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The principal features of severe methanol poisoning are metabolic acidosis and blindness. The first priority of management is to inhibit methanol metabolism using either intravenous ethanol or fomepizole. In addition, sodium bicarbonate and folinic acid should be administered to correct acidosis and increase formate metabolism respectively. Haemodialysis will enhance methanol and formate elimination...
Opioids cause a well-recognized toxidrome. In overdose their toxicity relates to both the amount ingested and speed of absorption. Addicts run into difficulty when a supply changes or they have had a period of relative abstinence resulting in loss of tolerance. Some opioids have additional properties which account for their toxicity, including dextropropoxyphene, methadone and tramadol. Naloxone is...
Lead poisoning is one of the oldest diseases known to man, and exposures still occur occupationally and following ingestion of lead-containing materials. Lead may be absorbed following inhalation or ingestion and is stored primarily in bone; elimination is predominantly renal. There are two principal mechanisms of lead toxicity. First, lead complexes with important functional chemical groups and,...
Bites by venomous snakes cause more than 85,000 deaths and 150,000 permanent sequelae each year, while scorpion stings kill thousands of children. These are neglected environmental diseases of the rural tropics. Most species of medically-important venomous snakes are elapids (e.g. cobras), vipers, adders or pit vipers and rattlesnakes. Clinical effects of their bites include local swelling, blistering...
Hydrogen sulphide is a potent inhibitor of cytochrome oxidase A 3 and a mucous membrane irritant at lower concentrations. Cyanosis, confusion, pulmonary oedema, coma, convulsions and respiratory arrest are common in severe poisoning and neurological and neuropsychiatric sequelae have been observed. Rescue, resuscitation if necessary, and the administration of oxygen are the mainstay of treatment.
The majority of patients who ingest thyroxine accidentally or deliberately remain asymptomatic. Sinus tachycardia, tremor, anxiety, irritability, hyperactivity, fever, sweating and diarrhoea occur commonly after a substantial overdose of thyroxine or tri-iodothyronine. Propranolol (40 mg t.d.s.) for 5 days is very effective in controlling symptoms.
Lithium has a narrow therapeutic index and poisonings are mostly due to chronic overdose secondary to an impaired renal elimination. Neurologic toxicity is predominant and poisonings can be classified into three grades according to the severity of symptoms. Lithium serum concentrations must be interpretated according to the type of poisoning (acute, acute-on-chronic or chronic) which explains the...
Sulphur dioxide forms sulphurous acid on contact with mucous membranes which causes irritation to the eyes, mucous membranes and skin. In severe cases, dyspnoea, rhinorrhoea, bronchorrhoea, bronchoconstriction, cyanosis, pulmonary oedema and respiratory arrest occur. Reactive airways disease and obstructive impairment of ventilatory function are observed subsequently; bronchiolitis obliterans has...
In quinine and chloroquine poisoning, severe cardiovascular toxicity results from their Na + -channel blocking effects with hypotension, shock, dysrhythmias and cardiac arrest. Other features include coma, convulsions and, in quinine poisoning, oculotoxicity. Severity of symptoms is closely related to the dose ingested and plasma/serum concentration. In chloroquine poisoning, hypokalaemia...
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...
300,000 people die each year from pesticide self-poisoning in the rural developing world where pesticides are widely used in smallholder agricultural practice. Significant acute poisoning is much less common in industrialized countries and it is the long-term effects of low-dose chronic exposure that most concern the population. Organophosphorus and carbamate insecticides cause most acute fatalities;...
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, 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 10 mg intravenously (100 μg/kg body weight...
Lysergic acid diethylamide (LSD) acts as an antagonist at peripheral 5-HT receptor subtypes, but as a 5-HT 2A receptor agonist in the CNS. In severe poisoning, hyperreflexia, tremor, muscle twitching, coma, seizures, hypotension and respiratory arrest have been reported. In addition, changes in perception, mood and behaviour, panic, agitation and excitement, visual hallucinations, delusions...
Isopropanol is oxidized to acetone by hepatic alcohol dehydrogenase. The effects of isopropanol on the nervous system are similar to those of ethanol, but are probably more severe. Coma and respiratory depression are the major sequelae following substantial exposure. The mainstay of treatment is supportive care, though in severe cases haemodialysis will remove isopropanol and acetone effectively.
The incidence of fungal poisoning varies a lot in a global perspective and it is related to local habits, economic factors and lifestyle. Among thousands of mushroom species fewer than a hundred are toxic. Most fungal toxins cause mild or moderate poisoning. It is, however, the ingestion of a few species of extremely poisonous fungi that define the medical dimension of the problem. Mushroom poisoning...
The intentional inhalation of toluene-containing glues, gas (lighter) fuels, nitrites and less commonly petrol (gasoline) produces features similar to alcohol inebriation, and death can occur from arrhythmias. Chronic abuse may produce severe neurological, renal, gastrointestinal and metabolic sequelae.
Non-steroidal anti-inflammatory drugs are widely available and a common component of overdose. Toxic effects are principally renal. At high doses coma and hepatic injury are rarely reported. Treatment is to a large extent supportive. Mefenamic acid is notable as it causes convulsions which are usually short-lived.
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