This document discusses clinical toxicology. Some key points:
- Clinical toxicology is the study of toxic or adverse effects of drugs and chemicals in the body. Clinical toxicologists identify, diagnose, and treat conditions resulting from exposure to harmful agents.
- Several factors influence the toxic effect of a substance, including dose, route of exposure, and duration of exposure.
- Initial evaluation of a patient with a suspected toxic exposure focuses on airway, breathing, circulation, and mental status. Vital signs and developing toxic syndromes provide clues to identify toxic agents. Serial monitoring of vital signs is important to assess treatment effectiveness.
Nausea and vomiting are common symptoms that can be caused by many conditions. Nausea is an uneasiness of the stomach that often precedes vomiting, which is the forceful emptying of stomach contents through the mouth. Chemotherapy-induced nausea and vomiting (CINV) is a major side effect of cancer treatment. The risk of CINV depends on the specific chemotherapy drugs used and can be acute, delayed, or anticipatory. Effective prevention and treatment of CINV is important for maintaining quality of life. Medications that target different receptor pathways in the brain and gut are used as preventative and rescue therapies for CINV.
A) Obtaining a thorough history from the patient, family members, or witnesses is essential to determine what toxin or drug was ingested, how much, and when. The physical examination focuses on vital signs, eyes, skin, nervous system, lungs and heart to identify symptoms that can indicate the toxin class. Recognizing a toxidrome pattern of signs and symptoms can help identify the possible toxin. Initial treatment priorities are stabilizing the airway, breathing, circulation and providing dextrose for altered mental status.
Si el envenenamiento es reconocido de forma temprana y reciben una atención medica adecuada, el pronostico es favorable.
La exposición a toxinas puede ocurrir por accidente (es decir, incidentes o interacciones medicamentosas) o intencionalmente (es decir, el abuso de sustancias o ingestas intencionales).
El envenenamiento depende de numerosos factores, como el tipo de sustancia, la dosis, el tiempo de exposición a la presentación a un centro de atención a la salud y el estado de salud preexistente del paciente.
This document discusses clinical toxicology and the management of poisoned patients. It begins by explaining factors that contribute to the action of poisons, such as dose, form, route of administration, and individual physiology. It then outlines the six key steps in managing a poisoned patient: 1) stabilization, 2) diagnosis, 3) preventing further absorption, 4) enhancing elimination, 5) administering antidotes, and 6) providing supportive care. Specific techniques to prevent further absorption discussed include decontamination, induced vomiting, gastric lavage, and use of activated charcoal or laxatives. The goal of management is to stabilize the patient and keep toxin levels low through prevention of absorption and increased elimination.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
Drug induced liver disease can have a variety of presentations, from acute hepatitis to chronic cholestatic conditions. Making an accurate diagnosis requires correlating the clinical presentation and liver injury pattern with the temporal relationship to suspected medications, exclusion of alternative causes, and considering factors like dechallenge/rechallenge responses and precedents of the drug causing hepatotoxicity. International criteria provide guidance on evaluating suspected cases and assigning levels of certainty regarding causality.
This document discusses drug overdoses, including definitions, common drugs involved, risk factors, evaluation and treatment. It notes that overdoses can be intentional or accidental and are a major cause of morbidity and mortality worldwide. The most common drugs involved in overdoses are opioid analgesics and benzodiazepines. Men ages 45-49 have the highest death rates. Evaluation involves assessing vital signs and mental status while treatment focuses on stabilization, supportive care, prevention of further exposure, and administration of antidotes if available.
Nausea and vomiting are common symptoms that can be caused by many conditions. Nausea is an uneasiness of the stomach that often precedes vomiting, which is the forceful emptying of stomach contents through the mouth. Chemotherapy-induced nausea and vomiting (CINV) is a major side effect of cancer treatment. The risk of CINV depends on the specific chemotherapy drugs used and can be acute, delayed, or anticipatory. Effective prevention and treatment of CINV is important for maintaining quality of life. Medications that target different receptor pathways in the brain and gut are used as preventative and rescue therapies for CINV.
A) Obtaining a thorough history from the patient, family members, or witnesses is essential to determine what toxin or drug was ingested, how much, and when. The physical examination focuses on vital signs, eyes, skin, nervous system, lungs and heart to identify symptoms that can indicate the toxin class. Recognizing a toxidrome pattern of signs and symptoms can help identify the possible toxin. Initial treatment priorities are stabilizing the airway, breathing, circulation and providing dextrose for altered mental status.
Si el envenenamiento es reconocido de forma temprana y reciben una atención medica adecuada, el pronostico es favorable.
La exposición a toxinas puede ocurrir por accidente (es decir, incidentes o interacciones medicamentosas) o intencionalmente (es decir, el abuso de sustancias o ingestas intencionales).
El envenenamiento depende de numerosos factores, como el tipo de sustancia, la dosis, el tiempo de exposición a la presentación a un centro de atención a la salud y el estado de salud preexistente del paciente.
This document discusses clinical toxicology and the management of poisoned patients. It begins by explaining factors that contribute to the action of poisons, such as dose, form, route of administration, and individual physiology. It then outlines the six key steps in managing a poisoned patient: 1) stabilization, 2) diagnosis, 3) preventing further absorption, 4) enhancing elimination, 5) administering antidotes, and 6) providing supportive care. Specific techniques to prevent further absorption discussed include decontamination, induced vomiting, gastric lavage, and use of activated charcoal or laxatives. The goal of management is to stabilize the patient and keep toxin levels low through prevention of absorption and increased elimination.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
Drug induced liver disease can have a variety of presentations, from acute hepatitis to chronic cholestatic conditions. Making an accurate diagnosis requires correlating the clinical presentation and liver injury pattern with the temporal relationship to suspected medications, exclusion of alternative causes, and considering factors like dechallenge/rechallenge responses and precedents of the drug causing hepatotoxicity. International criteria provide guidance on evaluating suspected cases and assigning levels of certainty regarding causality.
This document discusses drug overdoses, including definitions, common drugs involved, risk factors, evaluation and treatment. It notes that overdoses can be intentional or accidental and are a major cause of morbidity and mortality worldwide. The most common drugs involved in overdoses are opioid analgesics and benzodiazepines. Men ages 45-49 have the highest death rates. Evaluation involves assessing vital signs and mental status while treatment focuses on stabilization, supportive care, prevention of further exposure, and administration of antidotes if available.
Presentation deals with thorough understanding of management of toxicities and poisoning and measures and care to be taken of the patient. Useful for Clinical Pharmacologist, Chemical Biologists, Undergraduate and Postgraduate Students of Pharmacy and Pharmacology
The document discusses the general approach to managing a poisoned patient. It involves stabilizing the patient by addressing airway, breathing, and circulation issues first before obtaining a thorough history, performing a focused exam, and considering appropriate diagnostic tests and decontamination methods. Specific antidotes may be administered depending on the suspected toxin. The prognosis relies on delivering quality care in the first few hours to address symptoms that can range from abdominal pain to seizures.
Basics of poisoning and drug overdose managentSourabHiremath
The document provides information on poisoning and overdose. It discusses the basics, including epidemiology, factors influencing dose effects, diagnosis, treatment goals, supportive care, prevention of poison absorption, enhancement of elimination, administration of antidotes, and prevention of reexposure.
It defines poisoning and outlines the diagnostic approach, including obtaining a detailed history, physical exam focusing on vital signs and toxicological syndromes, and laboratory testing including toxicology screens.
Treatment involves supportive care to maintain homeostasis, gastrointestinal decontamination like activated charcoal or lavage, enhanced elimination such as multiple dose charcoal or urinary alkalinization, and administration of specific antidotes when available.
it involves the general principles of poisoning treatment and various basic principles of management of poisoning IT IS USEFULL FOR THE IV.PHARM D STUDENTS AND MEDICAL STUDENTS
Chap 1 General principles involved in the management of poisoningChanukya Vanam . Dr
1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document provides an overview of respiratory and cardiac assessment techniques. It discusses the importance of obtaining an accurate assessment in order to develop an appropriate treatment plan. The document outlines the components of a problem-oriented medical system and problem-oriented medical records. It provides detailed descriptions of techniques for subjective and objective patient assessment, including gathering a history and examining the chest. Key areas of focus include breathing patterns, chest expansion, tracheal position, and tactile vocal fremitus.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Hypersensitive drug reaction in children.pptxSabonaLemessa2
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction characterized by a rash, hematologic abnormalities including eosinophilia and atypical lymphocytes, lymphadenopathy, and involvement of internal organs. It has a long latency of 2-8 weeks between drug exposure and onset. Common culprit drugs include anticonvulsants, allopurinol, and sulfonamides. The pathogenesis involves an interplay of genetic susceptibility, virus reactivation, and immune responses. Diagnosis is based on clinical presentation along with supportive lab findings and exclusion of other conditions.
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents of different classes, one being a diuretic. Refractory hypertension is when blood pressure cannot be controlled despite four or more drugs at maximal doses. Pseudoresistant hypertension occurs when poor control is due to non-adherence or suboptimal treatment rather than true treatment resistance. Evaluation of patients with resistant hypertension includes screening for secondary causes like primary aldosteronism or renal artery stenosis through tests of electrolytes, renal function, and imaging studies. Treatment involves optimizing the current three-drug regimen before adding supplementary drugs like beta blockers or aldosterone antagonists.
This document discusses several major geriatric syndromes including falls, polypharmacy, cognitive impairment (delirium and dementia), urinary incontinence, and overactive bladder. It provides details on the evaluation and management of these conditions. Geriatric syndromes are multifactorial health conditions that occur with impairments in multiple body systems, and these syndromes cross disciplinary boundaries. Falls are one of the most common geriatric syndromes that internists encounter. Polypharmacy increases risks of adverse drug events in older adults. Delirium and dementia are forms of cognitive impairment that require evaluation and management of underlying causes.
This document discusses drug therapy in geriatrics. It begins by listing common drug classes used to treat various conditions in elderly patients, including antibiotics, antiallergics, antiasthmatics, and antihypertensives. It then discusses several age-related changes to pharmacokinetic and pharmacodynamic processes in geriatric patients. These changes can impact drug absorption, distribution, metabolism, and excretion. It also notes an increased risk of drug interactions and adverse reactions in elderly patients due to polypharmacy and physiological changes. Finally, it discusses the role of pharmacists in optimizing drug therapy for geriatric patients.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
Role of toxicological analysis in clinical practicalPh F. Al-t
Analytical toxicology plays an important role in clinical practice by aiding in the diagnosis and treatment of toxic exposures. It is useful for identifying the toxic substance and measuring the amount absorbed, which can help clinicians relate symptoms to effects. Toxicology laboratories also monitor chemical levels remaining in the body and being excreted to assess treatment effectiveness. Examples given were measuring acetaminophen, salicylate, alcohol, and glycol levels to evaluate overdoses and prognosis. The general clinical strategy for treating poisoned patients includes stabilization, prevention of further absorption, enhancing elimination, antidote administration if available, and supportive care.
1. Delirium is a common clinical syndrome characterized by inattention and acute cognitive dysfunction that is often caused by a medical condition, head injury, intoxication or withdrawal.
2. Predisposing factors for delirium include advanced age, dementia, medical comorbidities, and functional impairment. Precipitating factors are acute medical events, medications, infections, dehydration, and immobilization.
3. Delirium is managed through addressing underlying causes, supportive care including reorientation, a calm environment, and avoiding restraints. Medications like haloperidol may also be used.
Hashimoto's encephalopathy (HE) is a rare neurological condition characterized by cognitive impairment, seizures, and altered consciousness. It is associated with high levels of anti-thyroid antibodies and responds well to corticosteroid or immunosuppressive treatment. The pathophysiology is unclear but likely involves an autoimmune or inflammatory process. A diagnosis of HE should be considered for any patient presenting with unexplained encephalopathy, as early treatment can lead to full recovery.
The document discusses several key aspects of pharmacology in the elderly population. It describes how the aging process can impact absorption, distribution, metabolism and excretion of drugs. It also addresses increased risk of polypharmacy, adverse drug reactions, and use of potentially inappropriate medications in elderly patients. Additionally, it mentions factors like the placebo and nocebo effect that can influence drug responses in older adults. The conclusion emphasizes the importance of considering the physiological changes of aging when determining safe and effective pharmacotherapy for elderly individuals.
Post operative nausea and vomiting.pptxBayanKhalil5
This document summarizes post operative nausea and vomiting (PONV). It discusses the anatomy and physiology involved in vomiting, including the chemoreceptor trigger zone and neurological pathways. It identifies common risk factors for PONV and scoring systems to predict risk. It then describes the mechanisms and uses of different drug classes for preventing and treating PONV, including 5-HT3 receptor antagonists, butyrophenones, dexamethasone, and neurokinin-1 receptor antagonists. It concludes by mentioning other strategies for reducing PONV incidence such as acupuncture, multimodal antiemetic prophylaxis, and opioid-sparing analgesia techniques.
Chemotherapy works by damaging rapidly dividing cells, including cancer cells, through various mechanisms of action like inhibiting DNA synthesis or microtubule function. While chemotherapy aims to destroy cancer, it can also damage healthy cells and cause side effects stemming from low blood cell counts like fatigue, infections, and bleeding. Managing side effects is important for patient care during and after chemotherapy treatment.
Presentation deals with thorough understanding of management of toxicities and poisoning and measures and care to be taken of the patient. Useful for Clinical Pharmacologist, Chemical Biologists, Undergraduate and Postgraduate Students of Pharmacy and Pharmacology
The document discusses the general approach to managing a poisoned patient. It involves stabilizing the patient by addressing airway, breathing, and circulation issues first before obtaining a thorough history, performing a focused exam, and considering appropriate diagnostic tests and decontamination methods. Specific antidotes may be administered depending on the suspected toxin. The prognosis relies on delivering quality care in the first few hours to address symptoms that can range from abdominal pain to seizures.
Basics of poisoning and drug overdose managentSourabHiremath
The document provides information on poisoning and overdose. It discusses the basics, including epidemiology, factors influencing dose effects, diagnosis, treatment goals, supportive care, prevention of poison absorption, enhancement of elimination, administration of antidotes, and prevention of reexposure.
It defines poisoning and outlines the diagnostic approach, including obtaining a detailed history, physical exam focusing on vital signs and toxicological syndromes, and laboratory testing including toxicology screens.
Treatment involves supportive care to maintain homeostasis, gastrointestinal decontamination like activated charcoal or lavage, enhanced elimination such as multiple dose charcoal or urinary alkalinization, and administration of specific antidotes when available.
it involves the general principles of poisoning treatment and various basic principles of management of poisoning IT IS USEFULL FOR THE IV.PHARM D STUDENTS AND MEDICAL STUDENTS
Chap 1 General principles involved in the management of poisoningChanukya Vanam . Dr
1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document provides an overview of respiratory and cardiac assessment techniques. It discusses the importance of obtaining an accurate assessment in order to develop an appropriate treatment plan. The document outlines the components of a problem-oriented medical system and problem-oriented medical records. It provides detailed descriptions of techniques for subjective and objective patient assessment, including gathering a history and examining the chest. Key areas of focus include breathing patterns, chest expansion, tracheal position, and tactile vocal fremitus.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Hypersensitive drug reaction in children.pptxSabonaLemessa2
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction characterized by a rash, hematologic abnormalities including eosinophilia and atypical lymphocytes, lymphadenopathy, and involvement of internal organs. It has a long latency of 2-8 weeks between drug exposure and onset. Common culprit drugs include anticonvulsants, allopurinol, and sulfonamides. The pathogenesis involves an interplay of genetic susceptibility, virus reactivation, and immune responses. Diagnosis is based on clinical presentation along with supportive lab findings and exclusion of other conditions.
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents of different classes, one being a diuretic. Refractory hypertension is when blood pressure cannot be controlled despite four or more drugs at maximal doses. Pseudoresistant hypertension occurs when poor control is due to non-adherence or suboptimal treatment rather than true treatment resistance. Evaluation of patients with resistant hypertension includes screening for secondary causes like primary aldosteronism or renal artery stenosis through tests of electrolytes, renal function, and imaging studies. Treatment involves optimizing the current three-drug regimen before adding supplementary drugs like beta blockers or aldosterone antagonists.
This document discusses several major geriatric syndromes including falls, polypharmacy, cognitive impairment (delirium and dementia), urinary incontinence, and overactive bladder. It provides details on the evaluation and management of these conditions. Geriatric syndromes are multifactorial health conditions that occur with impairments in multiple body systems, and these syndromes cross disciplinary boundaries. Falls are one of the most common geriatric syndromes that internists encounter. Polypharmacy increases risks of adverse drug events in older adults. Delirium and dementia are forms of cognitive impairment that require evaluation and management of underlying causes.
This document discusses drug therapy in geriatrics. It begins by listing common drug classes used to treat various conditions in elderly patients, including antibiotics, antiallergics, antiasthmatics, and antihypertensives. It then discusses several age-related changes to pharmacokinetic and pharmacodynamic processes in geriatric patients. These changes can impact drug absorption, distribution, metabolism, and excretion. It also notes an increased risk of drug interactions and adverse reactions in elderly patients due to polypharmacy and physiological changes. Finally, it discusses the role of pharmacists in optimizing drug therapy for geriatric patients.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
Role of toxicological analysis in clinical practicalPh F. Al-t
Analytical toxicology plays an important role in clinical practice by aiding in the diagnosis and treatment of toxic exposures. It is useful for identifying the toxic substance and measuring the amount absorbed, which can help clinicians relate symptoms to effects. Toxicology laboratories also monitor chemical levels remaining in the body and being excreted to assess treatment effectiveness. Examples given were measuring acetaminophen, salicylate, alcohol, and glycol levels to evaluate overdoses and prognosis. The general clinical strategy for treating poisoned patients includes stabilization, prevention of further absorption, enhancing elimination, antidote administration if available, and supportive care.
1. Delirium is a common clinical syndrome characterized by inattention and acute cognitive dysfunction that is often caused by a medical condition, head injury, intoxication or withdrawal.
2. Predisposing factors for delirium include advanced age, dementia, medical comorbidities, and functional impairment. Precipitating factors are acute medical events, medications, infections, dehydration, and immobilization.
3. Delirium is managed through addressing underlying causes, supportive care including reorientation, a calm environment, and avoiding restraints. Medications like haloperidol may also be used.
Hashimoto's encephalopathy (HE) is a rare neurological condition characterized by cognitive impairment, seizures, and altered consciousness. It is associated with high levels of anti-thyroid antibodies and responds well to corticosteroid or immunosuppressive treatment. The pathophysiology is unclear but likely involves an autoimmune or inflammatory process. A diagnosis of HE should be considered for any patient presenting with unexplained encephalopathy, as early treatment can lead to full recovery.
The document discusses several key aspects of pharmacology in the elderly population. It describes how the aging process can impact absorption, distribution, metabolism and excretion of drugs. It also addresses increased risk of polypharmacy, adverse drug reactions, and use of potentially inappropriate medications in elderly patients. Additionally, it mentions factors like the placebo and nocebo effect that can influence drug responses in older adults. The conclusion emphasizes the importance of considering the physiological changes of aging when determining safe and effective pharmacotherapy for elderly individuals.
Post operative nausea and vomiting.pptxBayanKhalil5
This document summarizes post operative nausea and vomiting (PONV). It discusses the anatomy and physiology involved in vomiting, including the chemoreceptor trigger zone and neurological pathways. It identifies common risk factors for PONV and scoring systems to predict risk. It then describes the mechanisms and uses of different drug classes for preventing and treating PONV, including 5-HT3 receptor antagonists, butyrophenones, dexamethasone, and neurokinin-1 receptor antagonists. It concludes by mentioning other strategies for reducing PONV incidence such as acupuncture, multimodal antiemetic prophylaxis, and opioid-sparing analgesia techniques.
Chemotherapy works by damaging rapidly dividing cells, including cancer cells, through various mechanisms of action like inhibiting DNA synthesis or microtubule function. While chemotherapy aims to destroy cancer, it can also damage healthy cells and cause side effects stemming from low blood cell counts like fatigue, infections, and bleeding. Managing side effects is important for patient care during and after chemotherapy treatment.
2500_TOXICOLOGY - unit I - part i.pptxImedMAATOUK3
Toxicology is the study of the adverse effects of chemicals on living organisms. It is a multidisciplinary field that draws from areas like chemistry, pharmacology, biochemistry, physiology, biology, genetics, epidemiology, law, and economics. Toxicology examines both acute and chronic effects of toxicants. Acute effects occur from short term, high dose exposure while chronic effects result from long term, repeated exposure to lower doses. Toxicology seeks to understand how chemicals enter organisms, are distributed and metabolized, and how they impact various body systems, as well as their effects on populations, ecosystems, and the environment.
Toxicology is the study of the harmful effects of chemicals and physical agents on living organisms. It helps create a safer world by understanding how chemicals impact health at the molecular and cellular level. Examples of how toxicology affects everyday life include warnings about mercury in fish and bans on ephedra. Toxicology research has provided insights that protect public health, such as reducing lead exposure increasing IQs and economic productivity. It also examines issues like thimerosal in vaccines, mercury in fish, phthalates in consumer products, and the dioxin poisoning of Viktor Yushchenko.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
3. • Toxicology is the science of poison and its
effects in living organisms. There are several
divisions of toxicology, one of which is clinical
toxicology.
• Clinical toxicology is the study of the toxic or
adverse effects of agents, such as drugs and
chemicals, in the body. Most of these agents
are usually given to individuals in order to give
relief for symptoms or to treat and prevent
diseases.
4. • Clinical toxicology is focused on the diseases
associated with short-term and long-term
exposure to various toxic chemicals. It
typically coincides with other sciences such as
biochemistry, pharmacology, and pathology.
5. • Individuals who specialize in clinical toxicology
are referred to as clinical toxicologists.
• Their work focuses around the identification,
diagnosis, and treatment of conditions
resulting from exposure to harmful agents.
• They usually study the toxic effects of various
drugs in the body, and are also concerned
with the treatment and prevention of drug
toxicity in the population.
6. Several factors can influence the toxic effect of a
certain substance.
• One is the amount or dose of drug administered.
Most chemicals, including water and oxygen, are
often harmful to the body when taken in large
doses.
• Another factor is the route by which a person was
exposed. A person can be exposed to various
substances through ingestion, inhalation, and
skin penetration.
• The duration of exposure is also a vital factor in
the effect of toxic substances in the body.
7. • There are high numbers of hospital admissions
per year related to poisoning. The most
common drugs that resulted in poisoning are
paracetamol, salicylate, tricyclic
antidepressant, and phenothiazine.
8. Clinical toxicology scope is the determination of
factors that usually lead to drug overdoses
and poisoning.
• These factors include:
• patient's incorrectly using prescribed drugs,
• overprescribing of drugs,
• and inattention to drug warnings.
Drugs may also interact with other drugs the
patient is also taking.
Allergic reactions can also happen in
predisposed individuals.
9. • Drug-related emergencies often require
laboratory work to identify the drug that
caused the poisoning.
• Blood is usually extracted from the patient to
test for the measurements of arterial blood
gases, urea, electrolytes, and glucose, among
many others.
• A urine test is also frequently performed.
10. Medical Toxicology
• The development of medical toxicology as a
medical subspecialty and the important role of
poison control centers began shortly after
World War II.
11. • As new challenges and opportunities arise in
the 21 century, two new toxicologic disciplines
have emerged: toxicogenomics and
nanotoxicology.
• Toxicogenomics combines toxicology with
genomics dealing with how genes and
proteins respond to toxic substances.
• Nanotoxicology refers to the toxicology of
engineered tiny particles, usually smaller than
100 nm. Given the extremely small size of
nanoparticles,
12. INITIAL EVALUATION OF THE PATIENT:
VITAL SIGNS AND TOXIC SYNDROMES
• pulse rate, respiratory rate, and temperature
were incorporated into the bedside chart and
called “vitalsigns”.
• It was not until the early part of the 20th century,
that blood pressure determination also became
routine. Additional components of the standard
emergency assessment, such as oxygen
saturation
• By pulse oximetry, capillary blood glucose, and
pain severity, are now also beginning to be
considered vital signs.
13. Vital signs
• In the practice of medical toxicology, vital signs
play an important role beyond assessing and
monitoring the overall status of a patient, as they
frequently provide valuable physiologic clues to
the toxicologic etiology and severity of an illness.
• The vital signs also are a valuable parameter,
which are used to assess and monitor a patient’s
response to supportive treatment and antidotal
therapy.
14. • the normal vital signs
for various age groups.
• Only a complete
assessment of a patient
can determine whether
or not a particular vital
sign is truly clinically
normal.
15. • Many xenobiotics affect the autonomic
nervous system, which affects the vital signs
via the sympathetic pathway, the
parasympathetic pathway, or both.
• Careful attention to both the initial and
repeated determinations of vital signs is of
extreme importance in identifying a pattern of
changes suggesting a particular xenobiotic or
group of xenobiotics.
16. • The value of serial
monitoring of the vital
signs is demonstrated for
example by the patient
who presents with an
anticholinergic over dose
who is then given the
antidote, physostigmine.
In this situation,
• it is important to
recognize when
tachycardia becomes
bradycardia
17. • Similarly, consider the course of a patient who has
opioid-induced bradypnea (a decreased rate of
breathing) and then develops tachypnea (an increased
rate of breathing) after the administration of the opioid
antagonist naloxone.
• The analysis becomes exceedingly complicated when
that patient may have been exposed to two or more
substances, such as an opioid combined with cocaine.
In this situation, the effects of cocaine may be
“unmasked” by the naloxone used to counteract the
opioid, and the clinician must then be forced to
differentiate naloxone induced opioid withdrawal from
cocaine toxicity.
• The assessment starts by analyzing diverse
information, including vital signs, history, and physical
examination.
18.
19. Toxidromes
from the words toxic syndromes to describe
the groups of signs and symptoms that
consistently result from particular toxins.
These syndromes are usually best described by a
combination of the vital signs and clinically
apparent end-organ manifestations
20.
21. • In some instances, an unexpected
combination of findings may be particularly
helpful in identifying a xenobiotic or a
combination of xenobiotics.
• For example, a dissociation between such
typically paired changes as an increase in
pulse with a decrease in blood pressure (cyclic
antidepressants or phenothiazines),
• or the presentation of a decrease in pulse with
an increase in blood pressure (ergot alkaloids)
may be extremely helpful in diagnosing a toxic
etiology.
22. Blood pressure
Xenobiotics cause hypotension by four major
mechanisms: “4D’s”
- Decreased peripheral vascular resistance,
- Decreased myocardial contractility,
- Dysrhythmias, and
- Depletion of intravascular volume.
23. • Many xenobiotics can
initially cause
orthostatic hypotension
without marked supine
hypotension, and any
xenobiotic that affects
autonomic control of
the heart or peripheral
capacitance vessels may
lead to orthostatic
hypotension.
24. • Hypertension from xenobiotics may be caused
by:
- CNS sympathetic over-activity, increased
myocardial contractility or increased
peripheral vascular resistance, or a
combination of these.
- Blood pressure and pulse rate may vary
significantly as a result of changes in receptor
responsiveness, degree of physical fitness, and
degree of atherosclerosis.
25. Changing patterns of blood pressure often assist
in the diagnostic evaluation:
Ex. overdose with a monoamine oxidase
inhibitor (MAOI) characteristically causes an
initial normal blood pressure, to be followed
by hypertension, which, in turn, may be
followed abruptly by severe hypotension
26. Pulse rate
• Pulse rate is the net result of a balance between
sympathetic (adrenergic) and parasympathetic
(muscarinic and nicotinic) tone,
• many xenobiotics that exert therapeutic or toxic
effects or cause pain syndromes, hyperthermia,
or volume depletion also affect the pulse rate.
• With respect to temperature, there is a direct
correlation between pulse rate and temperature
in that pulse rate increases approximately
8beats/min for each 1.8°F (1°C) elevation in
temperature.
27. **The principle that no single vital sign abnormality can
definitively establish a toxicologic diagnosis.
In trying to differentiate between a sympathomimetic
and anticholinergic toxic syndrome, it should be
understood that although tachycardia commonly
results from both sympathomimetic and
anticholinergic xenobiotics:
• When tachycardia is accompanied by diaphoresis
(increase sweating) or increased bowel sounds,
adrenergic toxicity is suggested,
• But when tachycardia is accompanied by decreased
sweating, absent bowel sounds, and urinary retention,
anticholinergic toxicity is likely
28. Respiration
• “normal” respiratory rates are 16 to 24
breaths/ min in adults with more rapid rates
that are inversely related to age in children.
• The term hyperventilation may mean
tachypnea (an increase in ventilatory rate),
hyperpnea (an increase in tidal volume), or
both.
29. Hyperventilation may result from the direct
effect of a CNS stimulant, such as the direct
effect of salicylates, on the brainstem.
However,
• Salicylate poisoning characteristically
produces hyperventilation by tachypnea,
• but it also produces hyperpnea, with or
without tachypnea.
30. • Pulmonary injury from any source, including
aspiration of gastric contents, may lead to
hypoxemia with a resultant tachypnea.
• Later, tachypnea may change to bradypnea,
hypopnea (shallow breathing), or both.
• Bradypnea may occur when a CNS depressant
acts on the brainstem.
• A progression from fast to slow breathing may
also occur in a patient exposed to increasing
concentrations of cyanide or carbon monoxide
31. Temperature
Temperature evaluation and control are critical.
• The core temperature or deep internal
temperature (T) is relatively stable (98.6° ±
1.08°F; 37° ± 0.6°C) under normal physiologic
circumstances.
• Hypothermia (T <95°F; <35°C)
• Hyperthermia (T >100.4°F; >38°C)
32. • Life-threatening hyperthermia (T >106°F;
>41.1°C) from any cause may lead to extensive
rhabdomyolysis, myoglobinuric renal failure,
and direct liver and brain injury and must
therefore be identified and corrected
immediately.
33. • Hypothermia is probably less of an immediate
threat to life than hyperthermia, but it
requires rapid appreciation, accurate
diagnosis, and skilled management
34. • Hypothermia impairs the metabolism of many
xenobiotics, leading to unpredictable delayed
toxicologic effects when the patient is
warmed.
• Many xenobiotics that lead to an alteration of
metal status place patients at great risk for
becoming hypothermic from exposure to cold
climates.
35. PRINCIPLES OF MANAGING THE ACUTELY
POISONED OR OVERDOSED PATIENT
• Medical toxicologists and information specialists
have used a clinical approach to poisoned or
overdosed patients that emphasizes treating the
patient rather than treating the poison.
• The clinician must always be prepared to
administer a specific antidote immediately in
instances when nothing else will save a patient,
all poisoned or overdosed patients will benefit
from an organized, rapid clinical management
plan.
36. • most medical toxicologists began to advocate a
standardized approach to a comatose “coma” and
possibly overdosed adult patient, typically by:
- intravenous (IV) Administration of 50 mL of DW,
- 100 mg of thiamine and
- 2 mg of naloxone
- along with 100% oxygen at high flow rates.
The rationale for this approach was to compensate
for the previously idiosyncratic style of overdose
management encountered in different healthcare
settings.
37. • It was not unusual then to discover from a
laboratory chemistry report more than 1 hour
after a supposedly overdosed comatose
patient, that the initial blood glucose was 30
or 40 mg/dl… a critical delay in the
management of unsuspected and
consequently untreated hypoglycemic coma.
38. • Today, however, with the widespread
availability of accurate rapid bedside testing
for capillary glucose and pulse oximetry for
oxygen saturation, coupled with a much
greater appreciation by all physicians of what
needs to be done for each suspected overdose
patient, clinicians can safely provide a more
rational, individualized approach to determine
the need for, and in some instances more
precise amounts of, dextrose, thiamine,
naloxone, and oxygen.
39. • The American Academy of Pediatricians (AAP)
all but entirely abandoned its
recommendations for the use of syrup of
ipecac in the home.
• The efficacy of orogastric lavage, even when
indicated by the nature or type of ingestion, is
limited by the amount of time elapsed since
the ingestion. The value of whole-bowel
irrigation (WBI) with polyethylene glycol
electrolyte solution (PEG-ELS) appears to be
much more specific and limited.
40. • Similarly, interventions to eliminate absorbed
xenobiotics from the body are now much more
narrowly defined or, in some cases, abandoned.
• Multiple-dose activated charcoal (MDAC) is useful
for select but not all xenobiotics.
• Ion trapping in the urine is only beneficial,
achievable, and relatively safe when the urine can
be maximally alkalinized after a significant
salicylate, phenobarbital, or chlorpropamide
poisoning.
• Finally, the roles of hemodialysis, hemoperfusion,
and other extracorporeal techniques are now
much more specifically defined.
41. MANAGING ACUTELY POISONED OR
OVERDOSED PATIENTS
• If all of the circumstances involving a poisoned
patient is known.
- The history may be incomplete, unreliable, or
unobtainable;
- multiple xenobiotics may be involved; and
even when a xenobiotic etiology is identified,
it may not be easy to determine whether the
problem is an overdose, an allergic or a drug–
drug interaction.
42. • It is sometimes difficult or impossible to
differentiate between adverse effects of a
correct dose of medication and the
consequences of an unintentional overdose.
43. INITIAL MANAGEMENT OF PATIENTS
WITH A SUSPECTED EXPOSURE
*Similar to the management of any seriously
compromised patient, the clinical approach to
the patient potentially exposed to a xenobiotic
begins with:
• Recognition and treatment of life-threatening
conditions, including airway compromise,
breathing difficulties, and Circulatory
problems such as hemodynamic instability
and serious dysrhythmias.
44. • After the “ABCs” (airway, breathing, and
circulation) have been addressed, the
patient’s level of consciousness should be
assessed because this helps determine the
techniques to be used for Further
management of the exposure.
45. • After the “ABCs” (airway, breathing, and
circulation) have been addressed, the
patient’s level of consciousness should be
assessed because this helps determine the
techniques to be used for Further
management of the exposure.
46. MANAGEMENT OF PATIENTS WITH
ALTERED MENTAL STATUS
• Altered mental status (AMS) is defined as the
deviation of a patient’s sensorium from
normal. Although it is commonly construed as
a depression in the patient’s level of
consciousness, a patient with agitation,
delirium, psychosis, and other deviations from
normal is also considered to have an AMS
47. • After airway patency is established or secured,
an initial bedside assessment should be made
regarding the adequacy of breathing. If it is
not possible to assess the depth and rate of
ventilation, then at least the presence or
absence of regular breathing should be
determined.
48. • Any irregular or slow breathing pattern should be
considered a possible sign of the incipient apnea,
requiring ventilation with 100% oxygen by bag–
valve–mask followed as soon as possible by
endotracheal intubation and mechanical ventila-
tion.
• Endotracheal intubation may be indicated for
some cases of coma resulting from a toxic
exposure to ensure and maintain control of the
airway and to enable safe performance of
procedures to prevent GI absorption or eliminate
previously absorbed xenobiotics.
49. • Pulse oximetry to determine Oxygen
saturation has made arterial blood gas (ABG)
analysis less of an immediate priority, pulse
oximetry has not eliminated the importance
of blood gas analysis entirely.
50. • In addition, carboxyhemoglobin
determinations are now available by point of
care testing and both carboxy-hemoglobin and
methemoglobin may be determined on
venous or arterial blood specimens.
*In every patient with an AMS, a bedside rapid
capillary glucose concentration should be
obtained as soon as possible.
51. • The strength, rate, and regularity of the pulse
should be evaluated, the blood pressure
determined, and a rectal temperature
obtained.
52. Electrocardiogram (ECG) and continuous rhythm
monitoring are essential. Monitoring will alert
the clinician dysrhythmias that are related to
toxic exposures either directly or indirectly via
hypoxemia or electrolyte imbalance. For
example,
ECG demonstrating QRS widening and a right
axis deviation might indicate a life-threatening
exposure to a cyclic antidepressant or another
xenobiotic with sodium channel–blocking
properties.
53. • In these cases, the physician can anticipate
such serious sequelae as ventricular
tachydysrhythmias, seizures, and cardiac
arrest and consider Both the early use of
specific treatment (antidotes).
• such as IV sodium bicarbonate, and avoidance
of medications, such as procainamide and
Other class IA and IC antidysrhythmics, which
could exacerbate the situation.
54. • Extremes of core body temperature must be
addressed early in the evaluation and
treatment of a comatose patient. Life-
threatening hyperthermia (temperature
>105°F; >40.5°C) is usually appreciated when
the patient is touched (although the
widespread use of gloves as part Of universal
precautions has made this less apparent than
previously).
55. • Most individuals with severe hyperthermia,
regardless of the etiology, should have their
temperatures immediately reduced to about
101.5°F (38.7°C) by sedation if they are
agitated or displaying muscle rigidity and by
ice water immersion.
56. • Hypothermia is probably easier to miss than
hyperthermia, especially in northern regions
during the winter months, when most arriving
patients feel cold to the touch.
57. • Early recognition of hypothermia, helps to
avoid administering avariety of medications
that may be ineffective until the patient
becomes relatively euthermic, which may
cause iatrogenic toxicity as a result of a
sudden response to xenobiotics previously
administered.
58. • For a hypotensive patient with clear lungs and
an unknown over dose, a fluid challenge with
IV 0.9% sodium chloride or lactated Ringer’s
solution may be started. If the patient remains
hypotensive or cannot tolerate fluids, a
vasopressor or an inotropic agent may be
indicated, and may more invasive monitoring.
59. • At the time that the IV catheter is inserted, blood
samples for glucose, electrolytes, blood urea
nitrogen (BUN), a complete blood count (CBC),
and any indicated toxicologic analysis can be
obtained.
• A pregnancy test should be obtained in any
woman with childbearing potential.
• If the patient has an AMS, there may be a
temptation to send blood and urine specimens to
identify any central nervous system (CNS)
depressants or so-called drugs of abuse along
with other medications.
60. • Xenobiotic-related seizures may broadly be
divided into three categories:
(1) those that respond to standard
anticonvulsant treatment (typically using a
benzodiazepine);
(2) those that either require specific antidotes to
control seizure activity or that do not respond
consistently to standard anticonvulsant
treatment, such as isoniazid-induced seizures
requiring pyridoxine administration;
61. • (3) those that may appear to respond to initial
treatment with cessation of tonic–clonic activity but
that leave the patient exposed to the underlying,
unidentified toxin or to continued electrical seizure
activity in the brain, as is the case with carbon
monoxide poisoning and hypoglycemia.
62. Within the first 5 minutes of
managing a patient with an AMS,
1. High-flow oxygen (8–10 L/min) to treat a variety of
xenobiotic induced hypoxic conditions
2. Hypertonic dextrose: 0.5–1.0 g/kg of DW for an adult
or a more dilute dextrose solution for a child; the
dextrose is administered as an IV bolus to diagnose
and treat or exclude hypoglycemia
3. Thiamine (100 mg IV for an adult; usually unnecessary
for a child) to prevent or treat Wernicke
encephalopathy .
4. Naloxone (0.05 mg IV with upward titration) for an
adult or child with opioid-induced respiratory
compromise.
63. IDENTIFYING PATIENTS WITH
NONTOXIC EXPOSURES
The following general guidelines for considering an
exposure nontoxic or minimally toxic will assist
clinical decision making:
1. Identification of the product and its ingredients
is possible.
2. None of the US Consumer Product Safety
Commission “signal words” (CAUTION,
WARNING, or DANGER) appear on the product
label.
3. The history permits the route(s) of exposure to
be determined.
64. 4. The history permits a reliable approximation
of the maximum quantity involved with the
exposure.
5. Based on the available medical literature and
clinical experience, the potential effects
related to the exposure are expected to be at
most benign and self-limited and do not
require referral to a clinician.
6. The patient is asymptomatic or has
developed the expected benign self-limited
toxicity.