Classification of
Poisons
Poisons
Poison is a substance, natural or synthetic,
that causes damage to living tissues and
has an injurious or fatal effect on the body,
whether it is ingested, inhaled, or absorbed
or injected through the skin.
Includes Toxic and Venom
All things are poison and nothing is without
poison, only the dosage permits something
not to be poisonous.
Paracelsus
Poisoning
Is when the person is exposed to a
substance that can damage their
health or put their life in danger.
Signals of Poisoning
Nausea or vomiting.
Diarrhea.
Chest or abdominal pain.
Trouble breathing.
Sweating.
Changes in consciousness.
Seizures.
Headache.
Dizziness.
Weakness.
Irregular pupil size.
Burning or tearing eyes.
Abnormal skin color.
Burn injuries around the lips or tongue
Types of Toxic Reactions
Phototoxic and photoallergic reactions.
Formation of free oxygen radicals.
Further mechanisms dependent on the
specific type of toxic drugs.
Local or systemic toxicity
Reversible and irreversible effects
Chemical cancerogenesis
Malformations (teratogenesis)
Allergic reactions
Poisons
Most frequently influenced organs:
Liver
Kidney
Brain
Lung
Intestine
Poison: Evaluation
recognition of poisoning
identification of agents involved
assessment of severity
prediction of toxicity
Poisons: Management
Provision of supportive care
Prevention of poison absorption
Enhancement of elimination of
poison
Administration of antidotes
Specific therapy, if available
antivenins
antitoxins
chelators
Supportive care
ABC
Vital signs, mental status, and pupil size
Pulse oximetry, cardiac monitoring, ECG
Protect airway
Intravenous access
cervical immobilization if suspect trauma
Rule out hypoglycaemia
Naloxone for suspected opiate poisoning
Preventing absorption
Gastric lavage
Not in unconscious patient unless intubated (risk
aspiration)
Flexible tube is inserted through the nose into the stomach
Stomach contents are then suctioned via the tube
A solution of saline is injected into the tube
Recommended for up to 2 hrs in TCA & up to 4hrs in
Salicylate
Induced Vomiting
Ipecac - Not routinely recommended
Risk of aspiration
Preventing absorption
Activated charcoal
Adsorbs toxic substances or irritants, thus inhibiting
GI absorption
Addition of sorbitol laxative effect
Oral: 25-100 g as a single dose
repetitive doses useful to enhance the elimination of
certain drugs (eg, theophylline, phenobarbital,
carbamazepine, aspirin, sustained-release products)
not effective for cyanide, mineral acids, caustic
alkalis, organic solvents, iron, ethanol, methanol
poisoning, lithium
Elimination of poisons
Renal elimination
Medication to stimulate urination or
defecation may be given to try to flush the
excess drug out of the body faster.
Forced alkaline diuresis
Infusion of large amount of NS+NAHCO3
Used to eliminate acidic drug that mainly
excreted by the kidney
Serious fluid and electrolytes disturbance
may occur
Need expert monitoring
Elimination of poisons
Hemodialysis or hemoperfusion:
Reserved for severe poisoning
Drug should be dialyzable i.e. protein
bound with low volume of distribution
may also be used temporarily or as
long term if the kidneys are damaged
due to the overdose.
Antidotes
A therapeutic substance used to
counteract the toxic action(s) of a
specified xenobiotic.
Physical Antidote
Chemical Antidote
Pharmacological Antidote
Physical Antidote
Agent use to interfere with poison
through physical properties, not
change their nature
Adsorbing (activated charcoal)
Coating
Dissolving
Activated charcoal
Considered to be medicine's most
powerful absorbent and as such, it readily
works to absorb many toxins and poisons,
rendering them harmless
Charcoal acts to purify and cleanse the
body due to its amazing ability to attract
poisons to itself. Charcoal has a wide
range of absorption. Heavy metals,
viruses, bacterial and fungal toxins, etc.
are all absorbed effectively.
Chemical Antidote
Interact specifically with a toxicant,
or neutralize the toxicant
Complex Formation: Antidote make
complex with the toxicant making it
unavailable to cross the membrane or to
interact with receptors
Metabolic conversion: Detoxification
to less toxic product
Pharmacological Antidote
Counteract the effects of a poison by
producing the opposite pharmacological
effects
Preventing the formation of toxic metabolites
Facilitation of more rapid or complete
elimination of a toxicant
Competing with the Toxicants action at a
receptor site
Blocking receptors responsible for the toxic
effect
Aiding in the restoration of normal function
Different Classifications of Toxic
Agents:
Length of exposure:
Acute toxicity results from brief exposure.
Chronic toxicity exposure for months or
years. (Chronic low level exposure common
route in the workplace)
Route of exposure:
Direct contact
Ingestion
Inhalation
Injection
Different Classifications of Toxic
Agents:
Based on their toxic effects in the
body
Based on their behavior
Based on their origin
Based on their use
Based on the source asnaturally
occurringandman-made
Classification of Poisons
Based on their chemical and
physical nature
Gaseous
Organic
Inorganic
Miscellaneous
Gaseous Poisons
These poisons are present in the
gaseous state and if inhaled, destroy
the capability of the blood as a carrier
of oxygen and irritate or destroy the
tissues of the air passages and lungs.
Can kill or injure a person if present in a
high enough concentration.
Can cause injury more easily than solid
or liquid poisons because they
diffuse(move) in the air, exposing skin,
and are easily breathed in
Gaseous Poisons
Chemical Weapons Agent
Simple asphyxiants
Particulates
Mitochondrial toxins
Pulmonary irritants
Chemical Weapons Agent
A substance , such as a poisonous gas
rather than an explosive ,which can
be used to kill or injure people.
They interfere with the physiological
processes via chemical reactions
Choking agents (lung irritants)
Vesicants (blister gases)
Blood agents
Nerve gases
Choking agents (lung irritants)
Liquids dispersed in gas form
Fluid builds up in lungs & victim chokes on
own fluid
Rapid or delayed depending on the specific
agent.
Chlorine
Chloropicrin (PS)
Diphosgene (DP)
Phosgene (CG)
Choking agents (lung
irritants)
Exposure to low chemical concentrations
causes
chest discomfort
shortness of breath
irritation nose and throat
tearing eyes.
High agent concentrations may quickly cause
swelling of the lungs
respiratory failure
Death
Phosgene
Colorless or as a white to pale yellow
cloud. At low concentrations
Pleasant odor of newly mown hay or
green corn. At high concentrations,
the odor may be strong and
unpleasant.
Vesicants (blister gases)
Skin blisters
Damage eyes, mucous membranes, respiratory
tract, and internal organs
Initial effects rapid
Mustard agents
Destroy different substances within cells of living
tissue"
Initial effects occur 12 to 24 hours after exposure."
Symptoms variable"
- Death can occur from complications after lung
injury.
Vesicants (blister gases)
Victims inhaling blister agents may suffer
damage to their lungs.
A single low-level exposure -temporary impairment
High concentrations/repeated exposures -
permanent damage.
Examples
mustard gas
lewisite
agent T
nitrogen mustard
phosgene oxime
sulfur mustard
Sulfur Mustard Gas
Called mustard because of its horseradish- or
garlic-like smell.
It is fat-soluble, so it dissolves in the oils in
the skin, causing severe chemical burns and
blisters.
Lewisite
Easily penetrates ordinary clothing
Geraniums like odor
Upon skin contact immediate pain and itching
with a rash and swelling. Large blisters
(similar to those caused by mustard gas)
develop after approximately 12 hours
Blood agents
Highly volatile
Rapidly acting
Health Effects
seizures
respiratory failure
cardiac arrest
Agents
Hydrogen cyanide
Cyanogen chloride
Blood agents
Blood agents act through inhalation
or ingestion and impair cellular
oxygen use.
The central nervous system is
especially susceptible to this effect.
Symptoms of blood agent exposure
depend upon the agent concentration
and duration of exposure.
Hydrogen cyanide
Colorless gas
Extremely flammable
Bitter Almond Odor
Toxicity is caused by the cyanide ion, which
halts cellular respiration by acting as a non-
competitive inhibitor for an enzyme in
mitochondria
Cyanogen chloride
Condensed colorless gas
Weakly Bitter Almond Odor
Dangerous because it is capable of
penetrating the filters in gas masks
Nerve Gases
organophosphorus and organophosphate
compounds that inhibit tissue
cholinesterase
Disable enzymes responsible for
transmitting nerve impulses.
Initial effects of occur within 1-10 minutes
of exposure
Death
Within 15 minutes for Tabun, Sarin, and Soman
From 4-42 hours for VX.
Nerve Gases
Class G acting via inhalation
Tabun (GA)
Sarin (GB)
Soman (GD)
Cyclosarin (GF)
Cyclohexyl methylphosphonofluoridate
Class V acting through skin penetration or aerosol
VX
VE
VG (amiton)
VM
Tabun (GA)
First synthesized in 1936
Faint fruity odor
Harder to detect than chlorine,
phosgene, mustard gas, and hydrogen
cyanide
Sarin (GB)
Nearly Odorless
Harder to make than Tabun
More stable than tabun
Six times as potent as tabun
Soman (GD)
Replaced isopropyl alcohol with the
more difficult to make and more
expensive pinacolyl alcohol
Camphor to fruity odor
Twice as potent as Sarin
Easily penetrates skin
Lack o reliable antidote, making it
more difficult treat accidental
exposure
Class V
Simple Asphyxiants
Alveolar
displacement
O2
Non-irritating
No direct
mitochondrial
toxicity
Simple Asphyxiants
Methane
Carbon dioxide
(CO2)
Helium
Nitrogen
Nitrous oxide
Methane
Is a colorless, highly flammable gas
found in abundance in a variety of
industries such as manufacturing and
coal mining.
Althoughmethaneis nontoxic, high
concentrations of the gas can
displace oxygen and prevent
adequate ventilation in the
workplace
Carbon dioxide
Carbon dioxide (CO2) is a colourless and
odourless gas. It is non-flammable and
chemically non-reactive
It is produced during combustion and in
brewing, distillation and other fermentation
processes, and is one of the main
constituents, with methane, of landfill gas
and sewage treatment digester gas.
CO2is also used to increase plant growth by
elevating normal levels in greenhouses etc.
Carbon dioxide
Low concentrations are not harmful.
Higher concentrations can affect
respiratory function and cause excitation
followed by depression of the central
nervous system.
Symptoms
Tachypnea
Tachycardia
emotional upsets
fatigue
Helium
Used mainly in helium balloons, neon
signs and diving gas.
The gas is sometimes misused as an
inhalant
Huffing helium can cut off oxygen
supply or can cause an embolism if a
person inhales too deeply. In
addition, pressurized tank gas can
cause lungs to rupture.
Nitrogen
Is a colorless, odorless and tasteless gas that
makes up 78.09% (by volume) of the air we
breathe. It is nonflammable and it will not support
combustion.
Several harmful effects of nitrogen on human
health include causing vitamin A shortages,
decreasing function of the thyroid gland and
decreasing the blood's ability to carry oxygen.
These effects are seen when nitrogen occurs in an
ion form, such as nitrite or nitrate
Nitrogen compounds are present in organic
materials, foods, fertilizers, explosives and poisons
Nitrous oxide
Nitrous oxide is a colourless, sweet tasting gas
that has been used recreationally since the late
18th century
Nitrous oxide, sometimes called
laughinggas, is one option your dentist may
offer to help make you more comfortable during
certain procedures.
Nitrous oxide is considered to have
relativelylow toxicity However, it can cause
dizziness, so theres a risk of harm from falling
Nitrous oxide
Long-term and heavy-use of nitrous oxide
can lead to vitamin deficiency and
anaemia as a result of theinactivation of
vitamin B12 in the body which can cause
tingling in the fingers, toes and
extremities which can last for hours or
days. More severe cases can lead to
numbness and difficulty walking, and the
risks are heightened in people who are
already B12 deficient.
Simple Asphyxiants:
Symptoms
Loss of consciousness
Minimal warning
Non-irritating
Sustained exposure
Hypoxia
Cardiovascular collapse
Simple Asphyxiants:
Treatment
Safe rescue
100% oxygen
Evaluation for other injuries
Supportive care
Pulmonary Irritants
Can behave in part like simple
asphyxiants
Mucosal irritation
Acid or base formation
Some free radical formation
Pulmonary Irritants: Water Solubility
Highly water soluble:
Ammonia
Sulfur dioxide
Hydrogen chloride
Chloramine
Rapid onset
Sulfur dioxide
a toxic gas with a pungent, irritating smell.
It is released naturally by volcanic activity.
Inhaling sulfur dioxide is associated with
increased respiratory symptoms and disease,
difficulty in breathing, and premature death
Ammonia
Colorlessgaswith a characteristic pungent
smell.
The toxicity of ammonia solutions does not
usually cause problems for humans and other
mammals, as a specific mechanism exists to
prevent its build-up in the bloodstream.
Hydrogen chloride
A colorless gas with a sharp, pungent odor.
Nonflammable
Usedin the production of
hydrochloricacid. It is also an important
reagent in other industrial chemical
transformations, and for the production of
vinyl and alkyl chlorides.
Hydrogen chloride exposure may cause
corrosive injury to the skin , mouth, throat,
esophagus, and stomach.
Pulmonary Irritants: Intermediate
Solubility
Chlorine
A pungent smelling, corrosive, green/yellow gas. The best
known use is in water purification for domestic supplies and in
swimming pools
Exposure better tolerated initially
Increased duration exposure
Subsequent acid formation in upper and lower airways
Delayed effects
Acute lung injury
Pulmonary Irritants: Low
Solubility
Include
Phosgene
Nitrogen dioxide
Prolonged exposure
Delayed
Pulmonary edema
Acute lung injury
Pulmonary Irritants:
Treatment
Removal from exposure
Oxygen
Nebulized bronchodilators
For acid forming agents:
Nebulized sodium bicarbonate
1 part NaHCO3 to 3 parts saline or
water
Primarily for symptomatic relief
Pulmonary Irritants:
Treatment
Supportive care
Admission:
Severely symptomatic patients
Low and intermediate solubility
exposures
Arrange follow-up
Particulates and Aspirants
Gas exchange impaired
Supportive therapy
Intubation
ECMO
Bronchoaveolar lavage
Can be fatal in children
Hydrocarbon Aspiration
Surfactant disruption
Higher severity:
Agents
Low viscosity
Surface tension
High volatility
>30 mL exposures
Hydrocarbon Aspiration:
Symptoms/Signs
Cough
Choking
Dyspnea
Rales
Hypoxia
May progress to AL
HC Aspiration: Management
Assess for evidence of aspiration
Clinical
Radiographic
For asymptomatic patients without clinical
evidence of aspiration
Observe 6 hours
Radiograph at 6 hours
Admit if signs or symptoms aspiration
Mitochondrial Toxins
Carbon monoxide
Cyanide
Hydrogen sulfide
Carbon Monoxide
An important constituent of coal gas,
but is not present in natural gas.
A highly poisonous and combines with
hemoglobin and other heme- proteins
such as cytochrome oxidase, thereby
limiting the oxygen supply to tissue
and inhibiting cellular respiration.
The affinity for hemoglobin is about
200 times that of oxygen
Carbon Monoxide
Common sources of carbon monoxide
are
automobile exhaust
fumes
improperly maintained or ventilated
gas or fuel oil heating systems
smoke from all types of fires.
Carbon Monoxide
Carbon Monoxide: Management
Co-oximetry
Normal 0-5%
PPD Smokers 6-10%
CO Toxicity >15%
100% O2
Hyperbaric Oxygen Therapy
Aggressive supportive care
Serial neuro/Mini-mental exams
Cyanide
Salts used in:
Electroplating
Mining extraction
Photography
Jewelry
Nitroprusside
Amygdalins
Cyanide
Similar mechanism as CO
Mitochondrial toxin
Acute exposure
Rapid onset
Lactic acidosis
Vomiting, seizures, coma
Treatment: Cyanide Antidote
Kit
Known or
suspected
cyanide poisoning
Metabolic acidosis
End organ
damage
Hydrogen sulfide
Well known because of its bad egg odour,
which can be smelt down to less than 0.1ppm.
High concentrations (>60ppm) cannot be
smelt due to paralysis of the olfactory glands,
and exposure can lead to instant paralysis.
H2S is slightly heavier than air, and thus fixed
detectors are usually mounted 1 to 1.5 metres
from the ground, or near potential sources of
leaks.
H2S is produced during the decay
of organic materials, extracted
with oil (when the oil is said to be
sour) and is often found
underground during tunnelling and
in sewers
found in large quantities in sewage
treatment works, pumping
stations, press houses, boiler
houses, and virtually anywhere
where sewage is being treated
