Lec 1

Question 1

What is a toxin?

Answer 1

Any poisonous substance of whatever origin that reacts with specific cellular components to kill cells, alter growth or development, or kill the organism.

Question 2

How are poisons classified according to action?

Answer 2

• Local
• Remote
• Both

Question 3

What are examples of inorganic corrosives?

Answer 3

• Sulphuric acid
• Hydrochloric acid
• Nitric acid
• Alkaline potash

Question 4

What are the origins of poisons?

Answer 4

• Plant
• Animal
• Metallic
• Synthetic

Question 5

Name a plant poison and its source.

Answer 5

Atropine from Datura

Question 6

What are examples of selective organ toxicity?

Answer 6

• Hepato-toxins: Iron, Paracetamol
• Nephro-toxins: Mercury, Phenol
• Cardio-toxins: Digitalis, Quinine, Aconite
• Neuro-toxins: Amphetamines, cocaine, strychnine

Question 7

What factors modify the actions of a poison in the body?

Answer 7

• Factors related to the poison
• Factors related to the patient
• Drug interactions

Question 8

What are some factors related to the poison?

Answer 8

• Dose
• Form
• Concentration
• Route of administration

Question 9

How does an empty stomach affect poison absorption?

Answer 9

It leads to rapid absorption.

Question 10

What is tolerance in the context of toxicology?

Answer 10

Repeated use of the same dose will not produce the same effect, as in drug addiction.

Question 11

What is idiosyncrasy in toxicology?

Answer 11

Abnormal response to drugs with a hereditary basis.

Question 12

What are the components of supportive therapy in poisoning management?

Answer 12

• Airway management
• Breathing support (O2 therapy)
• Circulation monitoring
• CNS assessment

Question 13

What is the purpose of the Coma Cocktail?

Answer 13

To treat comatose patients with dextrose, thiamine, and naloxone.

Question 14

What does the primary assessment in poisoning cases involve?

Answer 14

Emergency management.

Question 15

What should be included in the secondary assessment of poisoning?

Answer 15

• History and circumstantial evidence
• Clinical examination
• Investigations

Question 16

What are some vital signs to monitor in poisoning cases?

Answer 16

• Blood Pressure
• Pulse
• Respiration
• Temperature

Question 17

enumerate Routine studies:

Answer 17

CBC, serum electrolytes, ABG, renal & hepatic function tests & serum glucose.

Question 18

enumerate Toxicological screening :

Answer 18

a- Preliminary tests (qualitative):

• Color tests.
• Thin layer chromatography (TLC).

b- Confirmatory tests (quantitative):

• Immunoassay (Semi- quantitative).
• Gas chromatography (GC) and high performance liquid chromatography (HPLC).
• Gas mass spectrometry (GC/MS) and liquid chromatography mass spectrometry (LC/MS).

c- Anion Assessment:

Question 19

What is the anion gap?

Answer 19

The difference between the measured cations and anions in serum.

Question 20

anion gap is elevated in
………..?

Answer 20

(MUDPILES).
* methanol
* uremia
* diabetic ketoacidosis
* paraldehyde
* iron
* lactic acidosis
* ethylene glycol and salicylates

Anion gap = (Na+) – (Cl-+ HCO3-) = 7±4 MMOL/L.

Question 21

. Abdominal X-ray: for ingested radio opaque toxins like what?

Answer 21

(CHIPES):
* Chloral hydrate
* Heavy metals
* Iron
* Phenothiazine
* [also packets of cocaine or heroin], Enteric-coated and Sustained- release preparations}.

Question 22

What are some methods of gastrointestinal decontamination?

Answer 22

• Emesis
• Gastric lavage
• Activated charcoal
• MDAC
• Cathartics
• Whole bowel irrigation

Question 23

What contraindications exist for using emesis?

Answer 23

• Corrosives
• Coma
• Convulsions
• Chronic poisoning
• Cardiac and elderly patients
• Infants below 6 months

Question 24

What is the primary use of activated charcoal?

Answer 24

To prevent the absorption of toxins.

Question 25

What are some contraindications for using activated charcoal?

Answer 25

* Paralytic ileus * Intestinal obstruction * Drowsy patients without airway protection

Question 26

True or False: Activated charcoal is effective in all types of poisoning.

Answer 26

False

Question 27

What is the effect of Activated Charcoal on certain poisons? Activated Charcoal is ineffective in which?

Answer 27

Activated Charcoal is ineffective in some poisons including: * Cyanide and Corrosives * Heavy metals (Iron, Lead, Arsenic, Mercury) * Alcohols * Rapid onset or absorption poisons (Cyanide, Strychnine) * Chlorine and iodine * Others insoluble in water * Aliphatic and poorly adsorbed hydrocarbons * Lithium ## Footnote Activated Charcoal poorly adsorbs these substances, limiting its use in detoxification.

Question 28

What are the disadvantages of Activated Charcoal?

Answer 28

Disadvantages include: * Adsorbs oral antidotes * May induce vomiting * Mechanical obstruction of airways if aspirated * Mechanical bowel obstruction with multiple doses ## Footnote Antidotes should be administered 1-2 hours after charcoal to ensure effectiveness.

Question 29

What are the indications for Multiple-Dose Activated Charcoal (MDAC)?

Answer 29

Indications for MDAC include: * Enterohepatic circulation drugs (TCA, Digitalis, Barbiturates) * Drugs that stick to the stomach (Salicylate) * Slow gut motility (Barbiturates, Morphine) ## Footnote MDAC enhances toxin elimination by creating a concentration gradient.

Question 30

What is the typical dosing for MDAC?

Answer 30

Dosing for MDAC is: * 0.5 – 1 gm/kg every 4 hours * Continuous intra-gastric flow (0.25-0.5 gm/kg/hr) via Ryle tube ## Footnote This method facilitates the removal of toxins from the plasma into the intestine.

Question 31

What are common cathartics used in poisoning treatment?

Answer 31

Commonly used cathartics include: * MgSO4 * Mg citrate * Sorbitol ## Footnote These agents help expedite the elimination of toxins from the gastrointestinal tract.

Question 32

What are the contraindications for using cathartics?

Answer 32

Contraindications include: * Paralytic ileus * Intestinal obstruction * Fluid overload in sodium-containing cathartics * Renal insufficiency in magnesium-containing cathartics ## Footnote These conditions can worsen with the use of cathartics.

Question 33

What is Whole Bowel Irrigation?

Answer 33

Whole Bowel Irrigation is the irrigation of the entire GIT with non-absorbable isotonic electrolyte solution containing Polyethylene Glycol through a nasogastric tube ## Footnote It is used to rapidly cleanse the bowel of poisons.

Question 34

What are the indications for Whole Bowel Irrigation?

Answer 34

Indications include: * Poorly adsorbed drugs by Activated Charcoal * Slow-release drugs (e.g., Salicylates, Calcium Channel blockers) * Expelling packets of illicit drugs (Body packers and Body stuffers) ## Footnote This method is particularly effective for certain drug overdoses.

Question 35

What are the general lines of poisoning treatment?

Answer 35

General lines include: * Gastro-intestinal (GIT) decontamination * Elimination of the poison from the blood * Administration of antidotes ## Footnote These steps are crucial in managing poisoning cases effectively.

Question 36

What is the purpose of antidotes in poisoning treatment?

Answer 36

Antidotes are substances that oppose the effects of poisons without causing damage to the body ## Footnote They can be local or systemic in nature.

Question 37

What are local antidotes?

Answer 37

Local antidotes include: * Physico-mechanical Antidotes: Adsorbents, Demulcents, Entanglers, Dissolvents * Chemical Antidotes: Neutralization, Precipitation ## Footnote These antidotes work at the site of the poison's action.

Question 38

What are systemic antidotes?

Answer 38

Systemic antidotes include: * Physiological or pharmacological antidotes * Chelating agents ## Footnote They act throughout the body to counteract the effects of toxins.

Question 39

Name a few examples of systemic antidotes and their corresponding toxins.

Answer 39

Examples include: * Naloxone for Opiates * N-Acetylcysteine for Acetaminophen * Atropine for Organophosphorus poison * Flumazenil for Benzodiazepines ## Footnote These antidotes are critical in managing specific poisonings.

Question 40

Complications of gastric lavage

Answer 40

* Asphyxia if the tube passes to the trachea. * Aspiration of stomach contents leads to aspiration pneumonia. * Esophageal perforation. * Hypertension & tachycardia as a stress reaction. * Electrolyte imbalance.