drug poisoning
DESCRIPTION
Definitions, Common Drug Poisoning, Drug Overdosage Evaluation, Management, Case ScenarioTRANSCRIPT
Dr Hemanth S Naik
Drug Poisoning & Overdosage
Dr Hemanth S Naik
Definitions
Common Drug Poisoning
DO Evaluation
Management
Case Scenario
Drug Abuse
Presentation Flow
Dr Hemanth S Naik
PoisonAny substance which when administered in living body through any route (Inhalation, Ingestion, surface absorption etc) will produce ill-health or death by its action which is due to its physical chemical or physiological properties.
Dr Hemanth S Naik
DrugAny substance or product that is used or intended to be used to modify or explore physiological systems or pathological states for the benefit of the recipient.
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Common Drug Poisoning
Analgesics
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Common Drug Poisoning
Barbiturates&
Benzodiazepines
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Common Drug Poisoning
Narcotics
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DO EvaluationMotive
Co-Morbidity
Related Drug
CO-Ingestion
Symptoms & Signs
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Motive
Accidental
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Motive
Suicidal
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Motive
Homicidal
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Co-morbidity
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Related DrugType
Time
Preparation
Dosage
?
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Co-Ingestion
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Symptoms & SignsHyperventilation
Amphetamine
Cocaine
Isoniazid
Anticholinergics
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Symptoms & SignsHypoventilation
Barbiturates
Opioids
Ethanol
Sedative-hypnotics
Capnograph
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Symptoms & Signs
Hypothermia
Ethanol
Sedatives
Opioids
Barbiturates
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Hypotension
Antihypertensives
Barbiturates
Diuretics
Symptoms & Signs
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Symptoms & Signs
Normal: 60-100 bpmBradycardia: <60 bpmTachycardia : >100 bpm
Bradycardia
Opioids
Digoxin
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InvestigationsBlood Glucose Test
SpO2
Serum Chemistry
Drug & Toxin Levels
ECG
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Management
ABCGIT
Decontamination
Enhance Elimination
Antidote
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GI Tract Decontamination
Emesis Oro Gastric
Lavage
Activated Charcoal
Whole Bowel Irrigation
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Seldom use, have Risk
Acute ingestion of potentially toxic substance ( < 1hr)
Pre-hospital setting with long transport time to medical care
Emesis
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Oro Gastric Lavage (GL) Large-bore fenestrated
orogastric tube (36-40 Fr) Require protected
airway Amount of poison
ingested is potentially life threatening
Within 60 minutes of ingestion (Except anti-cholinergic < 12 hr ingestion; salicylate < 24 hr ingestion)
Contraindications• Caustic/ Corrosive
ingestion• Large foreign bodies • Airway not protected• Suspected UGI injury• Hypoxia
Dr Hemanth S Naik
Activated Charcoal
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Large Surface Area Binding property Interrupts
Enterohepatic & Enteroentric Circulation
Activated Charcoal
One gram of activated carbon has the surface area (>400 m2) of approximately two tennis courts (260 m2) !
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Activated Charcoal
• Single Dose: 1g/kg• Multiple Dose: 0.5g/kg Q2-6H Dose
• Digoxin;Amitriptyline;Phenobarbitone; Dozepin;Theophylline;Salicylates;Phenobarbital;Dapsone;phyentoin;carbamazepine;Aspirin
Indication
• Ileus • GI perforation• Loss of airway protection
Contraindication
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Whole Bowel Irrigation• Mechanically flushing
the ingested poison out of the GIT before it can be absorbed into the body
• Iso-osmolar solution of polyethylene glycol
• Rate: 1-2L per hour (minimally)
• P.O. or R/T, Entire procedure usually takes 4 to 6 hours
• Till rectal effluent clear
Dr Hemanth S Naik
Whole Bowel Irrigation
IndicationNot well-absorbed by activated charcoal
(e.g. Fe, Li, Pb, Zn)
Sustained release/ Enteric coasted preparation
Rising drug level despite GL/AC
Dr Hemanth S Naik
Enhance Elimination
•Urinary Alkalinization
•Saline Diuresis
•Haemodialysis and Haemoperfusion
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AntidoteDrug Antidote
Benzodiazepine Flumazenil
Beta blockers Glucagon
Calcium blockers Calcium
Iron or Aluminum Deferroxamine
Isoniazide (INH) Vit B6
Methemoglobinemia Methylene blue
Methanol Ethanol
Opioid Naloxone
TCA anti-depressants Sodium bicarbonate
Coumarin Vit K1
Acetaminophen N-acetylcysteine
substance which can counteract a form of poisoning
Case Scenario
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Case
Nausea & VomitingAbdominal Pain
Child aged about 4 years
History of ingestion of unknown white tablets
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EvaluationMotive
Co-Morbidity
Related Drug
CO-Ingestion
Symptoms & Signs
Accidental
None
Not Determined
Suggestive of Paracetamol Poisoning
Dr Hemanth S Naik
•90-95% hepatic•t1/2: prolonged
•>90% Non-toxic sulfate & glucuronide conjugates pathway
•Increase in NAPQI, depletes glutathione stores->NAPQI accumulates
•Hepatocellular centribular necrosis and renal injury
•90-95% hepatic•t1/2: 2-3 hrs
•>90% Non-toxic sulfate & glucuronide conjugates pathway
•<5% by cytochrome P450 2E1 to N-acetyl-para-benzoquinoneimine (NAPQI),
Paracetamol
Therapeutic Overdose
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Paracetamol Overdose
• 0.5-24h• Nausea, vomiting, abdominal pain
Phase 1
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Management
ABCGIT
Decontamination
Enhance Eliminatio
nAntidote
AirwayBreathingCirculation
Gastric Lavage
Activated Charcoal
Urine Alkanizatio
nN-Acetyl Cysteine
Drug Abuse
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MorphineMorpheus-God of Dreams
Opiate analgesic
Addiction
Dependence
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Opium
NarcoticLatex of opium poppies Papaver somniferum
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Cultivation
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History
Sumerians4000 BC
Hippocrates460-357 BC
Opium War17th Century
F. W. Serturner1803
Sumerians4000 BC
Hippocrates460-357 BC
Opium War17th Century
F. W. Serturner1803
Dr Hemanth S Naik
Opium
NaturalMorphinecodeine
Semi SyntheticHeroin
HydromorphoneOxymorphone
oxycodone
SyntheticMeperidineMethadone
Fentanyl, etc
Classification
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Extraction
Raw Opium Morphine
BaseHeroin Base
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Heroin
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Medication• Methadone• Levo-alpha-acetyl-
methadol (LAAM)• Buprenorphine• Naltrexon
Behavioral Therapy • Counseling • Build Self Confidence• Build Personality
Treatment
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?
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Thank You