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Lithium has a narrow therapeutic index and most poisonings are chronic, secondary to impaired renal elimination. Neurological features predominate. Serum lithium concentrations must be interpreted according to the type of poisoning (acute, acute-on-therapeutic or chronic). Apart from symptomatic measures, the major therapeutic objective is to enhance lithium elimination either by administration of...
Substantial ingestion of an anticoagulant can result in haemorrhage into any internal organ; severe blood loss can result in hypovolaemic shock, coma and death. If active major bleeding occurs, dried prothrombin complex 25–50 units/kg and phytomenadione 10–20 milligrams intravenously (250 micrograms/kg body weight for a child) should be given.
Acetone is a mucous membrane irritant that can be absorbed by inhalation, by ingestion and through the skin. Its metabolism leads to increased glucose production. At high concentrations, it is a central nervous system depressant. Haemodialysis to enhance elimination may be indicated in severe poisoning.
Assessment of an acutely poisoned patient involves taking an appropriate history, assessing the level of consciousness, ventilation and circulation, undertaking a physical examination, and requesting appropriate toxicological and non-toxicological investigations. Diagnosis is based on the history, circumstantial evidence (if available), a cluster of common features (if present) and, occasionally,...
Ricin is a type 2 ribosome-inactivating protein derived from the beans of the castor oil plant, Ricinus communis. It exerts toxicity by inhibiting protein synthesis. Many of the features seen in poisoning can be explained by ricin-induced endothelial cell damage, which leads to fluid and protein leakage and tissue oedema, causing so-called ‘vascular leak syndrome’. Inhalational exposure is the primary...
Antidotes exert their beneficial effects by a variety of mechanisms, including forming an inert complex with the poison, accelerating detoxification of the poison, reducing the rate of conversion of the poison to a more toxic compound, competing with the poison for essential receptor sites, blocking essential receptors through which the toxic effects are mediated, and bypassing the effect of the poison...
Initial management involves the treatment of any potentially life-threatening conditions, such as airway compromise, breathing difficulties, haemodynamic instability and serious dysrhythmias. Thereafter, convulsions should be treated, fluid, acid–base and electrolyte abnormalities corrected, and measures taken to correct hypothermia or hyperthermia.
Methaemoglobin is formed when ferrous haemoglobin iron (II) is oxidized to ferric iron (III), which cannot participate in oxygen transport. Methaemoglobin-forming chemical groups of particular importance in poisoning are organic nitrites (e.g. amyl nitrite, isobutyl nitrite) and amino- or nitro-derivatives of benzene (e.g. aniline, dapsone, lidocaine). An asymptomatic, apparent ‘cyanosis’ is the earliest...
Management of poisoning involves the assessment and treatment of airway compromise, ventilation impairment and haemodynamic instability. Thereafter, temperature disturbances should be treated, convulsions controlled, fluid, acid–base and electrolyte abnormalities corrected, and complications such as methaemoglobinaemia, rhabdomyolysis and serotonin syndrome diagnosed and managed optimally. There is...
Substantial ingestion of an anticoagulant may result in haemorrhage into any internal organ; severe blood loss may result in hypovolaemic shock, coma and death. If active bleeding occurs, dried prothrombin complex (formerly known as prothrombin complex concentrate) 50 units/kg or recombinant activated factor VII 1.2–4.8 mg or fresh frozen plasma 15 mL/kg (if no concentrate is available) and phytomenadione...
Life-threatening poisoning from plant ingestions is rare though many plants contain potentially toxic substances. These include antimuscarinic agents, calcium oxalate crystals, cardioactive glycosides, pro-convulsants, cyanogenic compounds, mitotic inhibitors, nicotine-like alkaloids, alkylating agent precursors, sodium channel activators and toxic proteins (toxalbumins). Management is generally supportive...
Ricin is derived from the beans of the castor oil plant, Ricinus communis. Many of the features seen in poisoning can be explained by ricin-induced endothelial cell damage, which leads to fluid and protein leakage and tissue oedema, causing so-called ‘vascular leak syndrome’. Ricin’s use as a potential bioterrorism agent makes inhalational exposure the primary concern. Both vaccination (prophylaxis)...
Assessment of an acutely poisoned patient involves the taking of an appropriate history, assessment of the level of consciousness, ventilation and circulation, a physical examination, and requesting appropriate toxicological and non-toxicological investigations. Diagnosis is based on the history, circumstantial evidence (if available), a cluster of common features (if present) and, occasionally, the...
Methaemoglobin is formed when ferrous haemoglobin iron (II) is oxidized to ferric iron (III), which cannot participate in oxygen transport. Methaemoglobin-forming chemical groups of particular importance in poisoning are organic nitrites (e.g. amyl and isobutyl nitrite) and amino- or nitro-derivatives of benzene (e.g. aniline, dapsone and lidocaine). An asymptomatic, apparent ‘cyanosis’ is the earliest...
Initial management involves the treatment of any potentially life-threatening conditions, such as airway compromise, breathing difficulties, haemodynamic instability and serious dysrhythmias. Thereafter, convulsions should be treated, fluid, acid–base and electrolyte abnormalities corrected, and hypothermia managed by using a space blanket. Children under 5 years old who are suspected of having ingested...
Antidotes exert their beneficial effects by a variety of mechanisms, including forming an inert complex with the poison, accelerating detoxification of the poison, reducing the rate of conversion of the poison to a more toxic compound, competing with the poison for essential receptor sites, blocking essential receptors through which the toxic effects are mediated, and bypassing the effect of the poison...
Acetone is a mucous membrane irritant, which can be absorbed by inhalation, ingestion and through the skin. Its metabolism leads to increased glucose production. At high concentrations it is a central nervous system depressant. Haemodialysis to enhance elimination may be indicated in severe poisoning.
Management of poisoning involves the assessment and treatment of airway compromise, ventilation impairment and haemodynamic instability. Thereafter, temperature disturbances should be treated, convulsions should be controlled, fluid, acid–base and electrolyte abnormalities corrected, and complications such as methaemoglobinaemia, rhabdomyolysis and serotonin syndrome diagnosed and managed optimally...
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