Toxicology - University of Kentucky
Toxicology
Cosmetics generally safe (exceptions are wave neutralizer [boric acid] an nail products [acetonitrile, methacrylic acid, nitromethane)
Cleaning substances toxic when concentrated (Drano contains 54% NaOH)
Plants are variable (Philodendrons contain calcium oxylate crystals causing pain, Foxglove contains digoxin causing side effects)
Pharmaceuticals DUH!, most frequent are analgesics and cold/cough medicines, Pediatric fatalities often due to excessive iron intake
|Toxin |MOA |Effects |Treatment |Miscellaneous |
|Carbon Monoxide |binds to hemobglobin 240X stronger|tissue hypoxia, 30-50% HA, faint on exertion, |pure or hyperbaric oxygen |product of incomplete combustion shift oxygen dissoc. |
| |than oxygen |irritability, dizziness collapse; 60-70% cause ( HR, | |curve to left thus lowering partial pressure of oxygen |
| | |(CO, (RR, Pinkish skin discoloration | |availability to tissues, |
|Sulfur Dioxide |form acid w. contact mucous |increased mucous, bronchoconstriction |remove exposure and treat irritation| |
| |membrane | | | |
|Nitrogen Oxide | |pulm. edema, ENT irritation |reduce edema/inflam |from silage, gas/kerosene heaters |
|Ozone | |[low] = shallow rapid resp, (pulm compliance, [high] = |treat pulm edema and inflammation |prod by UV absorption by NO2 |
| | |pulm edema, bronchitis, (bronchoconstrictor sens | | |
|Arsenic |interacts with sulfhydryl groups |Acute = PAIN, corrosion of GI tract, bleeding, |supportive, Dimercaprol |colorless and tasteless, found in industry, herbicides,|
| |(pyruvate deh. in TCA cycle) |irritant, vomiting, “rice water” stool and death, | |insecticides, natural in ground water, burnt coal |
| | |Chronic = hyper-pig and -ker, cancer (skin, lung, | | |
| | |bladder), alopecia, BM depression, anemia | | |
|Cadmium |inhibits sulfur cont enzymes (esp.|Inhalation = Pulmonary edema + Nephrotoxicity, Oral = |Vitamin D, supportive, chelators |manufacturing, burnt fossil fuel, poorly absorbed from |
| |AAT) |osteomalacia via bad Ca/PO4 balance (bone pain) |ineffective |GI tract |
|Lead |bind sulfhydryl group (inhibit ALA|can replace Ca in bone (reversible), Acute = RARE, |EDTA, Dimercaprol, Penicillamine, |children, lead based paints |
| |dehydratase causing (heme |encephaloacolic, colic, Chronic = periph neuropathy, |Succimer (children), recommended | |
| |synthesis) |anemia, neurocognitive defects (children), growth |when conc >45 ug/dL | |
| | |retardation | | |
|Mercury |bind sulfhydryls, phosphoryl, |Acute = chest pain SOB, N/V, Chronic = CNS, tremors, |Penicillamine, Dimercaprol, ineff. |CNS and kidney are target organs, Methyl mercury is |
| |carboxyl, amide, amines |emotional fx, irritability, Mad Hatter syndrome |for methyl mercury |most toxic form |
|Iron |occur when Fe< binding cap of |corrosive on GI tract, ulceration, hemorrhage, coag |prevent additional absorption via |iron overload from vitamins (children), iron rapidly |
| |ferritin, |necrosis, (CO, shock, hepatic damage, bloody diarrhea, |ipecac induced emesis, gastric |cleared from plasma |
| | |tachycardia, hepatic failure, (SGOT, (SGPT |lavage, Deferoxamine | |
|Toxin |MOA |Effects |Treatment |Miscellaneous |
|Ethanol | |visual impairment, alcoholic ketoacidosis |symptomatic |preferentially metabolized in presence of Methanol |
|Methanol | |greatest acidosis of alcohols, glycols, or aldehydes, |Emesis, Lavage, Ethanol, Fomepizole |toxicity via metabolism to formaldehyde and formic |
| | |permenant blindness, metabolic acidosis, CNS depression |, Na-bicarb with major focus being |acid, ELEVATED ANION GAP ACIDOSIS |
| | |(euphoria, weakness, coma, convulsions), fixed dilated |correction of acidosis | |
| | |pupils, | | |
|Ethylene Glycol |( ox phos, (cell resp, and |Ca oxalate crystals damage tissues leading to pulm |Ethanol, Na Bicarb, hemodialysis, |toxicity via metabolism to oxalic acid, sweet taste, |
| |(glucose metab |edema, CHF, tachycardia, renal failure |Fomepizole |toxic doses as low as 100 mL, LARGE ANION GAP ACIDOSIS |
|Hydrocarbons |many |CNS depression, pneumonitis, edema, hemorrhagic |prevent aspiration |no emesis unless ingestion exceeds 1mL/KG or if |
| | |bronchopneumonia, | |contains metals, camphor, or insecticides |
|Atropine |Antimuscarinics |delirium, hallucinations, seizures, coma, tachycardia, |Physostigmine but not with TCAs, | |
| | |HTN, hyperthermia, mydriasis |control hyperthermia | |
|Cholinomimetics |OP inhibitors of AChE, Carbamate |Anxiety, agitation, seizures, coma, brady or |support respiration, Atropine, | |
| | |tachycardia, pinpoint pupils, salivation, sweating |Praloxidime | |
| | |(SLUD) | | |
|Opiods |Heroin, Morphine |Lethargy, sedation, coma, cool skin, bradycardia, |Naloxone, support respiration | |
| | |hypotension, hypoventilation, pinpoint pupils | | |
|Salicylates |uncouple ox phos |anion gap metabolic acidosis, lethargy, seizures, |alkalinize urine, potassium, Na | |
| | |hypokalemia, dehydration, hyperthermia |bicarb | |
|Sedatives-Hypnotics |Barbiturates, Ethanol, |hypotension, hypothermia, nystagmus, decreased muscle |Flumenazil for BDZ | |
| |Benzodiazepines |tone | | |
|Stimulants |Cocaine, Amphetamines |ANS modulation (vasoconstriction, myocardial |control seizures, BDZ, control |myocardial toxicity treated with hypertonic Na bicarb |
| | |stimulation), ventricular arrythmias and hypotension |hypterthermia | |
|Tricyclic Antidepressants |Fast Na channel block, (inotropism|widened ORS complex, CCC (coma, convulsion, |Diazepam (seizures), Phenytoin | |
| | |cardiotoxicity |(arryth) | |
|Acetaminophen |NAPQI reactive intermediate forms |No immediate effects short of N/V and malaise, |N-Acetyl Cysteine |reduced GSH primary reason for toxicity |
| |adducts |Hepatotoxic w. death in 7-10 days | | |
Anion Gap (for this class) is (Na + K) – (HCO3 + Cl) which should normally be 12-16 meq/L
Treatment of Intoxication
Chelators bind and stabilize metals, are water soluble (Renal excretion), often administered in Ca form (since will complex endogenous Ca)
|Drug |MOA |Use |Side Effects |Miscellaneous |
|Dimercaprol |chelator |acute Arsenic and Mercury, NOT Cadmium and Iron |tachycardia, HTN, N/V, ( PT |not cure neurological effects, Parenteral admin |
|Calcium Disodium Edetate (CDE)|chelator |Iron, Lead, Zinc |Nephrotoxicity (avoid in RTN) |IV admin, minimize toxicity with hydration and ................
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