Clinical Toxicology Laboratory

Date: March 20, 2023

Names of the Members:
Aguilar, Moreene Viane Kaye B.
Magbanua, Czariana Cassidy C.

Group Activity in the Management of Poisoning

I. Instruction: Choose a partner for this activity. Make a scenario among the
listed toxicity or overdosage of drugs or chemicals. The scenario that will be
constructed should include information on the basic vital signs, and their signs
and symptoms. This should be original. No copying on the internet.

Possible toxicity:
 Acute Marijuana Toxicity
 Carbon Monoxide Toxicity
 Chemical exposure to Chemicals used in cleaning
 Chronic exposure to paints
 Acute toxicity to Coumarin

Acute Marijuana Toxicity

Scenario:
A tragic accident causing death of a mother pushed a family down the drain.
This caused the father to be alcoholic and drug addict. The father would host
parties at home with party drugs included. After one party, the father left some
edible marijuana at their living room. His 3-year-old daughter mistaken saw the
pack of edible marijuana as gummy bears. Unbeknownst to the kid’s family, she
consumed almost half of the pack and went running to her sister after having
chest pain and heart rhythm disturbances. The kid was rushed to the hospital
and her vital signs were recorded as follows: 39.2°C, 130/90 mmHg, 124 bpm
pulse rate, 120 bpm heart rate, 15 cpm respiratory rate. She was also recorded
to have extreme hyperactivity, dry mouth, red eyes, impaired perception, and had
seizures few minutes after hospital arrival.

II. Research Questions:

1. In taking history, what are the important questions to be asked to the
poisoned patient or significant others? Give the rationale for the questions
asked.

As much as possible, gather detailed information about the situation. The "Five
Ws" of the history should be covered:
 Who (the patient's age, weight, relationship to other people present, and
gender)
 What (the name and dosage of medication(s) or illicit substance(s),
coingestants, and amount consumed)
 When (the time and date of ingestion; where—both the mode of poisoning
(e.g., ingestion or injection)
Clinical Toxicology Laboratory
Date: March 20, 2023
Names of the Members:
Aguilar, Moreene Viane Kaye B.
Magbanua, Czariana Cassidy C.

 Where the poisoning occurred

 Why (whether intentional or unintentional, and associated details. In addition,
a thorough historical medical history should be gathered, which should
cover any poisonings in the past, medical problems, concurrent
medications, psychiatric history, and drug usage history that may have
affected the patient's response to, metabolism, or clearance of ingestants.
Finding out if there is a history of drinking, renal disease, or hepatitis should
receive special attention.)

2. What is Gut decontamination?

It is the process of functionally eliminating a toxin from the GI tract in order to

reduce absorption or promote elimination. Several methods have been used in
the past, such as gastric evacuation (forced emesis or gastric lavage), intra-
gastric binding (most frequently with single or multiple doses of activated
charcoal), or accelerating the transit of toxins to shorten the duration of total
absorption (whole bowel irrigation or cathartics).

3. What are the different methods used in preventing the absorption of

poisons in the body? Give indications and contraindications/precautions.

 Gastric emptying: administration of IPECAC which work to cause vomiting

both centrally and peripherally on the chemotactic trigger zone. For children
1-2 years old 15 mL is available while 30 mL is for adults. Contraindications
includes consumption of substances that have the ability to change mental
status, active or past vomiting, caustic consumption, ingesting a substance
that is more hazardous to the lungs than the digestive system, and
ingesting substances that have the capacity to cause seizures. It has not
been shown to change outcomes when compared to therapy with activated
charcoal and a cathartic alone when ipecac syrup is given with activated
charcoal less than 60 minutes after intake.
 Orogastric Lavage: indicated for toxins that create huge bezoars or stay in
the stomach for a lengthy time. Contraindications includs nontoxic, non-life-
threatening, caustic, any patient whose airway integrity is uncertain, or toxic
ingestions that are more harmful to the lungs than the GI tract. Medications
that are known to not fit into the holes of the orogastric lavage hose.

4. What are the different methods used in enhancing the elimination of

poisons in the body?

 Urinary Alkalinization: it can decrease toxin serum half-life. Contraindication

includes Patients who are hypokalemic, have renal insufficiency, are
Clinical Toxicology Laboratory
Date: March 20, 2023
Names of the Members:
Aguilar, Moreene Viane Kaye B.
Magbanua, Czariana Cassidy C.

unable to tolerate the volume or sodium load, or who have consumed a

toxin that does not react to alkalinization.
 Hemoperfusion entails inserting a filter containing activated charcoal into the
hemodialysis machine's circuit in order to clean the patient's systemic
circulation.

5. What are the indications for using multiple-dose activated charcoal?

The repeated administration of charcoal (more than two doses) to speed up the
removal of a medication that has already been absorbed into the body is known
as MDAC. Contrast it with the initial dose administered to absorb poison that
stays in the Gastrointestinal tract. Just the initial dose of activated charcoal
should be administered with a cathartic, and only if the toxin itself is not
anticipated to produce diarrhea, in order to prevent excessive fluid loss and
electrolyte imbalance.

6. What are toxidromes? What are the different classes of substances

causing toxidromes? Give ate least 5 and identify the common findings
associated with them.

Toxidromes, which come from the words "toxic" and "syndrome," are a particular
set of signs and symptoms brought on by particular classes of drugs or
substances. Similar to how a heart attack might manifest with a particular set of
symptoms (chest discomfort, shortness of breath, changes in the
electrocardiogram, raised cardiac enzymes, etc.), exposure to particular
medications and chemicals can similarly manifest with a particular set of
symptoms.

The following toxidromes are the most frequently observed: (a) anticholinergic (b)
cholinergic, opioid, sedative-hypnotic, and sympathomimetic toxidromes
(sometimes called the adrenergic or stimulant toxidromes) are some examples of
toxidromes. Another type of toxidrome is toxic alcohols, neuroleptic malignant
syndrome, bradycardia, and serotonin syndrome (ethylene glycol, methanol,
etc.).

The symptoms of sympathomimetic and anticholinergic toxidromes are

comparable. Both people exhibit fever, tachycardia, hypertension, mydriasis, and
alterations in mental status. Contrary to sympathomimetic patients, who have
pale, diaphoretic skin, enhanced GI motility, and are often agitated,
anticholinergic patients have dry, red (flushed) skin, constipation, and delirium.
The opioid and sedative-hypnotic toxidromes are comparable as well. The opioid
Clinical Toxicology Laboratory
Date: March 20, 2023
Names of the Members:
Aguilar, Moreene Viane Kaye B.
Magbanua, Czariana Cassidy C.

toxidrome exhibits miosis and respiratory depression, but the sedative-hypnotic

toxidrome does not

7. Identify and describe the 4 techniques used in physical assessment

 Inspection
Use your senses of sight, smell, and hearing to examine each bodily system
and determine any differences from normal. When you evaluate each bodily
system, take note of its color, size, position, movement, texture, symmetry,
scents, and sounds.

 Palpation calls for you to apply differing amounts of pressure to the

patient utilizing various parts of your hands. Keep your fingernails short
and your hands warm because they are your tools. When touching
mucous membranes or places that have come into contact with bodily
fluids, wear gloves. Last, palpate the painful spots.

 Percussion
To detect organ borders, identify organ shape and position, and assess if an
organ is solid, fluid, or gas-filled, you can use percussion, which entails
tapping your fingers or hands fast and sharply against various regions of the
patient's body.

 Auscultation entails using a stethoscope to listen for different heart, lung,

and bowel sounds.

REFERENCES
https://www.aafp.org/pubs/afp/issues/1998/0101/p85.html#:~:text=The%20history%20should%20address%20the,(e.g.%2C%20ingestion%20or
%20injection)
https://www.uptodate.com/contents/gastrointestinal-decontamination-of-the-poisoned-patient#:~:text=Gastrointestinal%20decontamination%20refers
%20to%20the,absorption%20or%20increase%20its%20clearance.
https://www.vumc.org/poison-control/toxicology-question-week/jan-29-2001-what-are-indications-multiple-dose-activated-charcoal-mdac
https://www.iowapoison.org/media/cms/IA_Hotline0115_3DEBF4D037254.pdf
https://journals.lww.com/nursing/Fulltext/2006/11002/Assessing_patients_effectively__Here_s_how_to_do.5.aspx