Poisoning Lecture - University of Baghdad 2022-2023 PDF

University of Baghdad College of Medicine 2022-2023 Title:poisoniong Grade:fifth Module: pediatric Speaker:DR MUNEERA FADHIL Date: University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University...

University of Baghdad College of Medicine 2022-2023 Title:poisoniong Grade:fifth Module: pediatric Speaker:DR MUNEERA FADHIL Date: University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023  University of Baghdad/ College of Medicine 2022-2023 Acetaminophen: The chief target organ of acetaminophen poisoning is the liver, with the kidneys being involved in about 10 to 20% of those patients with hepatotoxicity. Rarely, nephrotoxicity may occur without significant hepatic involvement. The dose required to produce significant hepatotoxicity in adults is 7.5 to 10.0 g. The commonly stated hepatotoxic dose for children is to be >200 mg/kg.  University of Baghdad/ College of Medicine 2022-2023 Stage I: 0-24 hrs Early symptoms Mild Serum acetaminophen level 4 hrs post ingestion PLOT ON SPECIFIC NOMOGRAM. If > 900 µmol/L ---> POSSIBLE RISK Nausea, vomiting, malaise and diaphoresis. Normal bilirubin Transaminases and PT. University of Baghdad/ College of Medicine 2022-2023  University of Baghdad/ College of Medicine 2022-2023 Stage II: 24-48 hrs after ingestion. Better, less symptoms. Elevated bilirubin, transaminases and PT Stage III : ( 3-5 days) after ingestion University of Baghdad/ College of Medicine 2022-2023 Hepatic dysfunction (Rarely hepatic failure) Peak elevations in: Bilirubin Transaminases may reach > 1000 IU/L Prolonged PT Death or recovery begin  University of Baghdad/ College of Medicine 2022-2023 Stage IV : (4 days-2 wk) Clinical improvement LFTs returning to normal Probable toxicity should be treated University of Baghdad/ College of Medicine 2022-2023 with:- N-acetylcysteine bolus 140 mg/kg Then 70 mg/kg Q 4 hrs for 17 doses. Assess hepatic functions:- On presentation Daily Continue other supports. University of Baghdad/ College of Medicine 2022-2023  University of Baghdad/ College of Medicine 2022-2023 Organophosphorus compounds Organophosphorus compounds: Insecticides Inhibition of Cholinesterase enzymes all over the body. Muscarinic: N/V Abdominal pain/ fecal incontinence. Cholinergic : cough, resp.secretions, crepitation and even pulmonary edema. CVS : Tachycardia/ bradycardia/ block/ hypotension Nicotinic: restlessness, confusion, coma, meiosis, flaccidity/convulsion. C/F may be abbreviated by (DUMBBELS: Defecation , Urination, miosis, block(heart) bradycardia Emesis, Lacrimation and salivation). Diagnosis: blood Cholinesterase levels University of Baghdad/ College of Medicine 2022-2023 < 50% indicates poisoning. Atropine as test dose Management: A….B….C….. Stabilization Wash hair and body with soap & water Consider Gastric lavage if within 1hr Atropine sulphate I.V. till pupils are normal size. Dose = 0.02 mg/kg Q 15-20 mins  University of Baghdad/ College of Medicine 2022-2023 Atropine sulphate I.V. till pupils are normal size. Remember…Atropine has no effect on muscle paralysis ➔ must support breathing USE Cholinesterase reactivator such as Pralidoxime Dose = 1gm /kg IV Q 30 mins Caustic or Corrosive Ingestion:- University of Baghdad/ College of Medicine 2022-2023 The ingestion of strong alkalis or acids The most commonly ingested alkali is sodium hydroxide. The most commonly ingested acids are hydrochloric, phosphoric, and sulfuric acids. They are found in:- Acidic :-drain cleaners, rust removers, toilet bowl cleaners, tile cleaners. Alkaline:- drain cleaners, oven cleaners. Serious injury is associated with agents whose pH is >12 or