Poisoning v20241119

Chapter Three: Acute Poisoning

  • Author: MD & PhD Jia Xu

  • Affiliations:

    • First Affiliated Hospital of Zhejiang University

    • Chemical Poisoning Prevention and Control Center of Zhejiang Province

    • Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases

CONTENT

  1. Case Analysis

  2. Definition of Poisoning

  3. Acute Poisoning Treatment Principles

  4. Acute Organophosphate Insecticide Poisoning

Case Studies

  • Case 1:

    • Patient: 14-year-old female, unconscious for 30 mins, past health is good, conscious in mild coma, limbs move when stimulated.

    • Emergency Actions: Monitor airway, circulation, and breathing.

  • Case 2: 80-year-old patient, monitoring vital signs and results for myocardial enzymes and liver function.

Definition of Poisoning

  • Poisoning: Clinical state from exposure to a foreign chemical.

  • Toxicity: Ability of a chemical to cause bodily damage.

  • Selective Toxicity: Harmful effects on certain organisms while harmless to others.

  • Types of Poisoning:

    • NORPITAL Poisoning: Acute, chronic, occupational, non-occupational, intentional, and unintentional.

Acute Poisoning

  • Definition: Pathological changes after short-term exposure to toxic substances.

  • Acute Toxicity Symptoms: Cholinergic crisis, unstable vital signs, depressed respiration.

Treatment Principles

  • Goals: Remove toxicants, reduce absorption, and provide supportive care.

  • Antidotes:

    • Examples include atropine for organophosphate poisoning.

Organophosphate Insecticide Poisoning

  • Etiology: Often from pesticides; high global exposure.

  • Mechanism: Inhibition of acetylcholinesterase (AchE); causes excessive acetylcholine accumulation.

  • Principal Symptoms: Cholinergic crisis, muscarinic and nicotinic effects described by mnemonic DUMBBELS (Diarrhea, Urination, Miosis, Bronchospasm, Emesis, Lacrimation, Salivation).

Guidelines for Acute Poisoning Management

  • In-hospital: Focus on decontamination, symptom management, and monitoring.

  • PAM (Pralidoxime): Reactivates cholinesterase; helps with nicotinic effects.

Emergency Department Evaluation

  • Assessment: Gather history of exposure, monitor vital signs, obtain blood gas analysis.

  • Diagnosis Confirmation: Decreased plasma cholinesterase activity.

Notable Incidents

  • Case Analysis Examples:

    • Cholinergic crisis in a suicide attempt, treatment involved atropine and pralidoxime.

    • Anticholinergic syndrome exhibited through confusion, tachycardia, and dry skin.