TOXICOLOGY (GENERAL

PRINCIPLES)

Dr. D. Sandeep
Assistant Professor
Chebrolu Hanumaiah
Institute of Pharmaceutical Sciences
• Toxicology is the branch of science which deals with the study of poisons,
including their mechanism of action, adverse effects on the body and treatment
of the various conditions produced by the poisons.
• Poisons are unwanted substances which produce harmful effects on the body
and sometimes can be fatal by causing disturbances in vital physiological
functions majorly respiration and blood circulation.
• Antidotes are the substances used to reverse the harmful effects of the poison.
Antidotes act either by preventing absorption or by inactivating or antagonizing
the actions of poisons.
• Types of Poisons:
• All drugs in higher doses.
• Agricultural poisons
Eg: Organophosphorous compounds
• Atmospheric pollutants
Eg: Carbon monoxide, NO, Sulphur dioxide
• Occupational poisons
Eg: Methanol, Ethanol
• Heavy metals
• Types of Poisoning: 2 types

Acute Poisoning Chronic Poisoning

It may be either self or accidental It develops slowly
Symptoms appear suddenly soon after poison
Symptoms appear slowly
consumption
The symptoms may increase severely and may The symptoms disappear on removal of patient from
cause death if not attended immediately further exposure.
Should be treated immediately to save patient's
Can be treated by removing the cause
life
 GENERAL PRINCIPLES IN TREATMENT OF POISONING
• It includes two steps.
1. Identification of the poison
2. Removal of poison from the body
1. IDENTIFICATION OF POISON:
• The first step of the treatment is to identify the poisons.
• Cause of poison can be known from relative of patient or by patient himself if he is
conscious.
• Collect any empty bottles or syringes from the patient or neighbors.
• Observe physical parameters like;
SIGNS POISON CAUSE
VITAL SIGNS
Hypotension and bradycardia β- blockers, calcium channel blockers
Hypertension and tachycardia, rapid respiration Amphetamine
Hyperthermia Anticholinergics like atropine
EYE EXAMINATION
Miosis Organophosphates
Mydriasis Atropine
Pinpoint pupil Morphine, opioids
Ptosis Botulinum toxin
MOUTH EXAMINATION
Burnings or erosions Strong acids or alkalis
Bitter almond odour Cyanides
Garlic odour Organophosphates or Heavy metals
NERVOUS SYSTEM
Seizures Tricyclic antidepressants
2. REMOVAL OF POISON FROM THE BODY: 
If poison identified If poison NOT identified

Go for specific antidote Remove the poison from the

body by suitable methods
• If Poison Identified: Use Specific Antidotes
• There are certain specific antidotes for treating the specific cases of poisoning.
POISON ANTIDOTE
Atropine Physostignime, Neostigmine
Amphetamines Ammonium chloride
Barbiturates Sodium bicarbonate; Bemegride
Benzodiazepine Flumazenil
Carbon monoxide Oxygen (100 %)
Digoxin Digibind
Heavy metals Dimercaprol ; Penicillamine
Heparin Protamine sulphate
Lead Calcium edetate
Methanol Ethanol
Opioids Naloxone
Organophosphates Atropine ; Pralidoxime
Paracetamol N – Acetyl cysteine
Warfarin Vitamin – K

•Milk: Milk is a universal antidote. Its antidote property is attributed to Calcium and magnesium present in it which
acts as chelating agents.
• If Poison Not Identified: Remove poison from body by two processes.
i. Absorbed poison removal
ii. Unabsorbed poison removal
i. ABSORBED POISON REMOVAL: It can be done by 3 methods;
1. Diuretics:
• Most of the poisons after metabolism, are filtered at glomeruli and concentrated
in glomerular filterate. They can be further removed by diuretics.
• Osmotic diuretics like mannitol, urea can be used.
• 10 – 20 g/hr of these drugs administration gives 1 l/hr urine.
• These are NOT used in shock or renal failure or heart failure cases.
• Mostly used for treating poisoning of salicylates and barbiturates.
• Forced diuresis - used only if drug can actively be excreted through the urine.
• They may lead to cerebral edema. So used carefully.
• Drugs which can be removed by this process include alcohol, bromides,
salicylates, phenobarbitone, etc.
• High-ceiling diuretics like furosemide, ethacrynic acid have more side effects.
So utmost care should be taken while using them.
2. Alteration of Urinary pH:
– If poisoning is due to acidic drug, then alkalinize the urine.
• Eg: In case of acidic drug poisoning, alkalinize urine by sodium bicarbonate.

– If poisoning is due to basic/alkali drug, then acidify the urine.

• Eg: In case of basic/alkali drug poisoning, acidify urine by ammonium
chloride.

3. Dialysis:
• Peritoneal dialysis is very popular nowadays and used in the treatment of
methanol poisoning and in snake bite.
• Haemodialysis is more superior technique but requires highly sophisticated unit
for care.
• Peritoneal dialysis and haemodialysis have limited use in the treatment of
intoxication with chemicals.
UNABSORBED POISON REMOVAL:
• This process is also called as “decontamination”. Various methods include;

1. Decontamination of skin:
• The contaminated clothes must be removed and affected area should be washed with soap and
water thoroughly. This process is applied for eyes & wounds too.

2. Emesis:
• This is an important step in controlling further spread of the poison in the body.
• Induction of vomiting by Syrup of Ipecac is preferred.
• Dose of Ipecac syrup is 15 ml for children of less than 6 months and 30 ml for adults.
• Other agents like hypertonic saline solution, apomorphine, mechanical irritation of throat by
finger also evokes emesis.
• Emesis is contraindicated in the following cases-
– Coma patients.

– Caustic poisoning
– Petroleum distillates poisoning.
– Risk of convulsions in patient.
3. Gastric lavage: It is an important measure to control poisoning when it occurs
due to some aromatic substances such as perfumes.
• It is also helpful when emesis is contraindicated.
• Patient should be placed in a head down position, turned on his side and kept
like that throughout the process. 30 gauge Jacques tube is used.
• Agents used for this purpose are 300 ml warm water (380C), saline solution,
sodium thiosulphate, potassium permanganate etc.
4. Cathartics: These are the agents which help in expulsion of ingested materials
out of GIT rapidly.
• The poison was eliminated through fecal matter.
• It is used with care in children.
• Sorbitol syrup and Sodium Sulphate are frequently used cathartics.
5. Adsorbents: Activated charcoal adsorbs the poisons and delays the
gastrointestinal absorption of the poison.
• Helpful in treatment of poisoning from aromatic and alkaloid compounds.
• In general for 1 part of poison, 10 parts of activated charcoal is used.
6. Chelation: It is the metal complexation process. It is mostly used in cases of
heavy metal poisonings. The antidotes used are d-penicillamine and
desferroxiamine.
 SUPPORTIVE MEASURES
• General supportive measures are meant to ensure the well-being of the patient and
for the fast recovery from the poisoning.
• General measures includes following steps;
• Airway: Airways should be cleared of vomitus or any obstruction, with the help of
suction apparatus or oral airway tube.
• Breathing: Use of Oxygen therapy when there is hypoxia or probability of the same
in the patient.
• Circulation: Correction of the Blood Pressure of the patient by fluid therapy;
Dopamine may be required for correcting the BP.
• Dextrose: Usage of nutrient replenisher like dextrose prevents the brain cell damage.
• If there is cardiac arrhythmia in the patient then safety measures should be taken
under the supervision of the expert.
• Correction of plasma biochemistry like, acidosis or alkalosis in the blood.
• Monitoring of the patient after the episode of poisoning is over:
• After the patient is recovered from the adverse effects it is important to monitor the
patient for some time.
• This step is necessary and performed to ensure that there are no other complications
in the case.
• After ensuring that patient is fully recovered he is allowed to go home.