CLINICAL TOXICOLOGY LABORATORY the first aider.

Before approaching a victim, it's

Emergency first aid and
treatment
Introduction
● Safety of the Victim: Assessing the scene can
● First aid refers to the emergency or immediate
care you should provide when a person is
injured or ill until full medical treatment is
available. For minor conditions, first aid care
may be enough. For serious problems, first aid
care should be continued until more advanced
care becomes available.
● Number of Victims: Assessing the scene can
● The decision to act appropriately with first aid
can mean the difference between life and death.
● The purpose of first aid is to prevent the
person's condition from worsening and to
preserve their life until they can receive more
● Nature of the Injury: Finally, assessing the
important to make sure that the area is safe and
free from any potential hazards, such as
electrical wires, sharp objects, or unstable
structures. By doing this, the first aider can avoid
putting themselves in harm's way and can
provide more effective assistance to the victim
also help ensure the safety of the victim. If the
victim is in a hazardous area, the first aider may
need to move them to a safer location before
providing first aid. This can help prevent further
injury and ensure that the victim is in a stable
position while receiving treatment.
also help determine the number of victims that
need assistance. If there are multiple victims, the
first aider may need to prioritize their treatment
based on the severity of their injuries or their
proximity to the first aider. By assessing the
scene, the first aider can quickly identity any
additional resources that may be needed, such
as additional first aiders or emergency medical
services.
scene can help the first aider determine the
nature of the victim's injury or illness. By
observing the victim and the surrounding area,
the first aider can quickly identify the cause of
the injury or illness and provide appropriate
treatment. This can help ensure that the victim
receives the most effective care possible, which
can improve their chances of recovery

1.a. What to look in assessing the scene?

1. Danger
● This may include identifying hazardous
materials, damaged structures, or unstable
surfaces.
advanced medical treatment.
● You should also look for any sources of
electricity or gas that could be a potential
I. Assessing the scene
hazard.
● Assessing the scene before providing first aid is
● Once you have identified potential hazards, you
a critical step in ensuring the safety of the first
should take steps to remove or mitigate them to
aider, the victim, and any bystanders.
ensure the safety of everyone involved.
● Assessing the scene before providing first aid is
a critical step in ensuring the safety and
2. Number of casualties
well-being of the victim, the first aider, and any
● The next thing to determine is the number of
bystanders. By taking the time to assess the
victims that need assistance.
scene, the first aider can provide more effective
● You should look for any other individuals who
and appropriate care to the victim, which can
are injured or in distress and determine their
improve their chances of recovery.
condition.
● If there are multiple victims, you may need to
● Safety of the First Aider: Assessing the scene
prioritize their treatment based on the severity of
before providing first aid ensures the safety of
their injuries or their proximity to you.
 Step by step CPR
3. Nature of injury ● Call 911
● This may involve asking questions or observing ● Check the scene
the victim's symptoms. ● Check responsiveness
● It is important to determine whether the victim is ● Tapping the person's shoulder
unconscious, has difficulty breathing, or is ● while asking "Are you okay?"
bleeding heavily. ● Open airways
● These types of injuries require immediate ● Check for breathing ( if not breathing normally,
attention and intervention. start CPR)

4. Surroundings ● Perform Chest Compressions: Kneel beside

● Look around the area and observe any factors
that could affect the care you give to the
victim(s).
● This may include identifying any bystanders who
can help or hinder your efforts, as well as
determining the availability of resources and
equipment.
5. Others
● Age and gender of the victim, any medical
conditions they may have, and any medications
they may be taking.
2. Emergency contacts
Importance of emergency contact
● Rapid Medical Attention
● Access to important medical information
● Emotional support
● Legal consent
the person and place the heel of one hand on
the center of their chest, with the other hand on
top of the first. Press down on the chest with
your hands, using your body weight to help you.
Perform 30 chest compressions, at a rate of
about 100 compressions per minute.
● Give Rescue Breaths: After 30 compressions,
give two rescue breaths. Pinch the person's
nose shut, take a deep breath, and give two
slow breaths into their mouth.
● Continue CPR: Alternate between 30
compressions and two rescue breaths until
emergency medical help arrives, or until the
person starts breathing on their own.

List of emergency contacts

● 911
● Poison control
● Family physician
● Local hospital
● Emergency medical services
● Local Police Department
● Mental health crisis hotline

3. Basic first aid treatments and techniques

A. CPR (Cardio-pulmonary resuscitation)

● CPR, or Cardiopulmonary Resuscitation, is a CHOKING
life-saving technique that is used to help
someone whose heart has stopped beating, or is
not beating effectively.
● The goal of CPR is to restore blood flow to the
brain and other vital organs until emergency
medical help arrives.
● The technique involves chest compressions and
rescue breathing, which helps to pump
oxygen-rich blood to the brain and other vital
organs until medical help arrives.
 First aid for bleeding
First aid for choking
● Assess the situation: Determine if the person
is choking and if they need help. If they are
coughing or making noise, it's a good sign that
they can still breathe and may be able to clear
the obstruction on their own. If they are unable
to cough or speak, or if their face turns blue or
purple, it's a sign of severe choking and you
should act quickly.
● Call for help
● Encourage coughing
● Perform Heimlich maneuver
The Heimlich Maneuver
● Stand behind the person and wrap your arms
around their waist.
● Make a fist with one hand and place it just
above the navel.
● Grab your fist with your other hand and pull it
inward and upward quickly and forcefully, as if
trying to lift the person off the ground.
● Repeat thrusts until the object is dislodged and
the person can breathe or cough on their own.
First aid for choking
● Back blows and thrust : If the Heimlich
maneuver is not successful, give the person five
back blows and five abdominal thrusts.
● Stand behind the person and slightly to one side.
● Lean the person forward and give five back
blows between the shoulder blades with the heel
of your hand.
● mStand the person upright and give five
abdominal thrusts by placing your fist just above
D. BURNS
the navel, grasping it with your other hand, and
pulling inward and upward.
● Repeat the back blows and abdominal thrusts
until the object is dislodged or the person loses
consciousness.
First aid for choking
● Check the airway
● Get medical help
First aid for burns
C. BLEEDING
● Call 911
● Locate the bleeding
● Apply pressure: Once you have located the
source of bleeding, apply firm and continuous
pressure on the wound using a clean cloth or
gauze. If the bleeding is severe, apply pressure
using both hands.
● Elevate the affected area: If the bleeding is on
an arm or leg, elevate the affected limb above
the level of the heart to help slow down the
bleeding.
● Apply a tourniquet (if necessary): If the
bleeding cannot be controlled with pressure,
apply a tourniquet. A tourniquet is a device that
compresses the blood vessels and stops the
blood flow to the area. However, this should only
be used as a last resort and should only be done
by a trained individual as it can cause
permanent damage to the limb.
● Monitoring of vital signs: If the bleeding is
severe, the person may go into shock, which can
be life-threatening. Check the person's pulse,
breathing, and level of consciousness medical
immediately and seek attention
● Clean and dress the wound: Once the
bleeding is under control, clean the wound with
soap and water and apply a sterile dressing or
bandage to protect the wound from infection.
● Stop the burning process: If the person is on
fire, use a blanket or towel to smother the flames
or instruct them to stop, drop, and roll. If it's a
chemical burn, remove any contaminated
 clothing and rinse the affected area with cool
water for at least 20 minutes.
● Cool the burn: Run cool (not cold) water over
the burn for at least 10 to 20 minutes or until the
pain subsides. Do not use ice or very cold water
as it can cause further damage to the skin.
Alternatively, if running water is not available,
you can place a clean, cool, damp cloth over the
burn.
● Cover the Burn: Once the burn has been
cooled, cover the burn with a sterile,
non-adhesive bandage or a clean cloth to
protect the wound from infection. If the burn is
on the face, hands, feet, or genital area, seek
medical attention immediately.
● Apply medicine : Burns can be painful, so you
can give over- the-counter pain medication (e.g.
acetaminophen or ibuprofen) to manage the
pain. Never give aspirin to children under 18
years old, as it can lead to a rare but serious
condition called Reye's syndrome.
● Seek Medical Attention:Seek medical attention
if the burn is large, deep, or covers a large area
of the body. Also, seek medical attention if the
person shows signs of shock (e.g. pale skin,
rapid heartbeat, shallow breathing).
E. Fractures
First aid for Fracture
● Call for help
● Stabilize the affected area: If the person is
conscious and able to communicate, ask them to
stay still and avoid moving the affected limb. If
they need to be moved, stabilize the affected
area by splinting the limb with a rigid object (e.g.
a rolled- up newspaper or a stick). You can also
use a sling to support the arm.
● Apply ice: Apply ice to the affected area to help
reduce swelling and pain. Wrap a cold pack or a
bag of ice in a towel and apply it to the affected
area for 20 minutes at a time.
● Elevate the limb: If the fracture is on an arm or
leg, elevate the affected limb above the level of
the heart to help reduce swelling.
● Manage pain: Fractures can be painful, so you
can give over-the- counter pain medication (e.g.
acetaminophen or ibuprofen) to manage the
pain.
● Monitor Vital signs: If the person shows signs
of shock (e.g. pale skin, rapid heartbeat, shallow
breathing), check their pulse, breathing, and
level of consciousness and seek medical
attention immediately.
F. SHOCK
- life-threatening condition that can occur when
the body's organs and tissues do not receive
enough oxygen and nutrients.
First aid for shock
● Call for help
● Help the person lie down
● Keep the victim warm
● Monitor the person's breathing and pulse
● Do not give food or drink (may cause them to
vomit)
● Reassure the comfort of the victim
● Seek medical attention
What to do and not to do?
DO’s
● Do stay calm and remain focused on the
situation at hand.
● Do assess the scene and ensure that it is safe
before providing first aid.
● Do call for help if the situation requires
professional medical attention.
● Do use protective equipment (e.g. gloves) if
available to prevent the spread of infection.
● Do apply pressure to control bleeding.
● Do keep the injured or ill person comfortable and
warm.
● Do provide reassurance and comfort to the
person.
DON’Ts
● Don't panic or become overwhelmed by the
situation.
● Don't move a person who has a suspected neck
or spinal injury, unless it is necessary to prevent
further injury or to provide life- saving care.
● Don't give the person anything to eat or drink if
they are unconscious or vomiting.
● Don't remove any object that is impaled in a
wound.
● Don't apply a tourniquet unless it is absolutely
necessary to control severe bleeding and you
have been trained to do so.
 ● Don't attempt to clean a wound with anything
other than clean water, unless you have been
trained to do so.
● Don’t hesitate to seek professional medical
attention if you are unsure how to proceed.
ANTIDOTES
● WHO: defined as a therapeutic substance used to
counteract the toxic actions of a specific xenobiotics.
● Came from the greek word "Antididonai" which
means "given against"
● Antidotes are substances or treatments that are
administered to counteract the toxic effects of a
particular poison or drug.
● They are specifically designed to neutralize or
reverse the harmful effects caused by the toxic
substance, thereby providing therapeutic intervention
and promoting the recovery of an individual who has
been exposed to a poison or overdose.
● Antidotes are employed in the field of clinical
toxicology, which focuses on the diagnosis,
management, and prevention of poisonings and
overdoses. They are typically used in acute
toxicological emergencies and are crucial in reducing
morbidity and mortality associated with toxic
exposures.
COMMON TYPES OF TOXICOLOGICAL EXPOSURES
A. Drug Overdose
● Drug overdose refers to the ingestion or exposure to
a drug or drugs in quantities that exceed the normal
therapeutic dose or safe limit.
● It occurs when an individual takes a higher amount of
a substance than the body can metabolize or handle
effectively, leading to toxic effects.
● Drug overdoses can be accidental, resulting from
medication errors, miscalculations, or misuse.
● They can also be intentional, such as in cases of
deliberate self-harm or suicide attempts.
● Could be a prescription or OTC type or combinations
of such medication.
Severity of symptoms are dependent to:
● Drug involved
● The dose that is ingested
● Individual factors:
○ Age
○ Weight
○ Tolerance
○ And overall all health
● Symptoms can be mild or moderate
● Common Symptoms:
○ Altered mental status
○ Confusion
○ Drowsiness
○ Respiratory depression (in opioids or
sedatives)
○ Change in HR and BP
○ Seizures
○ Gl disturbances
○ In severe cases: loss of consciousness and
coma
● Prompt recognition and appropriate management of
drug overdosage are essential to prevent serious
complications and potentially save lives.
● Management: supportive care, monitoring of vital
signs, administration of antidotes, enhanced
elimination and providing symptomatic treatment for
associated symptoms.
● Note: drug overdose are for medical emergency
B. Poisoning from chemicals or toxins
● Poisoning from chemicals or toxins refers to the
harmful effects that occur when individuals are
exposed to substances that can cause toxicity.
● These substances can include various chemicals,
household products, industrial compounds,
environmental toxins, pesticides, and venomous
animal or plant substances.
● Poisonings can occur through ingestion, inhalation,
absorption through the skin, or injection.
● Mild to severe effects depending on:
○ Specific substance involved
○ Route of exposure
○ Dose
○ Individual's susceptibility
● Common signs and symptoms: nausea, vomiting,
abdominal pain, respiratory distress, dizziness
headache, confusion,seizures, altered mental status,
skin irritation and burns
● Prevention is key in reducing the incidence of
chemical or toxin poisoning.
○ practicing safe storage and handling of
chemicals,
○ following proper usage instructions for
household products,
○ wearing protective gear in hazardous
environments, and
○ promoting awareness of potential toxins in
the surroundings.
● Overall, prompt recognition, appropriate
management, and prevention of chemical or toxin
poisoning are crucial for minimizing the potential
harm and promoting the wellbeing of individuals
exposed to these substances.
C. Environmental Poison
● Refers to the exposure to toxic substances present in
the environment that can lead to adverse health
effects.
● Sources:
○ air pollution,
○ water contamination,
○ soil pollutants,
○ occupational hazards,
○ industrial waste,
○ agricultural chemicals, and
○ hazardous materials.
● Environmental poisoning can occur through
inhalation, ingestion, or direct contact with the toxic
substances.
 ● The effects of environmental poisoning can vary
depending on the specific toxins involved, the
duration and intensity of exposure, and individual
susceptibility.
● Prolonged or repeated exposure to environmental
toxins can have cumulative effects, leading to chronic
health problems.
● Some common environmental toxins include heavy
metals (lead, mercury, arsenic), pesticides, air
pollutants (particulate matter, volatile organic
compounds), industrial chemicals (benzene,
asbestos), and radiation.
● Effects are mild to severe type that includes
respiratory problems, cardiovascular disorders,
neurological impairment, developmental issues,
reproductive disorder, cancer organ damage and
even death.
A. Mechanisms of Antidote use
1. Neutralization:
● Works by neutralizing the toxic substance. Binds to a
stable complex that reduces its toxicity.
● Chemical reactions, precipitation, or chelation
● e.g. Dimercaprol or Succimer to Heavy metal
poisoning
2. Receptor Antagonism
● Competing with the toxic substance for receptor
binding sites.
● Inhibition action to reverse the toxic effects
● e.g. Naloxone for Opioid overdose
3. Enzyme inhibition
● Antidotes inhibit enzymes that can activate the
effects of poisons.
● e.g. Pralidoxime that reactivates
acetylcholinesterase in organophosphate poisoning
(inhibits acetylcholinesterase)
4. Enhancement of Elimination.
● Increase metabolism, promotes renal excretion or
enhance detoxification process
● e.g. Activated charcoal that adsorbs certain ingested
toxins and facilitate its elimination in the Gl tract and
Alkalinization technique to enhance the elimination of
acidic drugs.
5. Substrate Competition
● Antidotes act by competing with the toxic substance
for metabolic pathways or binding sites.
● By acting as alternative substrates or ligands, they
reduce the availability of the toxic substance for
interaction with target sites, thereby reducing its
toxicity.
● e.g Cyanide poisoning can be treated with antidotes
like hydroxocobalamin or sodium thiosulfate, which
compete with cyanide for binding to enzymes
involved in cellular respiration.
6. Supportive actions
● antidotes do not directly counteract the toxic effects
but instead provide supportive actions.
● For example, in cases of acute acetaminophen
(paracetamol) overdose, the administration of
N-acetylcysteine does not directly neutralize the toxic
metabolite but acts by replenishing glutathione stores
and providing antioxidant effects, thereby preventing
or mitigating liver damage.
B. Factors that influence the effectiveness of the antidote
1. Timing and administration: early administration could
lead to antidote effectiveness.
2. Dose and Route of administration: depends on factors
such as: severity of poisons, age and weight as well as
individual differences. The route of administration should
account for the pharmacokinetic properties of the antidote
and the urgency of the situation.
3. Specificity: Antidotes are often specific to particular toxins
or classes of toxins. They are designed to counteract the
specific mechanisms of action or effects caused by the toxic
substance. The effectiveness of an antidote depends on its
ability to target and neutralize the toxic substance involved.
Ensuring that the correct antidote is used based on the
specific toxin is crucial for achieving optimal outcomes.
4. Pharmacokinetic Interactions: can affect the
effectiveness of an antidote. These interactions occur when
the presence of another drug or substance alters the
absorption, distribution, metabolism, or elimination of the
antidote. Understanding potential interactions and adjusting
the dose or timing of antidote administration accordingly can
help optimize its effectiveness.
5. Patient Factors: Individual patient factors can influence
the effectiveness of an antidote. These factors include the
patient's age, weight, renal and hepatic function, underlying
health conditions, and concomitant medications. Certain
patient characteristics mav affect the pharmacokinetics or
pharmacodynamics of the antidote, potentially impacting its
effectiveness. Individualizing the dose and monitoring the
patient's response to treatment is important in optimizing
antidote effectiveness.
6. Co-ingestion of Multiple substances: In cases of
polypharmacy or co-ingestion of multiple substances, Ehe
frederestion other drugs ur toxins can complicate the
effectiveness of harmatidotearfropetities.
between the antidote and other substances may occur,
potentially altering its pharmacological properties or reducing
its efficacy. Identifying and managing the co-ingested
substances appropriately is necessary to optimize antidote
effectiveness.
7. Severity of Toxicity: The severity of the poisoning can
influence the effectiveness of an antidote. In severe cases of
poisoning, where extensive damage has occurred or where
the toxic substance has already reached critical targets, the
antidote may have limited efficacy in reversing the toxic
effects completely.
However, even in such cases, the antidote may still play a
role in mitigating further harm or supporting other therapeutic
interventions.
8. Supportive Care: Antidotes are often used in conjunction
with supportive care measures. Supportive care, including
maintaining vital signs, addressing complications, and
providing symptomatic treatment, is important for managing
the overall clinical condition of the patient. The effectiveness
of an antidote may be enhanced when combined with
appropriate supportive measures.
C. Routes of Administration of Antidotes
Intravenous route (IV):
● Intravenous administration is a common and often
preferred route for many antidotes.
● rapid and direct delivery of the antidote into the
bloodstream, ensuring a prompt therapeutic effect
● IV administration is particularly useful in emergency
situations where immediate intervention is required.
● This route allows for precise control of the antidote's
dose and enables healthcare professionals to monitor
the patient closely during administration.
Intramuscular route (IM):
● Intramuscular administration involves injecting the
antidote into a muscle.
● This route is often used when IV access is not readily
available or in situations where IV administration is
not feasible or practical.
● However, it should be noted that IM administration
may result in slower absorption and onset of action
compared to IV administration.
Oral Administration:
● Oral administration involves swallowing or ingesting
the antidote.
● While this route is convenient and non-invasive, it is
not commonly used for antidotes in emergency
situations.
● Oral administration is more frequently employed for
antidotes used in less urgent or chronic poisoning
cases.
● It may also be used for antidotes that are
well-absorbed orally and have sufficient
bioavailability.
Inhalation
● Inhalation administration involves inhaling the
antidote in the form of a gas, aerosol, or vapor.
● This route is specific to certain antidotes that are
delivered directly to the respiratory system to
counteract inhaled toxins or gases.
● Examples include the use of specific gases like
oxygen or nitrite inhalation for cyanide poisoning.
Intranasal Administration
● Intranasal administration involves delivering the
antidote through the nasal mucosa.
● This route is gaining recognition and popularity for
certain antidotes, especially in pre-hospital and
emergency settings.
● Intranasal administration offers advantages such as
rapid absorption, ease of use, and potential for
self-administration or administration by non-medical
personnel.
Topical Administration
● Topical administration involves applying the antidote
directly to the skin or affected area.
● This route is specific to antidotes used for localized
toxicity or dermal exposure.
● The antidote may be in the form of creams,
ointments, gels, or patches that are applied directly to
the skin to counteract the toxic effects.
Opioid Overdose Management
OPIOID OVERDOSES
● Opioid overdose occurs when an individual takes an
excessive amount of opioids, which can lead to
life-threatening consequences.
● Opioids are a class of drugs that include prescription
pain medications like oxycodone, hydrocodone, and
morphine, as well as illegal substances like heroin.
● Opioid overdose is a significant public health
concern, and understanding its signs, symptoms, and
management is crucial.
Causes of overdose:
● High dosage intake: Taking a higher dose of opioids
than the body can tolerate can overwhelm the central
nervous system, leading to respiratory depression,
reduced heart rate, and decreased level of
consciousness.
● Combination with other drug agents: Mixing
opioids with other depressant substances like
alcohol, benzodiazepines, or sedatives increases the
risk of overdose as these substances enhance each
other's effects.
● Loss of tolerance: If an individual has stopped using
opioids for a period and then relapses, their tolerance
may be reduced, making them more susceptible to
overdose with the same amount of opioids
Signs and Symptoms
● Extreme drowsiness or unresponsiveness
● Slow, shallow, or absent breathing
● Blue or purple lips and fingernails
● Pinpoint pupils (pupils constricted to a very small size
● Cold, clammy skin
● Slow or weak pulse
● Gurgling or snoring sounds
● Inability to wake up, even when shaken or shouted at
Management for opioid overdose
RECOGNITION. Recognize the signs and symptoms of
opioid overdose, which may include
○ pinpoint pupils,
○ unresponsiveness,
○ shallow or absent breathing,
○ slow or irregular pulse, and
unconsciousness.
○ It someone is found unresponsive and there
is suspicion of opioid overdose, assume it is
an emergency and take immediate action.
CALL.
● Call for Emergency Medical Services: Dial
emergency services (e.g., 911 in the United States) to
activate the local emergency response system.
● Inform the dispatcher about the suspected opioid
overdose and provide the exact location.
AIRWAY MANAGEMENT.
● Ensure the person's airway is open and
unobstructed.
 ● If needed, gently tilt the person's head back and lift
the chin to help maintain a clear airway.
● Remove any objects, vomit, or other obstructions
from the mouth.
RESCUE BREATHING.
● If the person is not breathing or breathing
inadequately, initiate rescue breathing.
● Provide mouth-to-mouth resuscitation or use a barrier
device if available.
● Deliver one breath every 5 to 6 seconds (10 to 12
breaths per minute.
● Continue rescue breathing until emergency medical
personnel arrive.
ADMINISTER NALOXONE.
● Naloxone is an opioid receptor antagonist that rapidly
reverses the effects of opioid overdose
● If naloxone is available, administer it according to the
provided instructions.
● Naloxone is typically administered as an
intramuscular (IM) or intranasal spray.
● Multiple doses may be required if the person does
not respond or if the opioid in the system has a
longer duration of action.
PERFORM CPR.
● If the person remains unresponsive and without a
pulse, start cardiopulmonary resuscitation (CPR)
immediately.
● Begin chest compressions by placing the heel of one
hand on the center of the person's chest (between
the nipples and interlocking the other hand on top.
● Perform chest compressions at a rate of 100 to 120
compressions per minute, with each compression
allowing the chest to fully recoil.
SUPPORTIVE CARE.
● While awaiting the arrival of emergency medical
services, provide supportive care to the person.
● This may include maintaining an open airway,
monitoring vital signs, and providing basic life support
measures as needed.
FOLLOW-UP CARE.
● Once emergency medical personnel arrive, provide
them with a detailed history of the events leading to
the overdose and any information regarding the
opioids involved.
● Follow their instructions and cooperate fully in the
further management and transport of the person to
the hospital.
● Remember, naloxone is a crucial tool in opioid
overdose management, and its availability and
accessibility can save lives.
● If you or someone you know is at risk of opioid
overdose, consider obtaining naloxone and receiving
proper training on its administration.
● It's essential to seek professional help, engage in
addiction treatment programs, and address the
underlying issues related to opioid use to prevent
future overdose incidents.
● It is important to note that the management of opioid
overdose should not be delayed or substituted by
non-medical interventions alone.
● Seek immediate medical assistance and follow the
guidance of healthcare professionals experienced in
emergency medicine or toxicology.
● Naloxone, in particular, has proven to be an effective
tool in reversing opioid overdose and should be made
readily available to individuals at risk of opioid
overdose and their close contacts.
Benzodiazepine Overdose Management
● Benzodiazepine overdose occurs when an individual
takes an excessive amount of benzodiazepine
medication, resulting in potentially dangerous effects.
● Benzodiazepines are a class of prescription drugs
commonly used to treat anxiety, insomnia, seizures,
and other conditions. However, misuse or accidental
overdose can lead to serious complications.
Causes:
● Accidental Overdose: Taking more benzodiazepine
medication than prescribed or taking it more
frequently than recommended can increase the risk
of overdose.
● Misuse or Abuse: Using benzodiazepines
recreationally, in higher doses, or in combination with
other substances like alcohol or opioids significantly
raises the risk of overdose.
● Tolerance and Dependence: Long-term use of
benzodiazepines can lead To tolerance, where higher
doses are needed to achieve the desired effect. In
such cases, accidental overdose can occur if the
person takes a higher dose without realizing their
increased tolerance.
Signs and Symptoms includes:
● Extreme drowsiness or sedation
● Confusion and disorientation
● Slurred speech and impaired coordination
● Slow, shallow, or labored breathing
● Blurred vision and dizziness
● Weakness and muscle relaxation
● Unresponsiveness or loss of consciousness
● Potentially life-threatening complications, such as
respiratory depression or cardiovascular instability.
Management
● RECOGNIZE THE SYMPTOMS
● CALL
● MONITOR VITAL SIGNS:
○ While waiting for medical professionals to
arrive, monitor the person's vital signs,
including their breathing rate, heart rate, and
blood pressure.
○ If the person's breathing is severely
depressed or absent, initiate rescue
breathing or cardiopulmonary resuscitation
(CPR) if necessary.
● DO NOT INDUCE VOMITING
○ Unlike some other types of overdose, it is
generally not recommended to induce
vomiting in cases of benzodiazepine
overdose.
 ○ Focus on supporting the person's vital
functions and let medical professionals
handle the situation.
● PROVIDE SUPPORTIVE CARE
● ADMINISTER ANTIDOTE
○ In severe cases of benzodiazepine overdose,
medical professionals may administer a
medication called flumazenil.
○ Flumazenil is a benzodiazepine receptor
antagonist that can rapidly reverse the effects
of benzodiazepines.
○ However, the use of flumazenil is typically
reserved for cases where the person is
experiencing significant respiratory
depression or if there is a concern for a
life-threatening overdose.
○ Flumazenil should only be administered by
healthcare professionals due to potential
risks and side effects.
● SUPPORT AND MONITORING
○ Once the person receives medical attention,
they may require further monitoring and
supportive care in a hospital setting.
○ This may involve close observation,
maintaining stable vital signs, providing fluids
if necessary, and addressing any
complications that may arise.
● It is essential to remember that benzodiazepine
overdose can be dangerous and potentially
life-threatening.
● Therefore, it is crucial to seek immediate medical
assistance in any suspected cases of overdose.
● Furthermore, individuals who regularly use
benzodiazepines should do so under the guidance of
a healthcare professional and follow the prescribed
dosage to minimize the risk of overdose
Calcium Channel Blockers and Beta-Blockers Overdose
Calcium Channel Blockers Overdose
Cause of Overdose:
● Accidental
● Intentional or misuse
● Drug interactions (potentiation)
Primary Symptoms:
● Dizziness
● Hypotension
● Bradycardia
● Arrhythmia
● Confusion
● Weakness
● Severe: loss of consciousness and cardiac arrest
Beta- blocker Overdose
Cause of Overdose:
● Accidental
● Intentional or misuse
● Drug interactions (potentiation)
Primary Symptoms:
○ Hypotension
○ Bradycardia
○ Shortness of Breath
○ Confusion
○ Weakness
○
Dizziness
○
Severe: Cardiac arrhythmias and cardiac
arrest
Management on CCB and Beta-blocker Overdose
● RECOGNIZE THE SYMPTOMS
○ Be aware of the signs and symptoms of
overdose, which may include low blood
pressure (hypotension), decreased heart rate
(bradycardia), dizziness, fainting, shortness
of breath, chest pain, confusion, and in
severe cases, heart rhythm disturbances.
● CALL
● SUPPORTIVE CARE
○ maintain an open airway and assist with
breathing if necessary. If the person is
unconscious but breathing, place them in a
recovery position on their side to prevent
choking in case of vomiting.
● ANTIDOTE
○ Antidotes are given in the hospital setting
○ The choice of antidote depends on the
specific medication involved and the person's
clinical condition.
○ Glucagon: Glucagon is an antidote used in
beta blocker and calcium channel blocker
overdose. It can increase heart rate, cardiac
contractility, and blood pressure. Glucagon is
often given as an intravenous or
intramuscular injection.
○ Calcium: In calcium channel blocker
overdose, intravenous calcium administration
may be used to counteract the effects of the
medication and restore cardiac function.
● MONITORING AND SUPPORT
○ Once in the hospital, the person will undergo
continuous monitoring of vital signs,
electrocardiogram (ECG) monitoring, and
evaluation of their cardiac function.
○ Treatment will be provided for any
complications that may arise, such as heart
rhythm disturbances or low blood pressure.
Management of Specific Toxicological Exposure
B. Poisoning from Chemicals or Toxins
● Cyanide Poisoning Management
● Organophosphate Poisoning Management
● Iron overdose Management
Cyanide Poisoning Management
● Cyanide poisoning is severe and potentially
life-threatening that is caused by EXPOSURE to this
type of chemical.
Found in various forms:
● Hydrogen cyanide gas
● Cyanide salts
● Chemicals used in the industrial process
Causes of Poisoning
● Industrial Exposure:
○ Industrial workers in certain industries such
as mining, metal processing, and chemical
manufacturing may be at risk of cyanide
exposure if proper safety measures are not in
place.
Fire and Smoke Inhalation:
● Burning materials such as plastics, wool, silk, and
other substances can release cyanide gas, which can ● ANTIDOTE ADMINISTRATION
be inhaled during a fire incident. ○ The primary antidote for cyanide poisoning is
Certain Foods and Plants: hydroxocobalamin, a form of vitamin B12 that
● Some plants, such as bitter almonds, apricot kernels, can bind to cyanide and form a non-toxic
and cassava, contain cyanogenic compounds that compound.
can release cyanide when ingested in large amounts. ○ Sodium thiosulfate may also be used as an
adjunct therapy.
○ These antidotes are typically administered
intravenously under medical supervision.
Medical Treatments: Follow the recommended dosage and
● In some medical treatments, such as certain cancer administration guidelines provided by medical
therapies, cyanide compounds are used and may professionals
cause cyanide poisoning if not properly managed ● SUPPORTIVE CARE
○ Provide supportive care to maintain vital
Symptoms on Cyanide Poisoning
functions and manage complications.
● Respiratory Symptoms
○ This may include administering intravenous
○ Difficulty of breathing
fluids to support blood pressure and
○ Gasping of air reflex
hydration, correcting acid-base imbalances,
○ Cardiovascular symptoms
and managing any cardiac arrhythmias or
○ Tachycardia
seizures that may occur.
○ Hypotension
● MONITORING AND HOSPITALIZATION
○ Chest pain
○ The person should be closely monitored in a
● Neurological symptoms
hospital setting, preferably in an intensive
○ Headache
care unit (ICU), where vital signs, oxygen
○ Dizziness
levels, and other parameters can be
○ Confusion
continuously monitored. Further treatment
○ Seizures
and observation will be provided as
○ Loss of consciousness
necessary.
● GI symptoms:
● COLLABORATIVE CARE
○ Nausea
○ Cyanide poisoning management often
○ Vomiting
requires a multidisciplinary approach
○ Abdominal pain
involving toxicologists, emergency
○ Diarrhea
physicians, critical care specialists, and other
● Skin symptoms:
healthcare professionals.
○ Cherry red coloration of the skin(late
○ Collaborate with the medical team to ensure
symptom)
comprehensive and coordinated care.
Management: ● SUPPORT OF COMPLICATIONS
● SCENE SAFETY: ○ Cyanide poisoning can lead to various
○ Ensure the safety of yourself and others by complications, such as neurological deficits,
assessing the scene for any ongoing cardiac abnormalities, and respiratory
exposure to cyanide. distress.
○ If possible, remove the person from the ○ Continuously assess and address these
source of exposure and remove the soiled complications with appropriate medical
garments if needed to prevent further interventions.
contamination.
ORGANOPHOSPHATE POISONING AND MANAGEMENT
○ washing exposed skin thoroughly with soap
and water, may be performed to prevent ● Organophosphate (OP) poisoning refers to the toxic
further absorption of cyanide. effects caused by exposure to chemicals known as
● CALL organophosphates.
● ABC'S: ● These compounds are commonly used in pesticides,
○ Assess and stabilize the person's airway, insecticides, and nerve agents.
breathing, and circulation (ABCs). ● Organophosphate poisoning can occur through
○ If the person is not breathing or has a various routes, including ingestion, inhalation, or skin
compromised airway, initiate contact.
cardiopulmonary resuscitation (CPR) CAUSES OF POISONING:
immediately. Occupational Exposure
● OXYGEN ADMINISTRATION ● Workers in agriculture, pest control, and
○ Administer supplemental oxygen using a manufacturing industries may be at risk of exposure
mask or other appropriate devices to help to organophosphates.
improve oxygenation. Accidental Ingestion
 ● Ingesting food or water contaminated with
organophosphates or unintentionally consuming
pesticides can lead to poisoning.
Suicide or Self Harm
Nerve Agent Exposure
● Sarin
SIGNS AND SYMPTOMS
● Respiratory Symptoms: Difficulty breathing,
wheezing, and respiratory distress.
● Neurological Symptoms: Anxiety, confusion,
dizziness, headache, tremors, seizures, and in
severe cases, coma.
● Gastrointestinal Symptoms: Nausea, vomiting,
abdominal cramps, and diarrhea.
● Muscular Symptoms: Muscle weakness, twitching,
and in severe cases, paralysis.
● Eye Symptoms: Blurred vision, pinpoint pupils, and
excessive tearing
MANAGEMENT:
● REMOVE FROM EXPOSURE AND
DECONTAMINATION
○ If possible, remove the person from the
source of OP exposure to prevent further
contamination and exposure.
○ Remove Contaminated Clothing: Safely
remove the person's clothing to prevent
further absorption of OP compounds.
○ Wash Exposed Skin: Thoroughly wash the
exposed skin with soap and water to remove
any residual OP compounds.
○ Eye Irrigation: If the eyes are exposed, flush
them with clean water for at least 15 minutes.
● CALL
● SUPPORTIVE CARE:
○ Ensure an Open Airway: Maintain a clear
airway for the affected person. If necessary,
provide respiratory support, including
administering supplemental oxygen or
performing artificial ventilation.
○ Stabilize Vital Signs: Monitor and manage
the person's vital signs, including heart rate,
blood pressure, and oxygen saturation.
■ Administer intravenous fluids if
needed to maintain hydration and
blood pressure.
● ANTIDOTE ADMINISTRATION
Atropine:
○ Atropine is the primary antidote used in OP
poisoning.
○ It works by blocking the excessive stimulation
of the parasympathetic nervous system
caused by OP compounds.
○ Atropine helps counteract symptoms such as
excessive salivation, bronchoconstriction,
bradycardia, and gastrointestinal effects.
Pralidoxime (2-PAM):
○ Pralidoxime is another antidote used in OP
poisoning. It works by reactivating the
inhibited cholinesterase enzyme, helping to
restore normal nerve and muscle function.
○ Pralidoxime is most effective when
administered early in the poisoning process,
before aging of the cholinesterase-OP
complex occurs
● CONTINUOUS MONITORING AND SUPPORT
○ Observation: The affected person should be
closely monitored in a hospital setting,
preferably in an intensive care unit (ICU) or a
specialized toxicology unit. Monitor vital
signs, oxygen levels, neurological status, and
cardiac function continuously.
○ Electrocardiogram (ECG): Perform
continuous ECG monitoring to detect and
manage any cardiac rhythm abnormalities.
○ Blood Tests: Conduct regular blood tests to
assess cholinesterase levels and other
relevant parameters.
● SYMPTOM-SPECIFIC TREATMENT
○ Seizures: Administer anticonvulsant
medications as necessary to control seizures.
○ Respiratory Support: If respiratory distress
occurs, provide additional respiratory
support, including assisted ventilation or
intubation if needed.
○ Fluid and Electrolyte Balance: Maintain
proper fluid and electrolyte balance through
intravenous fluid therapy, especially if there is
vomiting or diarrhea.
● PSYCHOSOCIAL SUPPORT
○ Provide psychological support to the affected
person and their family, as OP poisoning can
be a traumatic experience.
IRON OVERDOSE MANAGEMENT
● Iron overdose, also known as iron poisoning or iron
toxicity, occurs when an individual consumes or is
exposed to an excessive amount of iron, leading to
potential health complications.
● Iron supplements, particularly those containing high
levels of elemental iron, can be toxic when ingested
in large quantities, especially by children
CAUSES AND SOURCES OF IRON OVERDOSE
● ACCIDENTAL INGESTION
○ Iron overdose commonly occurs when
children ingest iron supplements or vitamins
containing iron, mistaking them for candies or
other treats.
● INTENTIONAL OVERDOSE
○ In some cases, individuals may intentionally
consume large amounts of iron as a
self-harm attempt.
● OCCUPATIONAL EXPOSURE
○ Occupational exposure to iron-containing
substances or industrial accidents involving
iron compounds can also lead to iron toxicity.
SYMPTOMS OF IRON OVERDOSE
● Initial Phase(within 6 hours of Ingestion)
○ Gastrointestinal Symptoms: Nausea,
vomiting, abdominal pain, and diarrhea are
common initial symptoms.
○ Vomiting may be red or brown, resembling
coffee grounds, due to blood in the stomach.
 ● Latent Phase (6-48 hours after ingestion)
○ Temporary Improvement: The person may
appear to recover or experience a brief
period of stabilization.
○ Laboratory Abnormalities: Blood tests may
reveal elevated levels of serum iron,
increased liver enzymes, and metabolic
acidosis.
● Organ System Dysfunction (12-96 hours of
ingestion
○ Severe Symptoms: Symptoms during this
phase can include cardiovascular collapse,
shock, liver damage (jaundice, elevated liver
enzymes), kidney failure, respiratory distress,
and neurological abnormalities (seizures,
coma).
○ Coagulation Abnormalities: Disseminated
intravascular coagulation (DIC), a serious
clotting disorder, may develop.
MANAGEMENT
● IMMEDIATE ASSESSMENT AND STABILIZATION
○ Call for Emergency Assistance: Contact
the local emergency services or poison
control center immediately for guidance and
assistance.
○ Airway Management: Ensure a patent
airway and assist with breathing if necessary.
Administer oxygen if needed.
○ Monitoring Vital Signs: Assess and monitor
the person's heart rate, blood pressure, and
oxygen saturation.
● DECONTAMINATION
○ Gastric Lavage: In some cases, gastric
lavage (stomach pumping) may be
considered if the iron ingestion occurred
within the past hour. This procedure involves
inserting a tube into the stomach to wash out
its contents.
○ Activated Charcoal: Administration of
activated charcoal may be considered to bind
any remaining iron in the gastrointestinal tract
and prevent its absorption.
● CHELATION THERAPY
○ Deferoxamine: Deferoxamine is a specific
iron-chelating agent used to bind iron and
enhance its elimination from the body.
■ It is typically administered
intravenously.
■ Deteroxamine forms a stable
complex with iron and is excreted
through the urine. It helps prevent
iron-induced tissue damage and
systemic toxicity.
■ The dosage and duration of
deferoxamine therapy will be
determined based on the severity of
iron overdose
● MONITORING AND SUPPORTIVE CARE
○ Monitoring: Continuous monitoring of vital
signs, cardiac function, and oxygen
saturation is essential. Regular blood tests
will be conducted to assess iron levels, blood
count, liver function, and electrolyte balance.
○ Fluid Resuscitation: Intravenous fluids may
be administered to maintain hydration and
support blood pressure.
○ Symptom Management: Treat symptoms as
they arise, such as providing antiemetic
medication for nausea and vomiting Or
administering anticonvulsants for seizures.
○ Correcting Acid-Base and Electrolyte
Imbalances: Address any acid-base
disturbances and electrolve abnormalities as
needed
● CONSULTATION AND COLLABORATION
○ Specialist Involvement: Seek consultation
with a medical toxicologist or poison control
center for guidance on the management of
iron overdose
○ Collaborative Care: Work closely with
healthcare professionals, including
emergency physicians, toxicologists, and
critical care specialists, comprehensive and
coordinated care
Antidotes for rare and special situations
Snake envenomation
● Refers to the injection of venom into the body by a
venomous snake during a bite.
● It is a significant global health issue, particularly in
regions where venomous snakes are prevalent.
● Snakebite envenomation can cause a wide range of
symptoms, from mild local effects to severe systemic
manifestations, including life-threatening
complications.
● Venomous snakes belong to different families,
including Viperidae (vipers), Elapidae (cobras,
kraits, mambas), and others.
● The composition of snake venom varies among
species and can contain a complex mixture of
proteins, enzymes, toxins, and other bioactive
substances. These components can have different
effects on the body's systems
Clinical Manifestations
● Local Effects: Snakebites often cause local
symptoms at the bite site, including pain, swelling,
redness, and bruising. Tissue damage, blistering, and
necrosis can also occur.
● Systemic Effects: Venom can spread through the
bloodstream, leading to systemic symptoms. These
may include nausea, vomiting, dizziness, headache,
abdominal pain, respiratory distress, bleeding,
cardiovascular disturbances, muscle weakness,
paralysis, and in severe cases, organ failure or death.
Management
First Aid and Initial Actions
● Ensure Safety: Move the patient away from the
snake to prevent further bites or injuries.
● Immobilization: Immobilize the affected limb or body
part to minimize venom movement. Use splints or
improvised immobilization techniques, such as a
bandage, to restrict movement.
 ● Positioning: Keep the bitten limb at or below the
level of the heart to slow the spread of venom.
● Reassurance: Calm and reassure the patient to
reduce anxiety, which can help slow the circulation of
venom.
Medical Assessment and Monitoring
● Assess the patient's vital signs, including heart rate,
blood pressure, respiratory rate, and oxygen
saturation.
● Conduct a thorough physical examination, paying
close attention to the bite site, signs of systemic
envenomation, and any complications.
● Observe and document symptoms, including local
effects (swelling, pain, discoloration) and systemic
effects (nausea, vomiting, dizziness).
Identification of the snake species
● If possible, try to identify the snake species
responsible for the bite.
● This can assist in determining the appropriate
antivenom and predicting the potential severity of
envenomation.
Antivenom administration
● Antivenom is the specific treatment for snakebite
envenomation and should be administered as soon
as possible.
● The choice of antivenom depends on the region,
snake species, and availability of specific
antivenoms.
● Antivenom should be administered under medical
supervision, following appropriate dosing guidelines
and precautions for potential allergic reactions
Supportive Care
● Pain Management: Administer analgesics to
alleviate pain at the bite site and overall discomfort.
● Wound Care: Cleanse the bite wound with mild
antiseptic solutions to reduce the risk of secondary
infection.
● Tetanus Prophylaxis: Administer tetanus
vaccination and prophylaxis if necessary, based on
the patient's immunization history and the nature of
the wound.
● Fluid Resuscitation: Intravenous fluids may be
required to maintain hydration and treat hypotension
if systemic envenomation is present.
● Respiratory Support: Provide respiratory support,
such as supplemental oxygen or assisted ventilation.
in cases of respiratory distress.
● Management of Complications: Address specific
complications, such as anaphylaxis, coagulopathy,
renal failure, or cardiovascular disturbances, through
appropriate interventions.
Monitoring and follow up
● Continuously monitor the patient's vital signs, urine
output, coagulation profile, and renal function.
● Reassess the patient regularly for signs of
improvement or worsening of symptoms.
● Arrange for appropriate follow-up care, including the
possibility of additional antivenom doses if needed.
Carbon Monoxide Poisoning
● Carbon monoxide (CO) poisoning occurs when an
individual inhales or is exposed to high levels of
carbon monoxide gas.
● Carbon monoxide is a colorless, odorless, and
tasteless gas that is produced by the incomplete
combustion of fuels such as wood, coal, natural gas,
gasoline, and oil.
Causes of CO poisoning:
● Inadequate Ventilation: Poorly ventilated or
enclosed spaces where combustion devices are
used, such as home heating systems, gas stoves,
fireplaces, generators, or car exhausts, can lead to
carbon monoxide buildup.
● Malfunctioning Appliances: Faulty or improperly
maintained appliances, furnaces, water heaters, or
chimneys can produce excess carbon monoxide.
● Car Exhaust: Carbon monoxide poisoning can occur
if a vehicle is left running in a closed garage or if the
exhaust system is damaged, causing exhaust fumes
to enter the cabin.
Symptoms of CO Poisoning
● Initial Symptoms: Headache, dizziness, weakness,
nausea, vomiting, and confusion are common early
signs of carbon monoxide poisoning.
● Progressive Symptoms: As exposure to carbon
monoxide increases, symptoms may worsen and
include difficulty breathing, chest pain, rapid
heartbeat, loss of consciousness, and eventually,
coma or death.
Management
Remove from the Source and Ensure Safety:
● Immediately remove the affected individual from the
source of carbon monoxide, whether it's a closed
space, a malfunctioning appliance, or a vehicle.
● Move the person to an open area with fresh air to
prevent further exposure to carbon monoxide.
● If necessary, call emergency services or the local
poison control center for immediate assistance and
guidance.
Assessment and Monitoring:
● Assess the person's level of consciousness, vital
signs (including heart rate, blood pressure,
respiratory rate, and oxygen saturation), and overall
clinical condition.
● Monitor the individual closely for any changes in
symptoms or the development of more severe signs
of poisoning.
Provide Oxygen Therapy:
● Administer 100% supplemental oxygen to the
affected person as soon as possible.
● Oxygen therapy helps to displace carbon monoxide
from hemoglobin and increase the oxygen-carrying
capacity of the blood.
● Use a tight-fitting mask or nasal cannula to deliver
oxygen and ensure efficient oxygenation.
Consider Hyperbaric Oxygen Therapy (HBOT):
● In severe cases of carbon monoxide poisoning or
when the patient presents with significant symptoms
or evidence of tissue injury, hyperbaric oxygen
therapy may be considered.
 ● Hyperbaric oxygen therapy involves breathing 100%
oxygen in a pressurized chamber, which accelerates
the elimination of carbon monoxide and promotes
tissue oxygenation.
● HBOT is particularly beneficial in cases of severe
poisoning, neurological symptoms, loss of
consciousness, or pregnancy.
Supportive Care:
● Provide supportive care to manage associated
symptoms and complications. This may include:
● Fluid resuscitation to maintain hydration and blood
pressure.
● Treatment of nausea, vomiting, or other
gastrointestinal symptoms.
● Close monitoring of cardiac function and correction of
any abnormalities.
● Management of any metabolic or acid-base
disturbances.
Monitoring and Observation:
● Continuously monitor the patient's vital signs, oxygen
saturation, and level of consciousness.
● Observe for any delayed or long-term effects of
carbon monoxide poisoning, such as neurological
deficits or organ dysfunction.
Psychological Support and Follow-up:
● Carbon monoxide poisoning can have psychological
effects on the affected person. Provide appropriate
psychological support and counseling as needed.
● Ensure appropriate follow-up care, including
evaluation for any delayed or long-term effects of
poisoning.
Methemoglobinemia
● Methemoglobinemia is a condition characterized by
the presence of an abnormal form of hemoglobin
called methemoglobin.
● Methemoglobin is unable to effectively carry oxygen
to the tissues, resulting in impaired oxygen delivery
and tissue hypoxia.
● Methemoglobinemia can be either inherited
(congenital) or acquired (acquired
methemoglobinemia).
Causes of Methemoglobinemia
● Inherited Methemoglobinemia: It is caused by
genetic defects in the enzymes responsible for
maintaining the normal balance between
methemoglobin and normal hemoglobin. Examples
include cytochrome b5 reductase deficiency and
hemoglobin M variants.
● Acquired Methemoglobinemia: It can result from
exposure to certain medications, chemicals, or toxins
that oxidize hemoglobin, converting it into
methemoglobin. Common causative agents include
nitrites, certain local anesthetics (e.g., benzocaine,
prilocaine), dapsone, and some antibiotics (e.g.,
sulfonamides, nitrofurantoin).
Symptoms of Methemoglobinemia
● Cyanosis: A bluish discoloration of the skin, lips, and
nail beds is the most characteristic sign of
methemoglobinemia. Cyanosis may be evident even
in the absence of significant respiratory distress or
low oxygen levels.
● Chocolate-Brown Blood: Blood color may appear
dark brown or chocolate brown, distinguishing it from
the bright red color of oxygenated blood.
● Other Symptoms: Headache, dizziness, fatigue,
shortness of breath, rapid heart rate, confusion, and
seizures may also occur, especially with higher levels
of methemoglobin.
Management :
Identify and Remove the Causative Agent:
● In acquired methemoglobinemia, the first step is to
identify and remove the causative agent or toxin that
led to the condition.
● This may involve discontinuing the use of
medications or avoiding exposure to chemicals or
substances known to cause methemoglobinemia.
Supportive Measures:
● Oxygen Administration: Supplemental oxygen
therapy is provided to improve oxygen saturation and
alleviate tissue hypoxia.
○ Oxygen can be administered via nasal
cannula, face mask, or, in severe cases,
through non-invasive or invasive ventilation.
Monitoring: Close monitoring of the patient's vital signs,
including heart rate, blood pressure, respiratory rate, and
oxygen saturation, is essential to assess the response to
treatment and identify any worsening of symptoms.
Methylene Blue Therapy:
● Methylene blue is a reducing agent that helps convert
methemoglobin back into normal hemoglobin,
restoring its oxygen- carrying capacity.
● It is the specific treatment for symptomatic
methemoglobinemia or cases with severe
methemoglobinemia (>30-40%).
● Methylene blue is typically administered
intravenously over a period of time. The dosage and
duration of treatment depend on the severity of the
condition and the patient's response to therapy.
● Special caution is necessary when administering
methylene blue to patients with glucose-6-phosphate
dehydrogenase (G6PD) deficiency, as it can cause
hemolysis in these individuals. G6PD deficiency
should be ruled out or considered before initiating
methylene blue therapy.
Consideration of Other Treatments:
● If methylene blue is contraindicated or not available,
alternative treatments may be considered in
consultation with a specialist, such as ascorbic acid
(vitamin C) or hyperbaric oxygen therapy.
● These treatment options are generally used in
specific situations or when methylene blue is
ineffective or unavailable.