Poisoning Treatment Methods Quiz

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Questions and Answers

Which method of treatment for poisoning utilizes a chemical that can precipitate compounds?

Precipitation (correct)

Reduction

Oxidation

Neutralization

What is a consequence of using sodium bicarbonate as an antidote?

Precipitation of lead salts

Formation of harmful carbon dioxide (correct)

Increase in gastric acidity

Reduction of hydrogen ion concentration

Which of the following antidotes is classified as divalent and toxic?

Mercurous chloride (correct)

Tannic acid

Oxalic acid

Skimmed milk

What is the role of weak acids in treating alkaline corrosive poisoning?

To neutralize alkaline substances (D) Signup and view all the answers

Which compound can be used as an oxidizing agent in the treatment of poisoning?

Hydrogen peroxide (D) Signup and view all the answers

Which of the following factors is NOT considered in diagnosing poisoning?

Dietary preferences (A) Signup and view all the answers

In cases of toxic reactions, which of the following best describes hypersensitivity?

An exaggerated immune response to a drug (C) Signup and view all the answers

What is the significance of 'toxidromes' in a clinical examination for poisoning?

They are patterns of symptoms indicating exposure to a toxic substance. (C) Signup and view all the answers

Which of the following methods is used for gastrointestinal decontamination to prevent absorption of poisons?

Gastric emptying (B) Signup and view all the answers

Which of the following is NOT a laboratory investigation method used in diagnosing poisoning?

Psychological assessments (D) Signup and view all the answers

Which symptom is likely associated with poisoning from carbon monoxide (CO)?

Signs of asphyxia (C) Signup and view all the answers

What is the primary indication for using emesis as a treatment method?

Recent ingestion of substances within 3 hours (A) Signup and view all the answers

Which of the following would NOT be examined in a postmortem assessment for poisoning?

Liver and kidney functions (D) Signup and view all the answers

Which patient condition is a contraindication for the use of emesis?

Coma or unconsciousness (B) Signup and view all the answers

When is gastric lavage particularly indicated?

When emesis has failed and is within 3 hours of ingestion (A) Signup and view all the answers

What indicates tolerance to a drug in the context of toxic responses?

Diminished response to the drug over time (A) Signup and view all the answers

What type of substances can be treated effectively with gastric lavage beyond 3 hours post-ingestion?

Slow motility poisons (A) Signup and view all the answers

Which finding is most indicative of poisoning by corrosive substances during a postmortem examination?

Presence of seed particles in the stomach (B) Signup and view all the answers

Activated charcoal is effective because it performs which of the following functions?

Adsorbs poisons and prevents their absorption (C) Signup and view all the answers

What type of emesis method involves the use of drugs that induce vomiting via the central nervous system?

Centrally acting emesis (A) Signup and view all the answers

Which of the following substances poses the greatest risk for aspiration pneumonia if emesis is attempted?

Volatile hydrocarbons (A) Signup and view all the answers

Which classification of poisons is based on their physical state?

Classification by Nature (A) Signup and view all the answers

What factor does NOT modify the toxic effects of a poison?

Patient's emotional state (C) Signup and view all the answers

Which of the following represents an example of chemical antagonism?

BAL reducing the toxic effects of Lead (D) Signup and view all the answers

Which substance is classified as a CNS depressant?

Narcotics (B) Signup and view all the answers

Which of the following routes of administration has the highest descending order of toxicity?

Intravenous (C) Signup and view all the answers

What term describes the situation where the effects of two chemicals added together are greater than the sum of their individual effects?

Synergism (D) Signup and view all the answers

Which factor can enhance the toxicity of acid poisons?

Increased gastric acidity (C) Signup and view all the answers

Which of these examples demonstrates a target organ classification of poisons?

Digitalis affecting the cardiovascular system (D) Signup and view all the answers

What is the purpose of administering sodium bicarbonate in the context of poisoning treatments?

To maintain urine pH between 7.5 and 8.0 (B) Signup and view all the answers

In which situation is dialysis indicated for the treatment of poisoning?

In cases of renal failure where the poison is removed by kidneys (C) Signup and view all the answers

Which substances are poor candidates for removal via traditional dialysis?

High lipid-soluble and high protein-binding drugs (A) Signup and view all the answers

What is the mechanism of plasma exchange in the treatment of poisoning?

Exchanging plasma with a crystalloid solution while returning other blood components (B) Signup and view all the answers

Which of the following is a contraindication for hemoperfusion?

Presence of coagulopathy (A) Signup and view all the answers

What is an essential condition that must be met before initiating gastric lavage for patients with cardiac dysrhythmias?

Ensure cardiac dysrhythmias are controlled. (C) Signup and view all the answers

What type of antidote is represented by substances such as EDTA and penicillamine?

Chemical antidotes (A) Signup and view all the answers

Which of the following assessments indicates that the tube from gastric lavage is correctly placed in the stomach?

Absence of bubbling when the end of the tube is immersed in water during expiration. (C) Signup and view all the answers

What is the primary action of activated charcoal in treating poisoning?

Adsorbs poisons in the gastrointestinal tract to decrease their absorption. (D) Signup and view all the answers

Which method is most suitable for treating toxins that are poorly filtered or dialyzed?

Hemoperfusion (A) Signup and view all the answers

What is a characteristic role of physicomechanical antidotes?

They adsorb or entangle toxins to prevent absorption. (D) Signup and view all the answers

What is a contraindication for using gastric lavage during convulsions?

Lavage can be performed under general anesthesia. (B) Signup and view all the answers

Which of the following statements about the structure of the gastric lavage tube is true?

It has multiple holes on the sides of its tip. (C) Signup and view all the answers

What is a common substance poorly adsorbed by activated charcoal?

Cyanide. (C) Signup and view all the answers

Why is it important to assess the patient's responsiveness before administering gastric lavage?

To avoid aspiration pneumonia during the procedure. (A) Signup and view all the answers

Which of the following is an effect of activated charcoal’s porous structure?

Adsorbs a large number of poison molecules. (C) Signup and view all the answers

Study Notes

General Toxicology

Toxicology is the study of poisons on living organisms
The term derives from Greek and Latin, with toxicum meaning poison and logia meaning study
Toxicology encompasses the source, kinetics, action, diagnosis, and treatment of poisonings
All substances are poisons, only the dose determines the effect
Poisons are often classified by nature (solid, liquid, gaseous), site of action (local, remote), and target organ (e.g., gastrointestinal tract, kidneys, liver, central nervous system).

Classification of Poisons

Nature: Poisons can be solid, liquid, or gaseous.
Site of Action:
Local: Inorganic corrosives
Remote: Alkaloids and many therapeutics
Local & Remote: Certain metals and organic compounds.
Target Organ:
Gastrointestinal (GIT): Metals and corrosives
Kidneys: Mercury, phenol, cadmium
Liver: Paracetamol, iron, carbon tetrachloride
Cardiovascular System (CVS): Digitalis, aconitine
Lungs: Metal fumes
Central Nervous System (CNS): CNS stimulants (amphetamines, cocaine, strychnine) and CNS depressants (hypnotics, narcotics, alcohol, anesthetics)

Factors Modifying Toxic Effects

Factors related to the poison:
State of toxic agent: The dose of the poison, the route of administration (inhalation > intravenous > intraperitoneal > subcutaneous > intramuscular > intradermal > oral > topical)
Cumulation: The rate of intake exceeding the rate of elimination (e.g., digitalis)
Chemical interaction:
Addition: Effects of chemicals combined (e.g., Aspirin + Paracetamol)
Synergism: One chemical increasing another's effect (e.g., alcohol + barbiturate)
Antagonism: One chemical reducing another's effect (e.g., BAL + lead)
Metabolism: Some poisons are metabolized into equally or more/toxic substances (e.g., methanol to formaldehyde and formic acid)
Factors related to the patient (Host factors):
Gastrointestinal (GIT): pH of stomach and food type influence poison toxicity
Age: Age can affect responses to poisons.
State of health: Overall health can impact how a person responds to toxins
Toxicogenetics (Idiosyncrasy): Unusual responses to drugs or toxic substances due to genetics. (e.g., favism, G6PD deficiency)
Hypersensitivity (Allergy): Enhanced response to a substance (e.g. aspirin or penicillin) due to an antigen-antibody reaction
Tolerance: Decreased response to a substance over time.

Diagnosis of Poisoning

History: Sudden appearance of symptoms, symptoms in a group of people, history of poison purchase, or presence of suicidal notes
Clinical Examination: Vital signs (BP, pulse, respirations, temperature), neurological examination, observation of chest, abdomen, skin, and breath odor, detection of signs and symptoms known as toxi-dromes
Laboratory Investigations: Analysis of blood, urine, vomit, stool, hair, and nail (in living or dead individuals), and also ECG, EEG, electrolytes, blood gases, liver and kidney function tests

Postmortem Picture

Stomach: Smell of substances like phenol, opium, organophosphates, cyanide, presence of ulcers for corrosives and tablets, identification of seeds/plants
Skin: Eschar characteristics (e.g., black, yellow, white) and presence of injection sites
Brain: Edema or congestion indicative of CO poisoning, signs of asphyxia
Respiratory system: For signs of asphyxia

Coma and Poisoning

Causes of Coma: Toxic causes (CNS depressants, anticholinergics, HCN, CO), pathological causes (hepatic, renal, metabolic issues, hypoglycemia, hypertensive encephalopathy), or traumatic causes (head injuries)
Coma Scales:
AVPU system: Alert, Verbal, Pain, Unresponsive. A rapid method for evaluating level of consciousness
Reed's coma scale: More detailed evaluation of coma, used as an alternative to the Glasgow Coma Scale since it often provides a more accurate reflection of impairment

Treatment of Poisoning

Supportive Therapy: Treating the patient, supporting ABCs (airway, breathing, circulation), and managing a patient's condition.
Airway: Maintaining and securing the airway (e.g., positioning the head, using oropharyngeal airways, suctioning secretions, insertion of an endotracheal tube).
Breathing: Providing supplemental oxygen (e.g., simple face mask, nasal cannula), mechanical ventilation if necessary
Circulation: Treating hypotension (low blood pressure), managing cardiac arrhythmias, and fluid support.
CNS: Treating altered mental status, providing dextrose, thiamine, and naloxone
Gastrointestinal Decontamination: Removing or preventing the absorption of poisons from the gastrointestinal (GI) tract (e.g., emesis, gastric lavage, activated charcoal).
Emesis: Inducing vomiting to remove substances from the stomach within 3 hours of ingestion
Gastric lavage: Flushing the stomach with a solution to remove ingesting substances. Contraindicated with certain poisons.
Activated charcoal: Absorbing poisons to prevent them from being absorbed into the bloodstream. Poisons poorly absorbed by this include Cyanide, heavy metals, alcohols, and others.
Elimination of the poison from the blood (enhanced elimination): Methods include:
Forced diuresis: Increasing urine output to excrete the poison. (using substances like Mannitol or a saline solution)
Alteration of urine pH (ion trapping): Adjusting urine acidity to prevent the absorption of certain types of ionized substances/poisons into the bloodstream
Dialysis (hemodialysis, peritoneal dialysis): Removing toxins from the blood when the kidneys cannot do so on their own.
Hemoperfusion: Removal of certain toxins from the blood using a specialized filter (used for substances that aren't removed via dialysis)
Plasmapheresis: Removing the plasma component of the blood, which can contain toxins/poisons.
Antidotes: Specific substances used to counteract the effects of certain poisons. This may include chelators used to bind and remove specific ions to then be excreted in the urine.

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Description

Test your knowledge on various treatment methods for poisoning. This quiz covers the use of antidotes, the role of weak acids, and specific compounds in poisoning treatment. Explore concepts such as divalent antidotes and the consequences of using sodium bicarbonate.