
exposure of the organisms.

Forensic toxicology is the analysis of biological samples for the presence of toxins, including
drugs. The toxicology report can provide key information as to the type of substances present in
an individual and if the amount of those substances is consistent with a therapeutic dosage or is
above a harmful level. These results can be used to make inferences when determining a
substance's potential effect on an individual's death, illness, or mental or physical impairment.

Risk Assessment
• estimate of potential effects of poison to
human health and environmental
significance of various types of chemical
exposure
• Hazard – ability of a chemical agent to
cause injury in a given situation or setting •
Risk – expected frequency of the
occurrence of an undesirable effect arising
from exposure to a chemical or physical
agent.

Poison - is a substance that is capable of

causing the illness or death of a living organism
when introduced or absorbed.

• deleterious effects
• physical injuries
• death
• Toxin – natural source
• Toxicants – man made/ artificial source

sola dosis facit venenum

– “the dose makes the poison”
Difference between Side Effects
& Adverse effects of Chemicals or Drugs.

Effects of Poison:

Route of Administration:

Frequency of Poison Administration: General Management of Poisoned Patient:

Primary Survey:

B. Breathing

Breathing Problems
Ventilatory Failure Paralysis of Ventilatory Muscles:
• Flaccid paralysis: Neuromuscular blockers, Botulinum toxin
• Spastic paralysis: Tetanospasmin, Strychnine, Saxitoxin, Tetrodotoxin
CNS Depression: Alcohols, Sedative-hypnotics, Opioids,
Antidepressant, Antipsychotics

Hypoxia Inert gasses: CO2, Methane, Propane, Nitrogen

Cellular hypoxia: CO, Cyanide, Methemoglobinemia, H2S, Sulfahemoglobinemia
Pneumonia: Aspiration of gastric contents

Bronchospasm Beta-blocker, Hydrocarbon aspiration, organophosphates and carbamates

C. Circulation

Circulation Management
• Check blood pressure and pulse rate and rhythm
• Begin continuous ECG monitoring
• Secure venous access
• Draw blood for routine studies
• Begin IV infusion

D. Degree of Disability:
E. Exposure/Environment

HISTORY AND PHYSICAL EXAMINATION

Also known as Secondary Survey (“AMPLE”)

DECONTAMINATION

A. Surface Decontamination

1. Dermal
• Remove contaminated clothing
• Wash with copious amount of running (tap) water for 30 minutes

Topical Agents for Chemical Exposure to the Skin

Hydrofluoric acid Calcium soaks
Oxalic acid Calcium soaks
Phenol Mineral oil, Isopropyl alcohol
White Phosphorus Copper sulfate 1%

2. Inhalational
• Remove the patient from the toxic environment → O2 supplementation

3. Ocular
• Wash with BSS/ NSS for 15 minutes of consume 2L with lids retracted

B. Gastric Decontamination

1. Activated Charcoal
• Highly absorbent powdered material made from a distillation of wood pulp
• Dose: 10:1 (charcoal to toxin)
• Contraindications:
- • Unconscious patients
• Poorly adsorbed substances: alkali, cyanide, alcohols, fluoride, heavy metals, iron, lithium, mineral acids potassium

2. Emesis
• Use of syrup ipecac
• Use when other measures are not available (especially for agents not adsorbed by activated charcoal)
• Contraindication
- • Unconscious patients, ingestion of CNS depressants, patients < 6 months old
- • Ingestion of corrosive agents
- • Ingestion of aliphatic HC

3. Gastric lavage
• Used for massive ingestion
• Contraindication:
• Unconscious patients
• Ingestion of corrosive substances
• Ingestion of SR and enteric-coated tablets
4. Cathartics
• Enhances gastrointestinal transit
• Contraindications:
- • Ileus/ intestinal obstruction
- • Renal insufficiency (Na/ Mg – containing cathartics)

5. Whole Bowel irrigation

• Use of a bowel-cleansing solution: non-absorbable polyethylene glycol in a balanced electrolyte solution
• Generally used for substances poorly absorbed by activated charcoal
• Indications:
- • Iron/ lithium tablets
- • SR/ enteric-coated tablets
- • Foreign bodies, drug-filled packets, condoms
• Contraindications:
- • Ileus/ intestinal obstruction
- • Unconscious patients

Oral Binding Agents:

Drug/ Toxin Binding Agent/s

Calcium Cellulose sodium phosphate

Chlorinated hydrocarbons, Digitoxin Cholestyramine
Heavy metals Egg white, milk
Iron Sodium bicarbonate
Lithium, Potassium Sodium polystyrene sulfonate (Kayexalate®)
Thallium Prussian blue

ANTIDOTAL THERAPY

Physiologic Antidote Pharmacologic Antidote

• Binds to the same site/ receptor with the poison • Binds to a different site/ receptor from the poison
• Ex. Opioids: Naloxone • Ex. Anaphylaxis: Epinephrine

Universal antidote:

Activated charcoal
Magnesium oxide
Tannic acid