Toxicology Basics Blended

Toxicology Basics

  • Definition: Study of the adverse effects of chemicals on living organisms.

Poisonings Per Month

  • Trends: Poisoning rates vary by month.

  • Significant Months: Some months show a higher frequency of incidents than others.

  • Reference: Nancy Caroline 6th ed. 33- Figure 2

Toxicologic Emergencies (1 of 2)

  • Types of Emergencies:

    • Unintentional toxicologic emergencies

    • Medication dosing errors

    • Childhood poisonings (unreliable narrators; they can sometimes lie or not even tell you what they took to avoid getting in trouble)

    • Workplace hazards

    • Simple neglect or oversight

    • Reference: Nancy Caroline 6th ed. 33-2

Poisoning Statistics

  • Categories:

    • Unintentional

    • Intentional

    • Adverse reactions

    • Unknown

    • Source: https://www.poison.org/poison-statistics-national

Unintentional Poisoning Categories

  • Statistics:

    • General (non-specific): 46.1%

    • Environmental: 2.5%

    • Occupational: 1.4% (chlorine in pools)

    • Therapeutic Error: 14.2% (mis/over/under dose)

    • Misuse: 8.5%

    • Food Poisoning: 0.9%

    • Unknown: 0.2%

    • Source: https://www.poison.org/poison-statistics-national

Intentional Poisonings

  • Categories:

    • Suicide: patient’s that are attempting to harm themselves are more likely to use more toxic and lethal medicine.

    • Misuse

    • Abuse

    • intent to harm others

    • Unknown

    • Source: https://www.poison.org/poison-statistics-national

Outcome by Exposure Intent (2020)

  • Data Overview:

    • Unintentional exposure results in various outcomes.

    • Intentional poisoning can lead to severe effects or death.

    • Source: https://www.poison.org/poison-statistics-national

Most Common Substances Involved in Poisoning

  • Statistics:

    • Cosmetics: 10.8%

    • Cleaning Supplies: 10.7%

      • both easily accessible not just in where it is stored but its availability

    • Analgesics: 7.6%

    • Homeopathic: 7.0%

    • Foreign Bodies/Toys/Misc: 6.5%

    • Vitamins: 4.8%

    • Topical Preparations: 4.2%

    • Plants: 3.6%

    • Pesticides: 3.3%

    • Source: https://www.poison.org/poison-statistics-national

Most Serious Pediatric Poisoning Causes

  • Data:

    • Analgesics: 60 cases (20.55%)

    • Fumes/Gases/Vapors: 57 cases (19.52%)

    • Unknown Drug: 22 cases (7.53%)

    • Batteries: 16 cases (5.48%)

    • Cardiovascular Drugs: 15 cases (5.14%)

    • Stimulants and Street Drugs: 14 cases (4.79%)

    • Antihistamines: 13 cases (4.45%)

    • Alcohols: 10 cases (3.42%)

    • Chemicals: 9 cases (3.08%)

    • Anesthetics: 7 cases (2.40%)

    • Source: https://www.poison.org/poison-statistics-national

Overdose Drugs

  • Statistics from 2000-2016:

    • Significant increase in overdose deaths due to synthetic opioids other than methadone (20,145 cases).

    • Other drugs include heroin (15,446), natural and semi-synthetic opioids (14,427), cocaine (10,619), and methamphetamine (7,663).

    • Source: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm

Iron Overdose

  • classified toxicity: corrosive and cellular
    - Corrosive toxicity: Iron can cause damage to the gastrointestinal tract, leading to ulceration and bleeding.

Battery Ingestion/magnets

  • when batteries are ingested they can still conduct electricity and burn through tissue and organs

  • magnets, when strong enough can rupture and or obstruct bowels and intestines

Toxicologic Emergencies (2 of 2)

  • Types:

    • Intentional poisoning

    • Bioterrorism

    • "Date rape" drugs

    • Pharmacologic agents in homicide

    • Recreational drugs

Poison Centres in Canada

  • Information:

    • Essential resource for cases of poisoning.

    • Information specialists collect data on:

      • Name

      • Gender

      • Weight (physiological differences, and ability to metabolize the substance)

      • Substance and quantity swallowed

      • information on the label

      • time (when or how long ago was the substance swallowed)

Routes of Absorption (1 of 3)

  • Ingestion:

    • Effects can be delayed.

    • Considerations: what was ingested, assessment clues like burns or irritation.

Assessment Clues

  • Recognition:

  • Signs of poisoning based on visible symptoms:

    • Mucosal irritation

    • Unexpected symptoms

Treatments

  • Antidotes: Limited options available:

    • Acetylcysteine for Acetaminophen poisoning

    • Amyl nitrite for cyanide (house fire, apple seeds)

    • Digibind for digoxin

    • Naloxone for opioids

    • Specific antidotes for various poisons

Treatments (Continued)

  • antidotes most be used within the hour of consumption, to make sure the pills or products have not been digested yet.

  • Other Treatments when other antidotes arent available

    • Syrup of Ipecac

    • Activated charcoal- sponge; absorbs chemicals and toxins. you only have an hour after ingestion to use activated charcoal to reverse the effects of other toxins.

Gastric Lavage

  • Procedure: Used in certain cases of poisoning to clear harmful substances from the stomach.

    • Reference: https://www.youtube.com/watch?v=uf0ms5XzwZo

Treatments (Continued)

  • Hemodialysis: Effective in specific cases of poisoning where the toxic substance is already in your blood stream.

Routes of Absorption: Inhalation

  • Examples: Exposure to substances like carbon monoxide, chlorine, which can have rapid effects.

Contact Dermatitis

  • Reaction: Caused by skin contact with toxic substances (e.g., poison ivy).

Routes of Absorption: Injection

  • Examples: Insect bites and illicit drug use can result in rapid effects.

Understanding and Using Toxidromes (1 of 2)

  • Concept: Similar signs and symptoms produced by various drugs.

  • Example: Narcotics and their effects.

Stimulants (1 of 5)

  • Characteristics: High potential for abuse leading to rapid addiction.

  • Clinical Presentation: Can result in severe side effects including psychosis and seizures.

Stimulants (2 of 5)

  • Types:

    • Cocaine: A powerful stimulant with significant impact on public health.

Stimulants (3 of 5)

  • Other Types: Amphetamines and their medical uses; MDMA and its effects.

Alcoholism (1 of 4)

  • Prevalence: Widely abused, with significant portions of the Canadian population consuming alcohol.

Alcohol-associated Incidents

  • Impact: Notable correlation between alcohol consumption and ambulance calls in college towns.

Narcotics, Opiates, and Opioids (1 of 4)

  • Division: Includes substances derived from opium and synthetics like fentanyl.

Management of Narcotics Overdose

  • Care: Ensure airway is patent, ventilation is adequate; administer naloxone as needed.

Carbon Monoxide (3 of 5)

  • Challenges: Diagnosis difficulties and symptoms are vague, requiring fast response under specific circumstances.

Cyanide Incident (1982)

  • Background: Notorious case illustrating sudden and impactful poisoning through a common medication.

Summary

  • Key Takeaways:

    • Types of toxicologic emergencies, routes of absorption, toxidromes, substance abuse, assessment, and management strategies.