PRINCIPLES OF TOXICOLOGY
Toxicology is the study of the toxic or harmful effects of chemicals. It is also concerned with the symptoms and treatment of poisoning and the identification of the poison.
The variety of potential adverse effects and the diversity of chemicals in the environment make toxicology a very broad science. There are several fields of toxicology, including environmental (e.g., air and water pollution), economic (e.g., food additives, pesticides), legal (e.g., forensics, regulation of emissions, and additives), laboratory (e.g., analytical testing for chemicals), and biomedical (e.g., toxicities of drugs used to treat disease in humans and animals).
The general principles of the toxic effects of chemicals are, for the most part, the same as the principles of the therapeutic effects of drugs.
GENERAL PRINCIPLES IN THE TREATMENT OF POISONING
Intentional and accidental poisonings are major medical problems. Every natural or synthetic chemical can cause injury if the dose is high enough.
The single most important treatment of poisoned patients is supportive care.
This is so important. You must treat the patient and not the poison. Provide airway support and ventilation and support blood pressure if needed. Toxicology screens of blood or urine take time and rarely change your therapy. If you know the poison, great; if not, treat the patient.
To reduce absorption in an alert, relatively asymptomatic patient, use activated charcoal.
To reduce the absorption of poisons from the gastrointestinal (GI) tract one can empty the stomach with gastric lavage, which needs to be carried out within 1 hours of ingestion, by administration of activated charcoal. Activated charcoal remains in the GI tract, absorbing poison throughout. Induction of emesis is no longer recommended.
To enhance elimination, a number of techniques can be used. Multiple doses of charcoal reduce the half-life and increase clearance. Increasing the pH of the urine enhances elimination of weak acids. Hemodialysis and hemoperfusion can be used to help remove specific agents from the blood.
For some overdoses and poisons, specific antidotes are available. These are prime examination material and are relatively easy to learn (some you already know).
++ Table Graphic Jump Location
|Toxin ||Antidote |
|acetaminophen ||N-acetylcysteine |
|arsenic, mercury, gold ||BAL (dimercaprol) |
|β-blocker ||glucagon |
|benzodiazepines ||flumazenil |
|carbon monoxide ||oxygen, hyperbaric oxygen |
|coumarin ||vitamin K |
|cyanide ||nitrites |
|digoxin ||digoxin-specific Fab fragments |
|ethylene glycol or methanol ||fomepizole |
|heparin ||protamine |
|iron ||deferoxamine |
|isoniazid ||pyridoxine |
|lead ||dimercaprol, penicillamine, or succimer |
|narcotics ||naloxone |
|nitrites ||methylene blue |
|organophosphates ||atropine, pralidoxime |
Scan through this list and pick out the ones you already know. You should remember that flumazenil is the benzodiazepine receptor antagonist and that naloxone is the narcotic antagonist. You should know from biochemistry that oxygen and carbon monoxide compete for the ...