Anyone who is seeking information about Clinical toxicity, poisoning, poisoning treatment, comparison between snake venom and poison, food poisoning and treatment, source of poison exposure, poisonous incidence, rules of poison center; then this document will be helpful for you.

1. Clinical Toxicity
Pharmacy 6th Batch
MBSTU
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2. Content
1. Clinical Toxicity.
2. Poison & Toxin.
3. Role of Poison
centers.
4. Analysis and
assessment of
poison exposure.
5. General treatment .
6. Symptoms and
management of
poisoning cases.

3. Clinical toxicity
“Clinical toxicity” is the study of the harmful effects of chemicals, drugs, and toxins on humans. It involves
research, prevention, and treatment of diseases caused by these substances. Clinical toxicology is especially
useful when dealing with people who are poisoned or who have overdosed .
Examples of clinical toxicity include:
Acetaminophen overdose: Acetaminophen is a common pain reliever that can cause liver damage if taken
in large amounts .
Lead poisoning: Lead is a toxic metal that can cause serious health problems if ingested or inhaled .
Carbon monoxide poisoning: Carbon monoxide is a colorless, odorless gas that can cause headaches,
dizziness, nausea, and even death if inhaled in large amounts .

4. Poison
A poison can be described as ‘any substance which when introduced into or absorbed by a living organism,
destroys life or injures health’.
 Toxicology, or the science of poisons, is the study of the adverse effects of chemicals or physical agents
on living organisms. The adverse effects may take many forms from immediate death to subtle changes
not realised until months or years later. The degree of exposure to a substance is the key to the potential
for adverse effects or poisoning to occur .
 Poisons can be safely used and be of benefit to society when used appropriately . For example, Warfarin
is used in high doses as a rat poison but low doses are used clinically to prevent blood clots after a stroke
or heart attack .
Familiar poisons include:
Arsenic
Carbon
monoxide
Hydrogen
cyanide
Strychnine Ricin

5. Drug Poisoning
Drug poisoning can occur due to various reasons, including accidental or intentional overdose, drug
interactions, and allergic reactions . The most common causes of drug poisoning include prescription drugs,
over-the-counter medications, and illegal drugs .
Symptoms of drug poisoning can vary depending on the type of drug and the amount ingested. Some
common symptoms include :
Nausea
Vomitting
Dizziness Confusion
Seizures
Breathing difficulty
Toxin:
A “toxin” is a poisonous substance produced by living cells or organisms that can cause harm to other living
organisms . Toxins can be produced by plants, animals, fungi, and bacteria .

6. Animal Toxins
“Zootoxins” are toxins that are produced by animals. They can be divided into several categories:
(1) Oral poisons: those that are poisonous when eaten;
(2) Parenteral poisons or venome: those that are produced by a specialized poison gland and administered
by means of a venom apparatus; and
(3)Crinotoxins: those that are produced by a specialized poison gland but are merely released into the
environment, usually by means of a pore .
Some examples of zootoxins include-
Batrachotoxin Ciguatoxin Tetrodotoxin Snake Venom

7. Poison centers
The World Health Organization (WHO) has published guidelines for establishing a poison center . Poison
centers are established in many countries as sources of specialized expertise to address the fact that health
professionals could not be expected to know about the toxicity of every chemical substance and product and
also to provide a focus for toxicological research.
(WHO) has published guidelines for establishing a poison center . The guidelines provide detailed practical
guidance on planning and operations, including the services that may be offered by a poison center .
Here is the steps involved in establishing a poison center:
Develop
a plan
Assess
the need
Establish
partnerships
Develop
protocols
Train staff
Monitor and
evaluate
Quality
control

8. Incidence of Poisoning
According to the American Association of Poison Control Centers, in 2021, there were over “2.08 million
human poison exposures” in the United States . Pain medications (analgesics) continued to lead the list of the
most common substances implicated in adult poison exposures, followed by sedatives, sleeping medications,
and household cleaning supplies . Cosmetics and personal care products continued to lead the list of the most
common substances implicated in pediatric exposures .
Nearly 88% of opioid-involved overdose deaths involved synthetic opioids (other than methadone) . In 2021,
there were over “107,000 drug overdose deaths” in the United States .
Here is a list of some common substances that can cause poisoning:
1. Analgesics: Acetaminophen, ibuprofen, and aspirin .
2. Sedatives and sleeping medications: Benzodiazepines and Barbiturates .
3. Household cleaning supplies: These include products such as bleach, ammonia, and drain cleaners .
4. Opioids: Oxycodone and Hydrocodone as well as illegal drugs such as heroin and fentanyl .
6. Alcohol: Alcohol poisoning can occur when a person drinks too much alcohol in a short period of time .

9. The analysis of food poisoning involves several steps to identify the causative agent, determine the source of
contamination, assess the severity of the outbreak, and implement appropriate measures to prevent further cases.
How do doctors diagnose food poisoning?
Medical history Physical exam
Blood tests
Stool tests

11. Assessment :
Assessment of clinical toxicity in humans is a complex process that involves evaluating the toxic effects of a
substance on human health. The assessment of toxicity involves two steps: hazard identification and dose-
response evaluation.
Hazard identification:
Hazard identification includes a description of the specific forms of toxicity (neurotoxicity, carcinogenicity, etc.)
that can be caused by a chemical and an evaluation of the conditions under which these forms of toxicity might
appear in exposed humans. Data used in hazard identification typically are derived from animal studies and
other types of experimental work, but can also come from epidemiologic studies.
Dose-response evaluation :
Dose-response evaluation is a more complex examination of the conditions under which the toxic properties of
a chemical might be evidenced in exposed people, with particular emphasis on the quantitative relationship
between dose and toxic response. This step also includes study of how response can vary from one population
subgroup to another.

12. General principles for the treatment of clinical toxicity:
• First - Removal of the patient from the source of exposure.
• Second - Emergency aids to stabilize the patient.
• Third - Proper clinical evaluation.
• Fourth - Removal of unabsorbed part of poison from G.I. Tract/ Skin/ Eyes.
• Fifth - Removal of absorbed part of poison by forced diuresis, dialyses etc.
• Sixth - Administration of specific antidote (A list of antidotes for common poisoning cases is
appended).
• Seventh- Symptomatic treatment and assessment of clinical improvement.

13. Sources of
Poison Exposure
1.Household
Chemicals
2.Medications
3.Plants
4.Food and Drink
5.Lead
6.Industrial Chemicals
7.Environmental
Pollutants
8.Insect and Snake
Bites
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14. Pesticide Poisoning
What is Pesticides poisoning?
Pesticide poisoning occurs when individuals are exposed to toxic levels of pesticides, either through direct contact, inhalation,
or ingestion. It is important to note that pesticide poisoning can be a medical emergency, and immediate medical attention
should be sought if poisoning is suspected.
Symptoms of pesticides poisoning
The symptoms and management of pesticide poisoning can vary depending on the specific pesticide
involved and the route of exposure. Common symptoms of pesticide poisoning may include:
Skin irritation or rash
Respiratory distress Gastrointestinal problem
Neurological symptoms
Eye and mucous membrane
irritation

15. Management of pesticides poisoning
Remove the person from the source of exposure
If the poisoning occurred due to inhalation, move the affected person to an area with fresh air. If exposure was
through skin contact, remove contaminated clothing and wash the affected area with soap and water. In the
case of ingestion, do not induce vomiting unless instructed to do so by a medical professional.
Seek medical help immediately
Contact emergency services or a poison control center for guidance on further actions. Provide them with
information about the type of pesticide involved, the route of exposure, and the symptoms exhibited by the
affected person.
First aid and supportive care
While awaiting medical assistance, administer first aid as appropriate. For skin exposure, gently wash the
affected area with soap and water. If pesticide enters the eyes, flush with clean water for at least 15 minutes.
In case of ingestion, do not give anything by mouth unless instructed by a healthcare professional.
Decontamination and detoxification
Depending on the specific pesticide, decontamination measures such as activated charcoal administration, gastric
lavage (stomach pumping), or the use of antidotes may be necessary. These procedures should be carried out by
trained medical personnel.

16. Fumigants
Fumigants are chemicals or substances that are used to disinfect, sterilize, or eliminate pests, such as insects, rodents,
nematodes, and microorganisms, from an enclosed space or a specific area. They are often employed in agriculture, pest
control, and the preservation of stored products. Fumigation is the process of applying fumigants to control or eliminate
pests.
Types of Fumigants:
 Inorganic Fumigants: sulfur dioxide, hydrogen cyanide, and
formaldehyde.
 Organic Fumigants: methyl bromide, phosphine gas, and
chloropicrin.
 Botanical Fumigants: Some naturally occurring plant extracts, such as neem oil and essential oils, can also be used as
fumigants to control pests.
Process of fumigation
Fumigation generally involves the following phases: first, humans are evacuated from the area intended for fumigation and the area
covered to create a sealed environment. Next, the fumigant is released into the space to be fumigated. The space is held for a set period
while the fumigant gas percolates through the space and acts on/kills any infestation in the area. Finally, the space is ventilated so that the
poisonous gases are allowed to escape from the space, rendering it safe for humans to enter. If successful, the fumigated area is now safe
and pest free.

17. Safety Considerations:
 Fumigants are often toxic to humans and can pose serious health risks if not handled
properly.
 They should only be applied by trained and certified professionals who follow strict
safety protocols.
 Adequate ventilation and monitoring are crucial to ensure that the fumigant
concentration does not exceed safe levels.
Application Methods:
Soil fumigation is used
in agriculture to
control soil-borne pests
and diseases.
Space fumigation involves
sealing an area, such as a
building or storage facility, and
introducing the fumigant to
eliminate pests within that space.
Commodity fumigation is
used to treat stored products,
such as grains, nuts, and
dried fruits, to prevent
infestations during storage.

18. Heavy metal poison
Heavy metal poisoning (toxicity) is the result of exposure to heavy metals like lead, mercury and arsenic.
Management :
 Taking chelating agenet.
 Gastric lavage.
 Hemodialysis for kidney failure.
 Medicines to treat symptoms use (EDTA), Penicillamine.

19. Vapor poisoning
Vapor poisoning, also known as chemical or gas exposure, can result from inhaling toxic gases or
chemicals. Toxic gas include ammonia, chlorine , ozone, CO, nitric oxide etc.
Management of vapor poisoning : First aid treatment include –
 Open window and door and turn on the fans in the room
 Leave the area and go outside to get fresh air
 For eye irritation eyes flush with lukewarm watet for 5-10 minutes
 For throat irritation drink a glass of cold water or milk
 Further treatment is given by healthcare professional.

20. Snake venom
Snake venom is a glandular secretion which snakes use to immobilize and digest their prey . It
can be dangerous for circulator system, nervous system, or muscle system. They can destroy the
outer membrane of capillary vessels, causing internal bleeding . Snake bites should always be
taken seriously. Though some are dry bites, which aren't as dangerous and will likely cause
some swelling, others are venomous bites, which, if not treated carefully and quickly, can result
in death.

21. Snake poisons vs venoms
The hallmark of venom is that it's
introduced via a wound. It can be
injected through a number of
means, including teeth, a sting,
spines or claws.
Poison is different as there is no
wound involved. It can be absorbed
into the bloodstream through the
skin, inhaled or ingested
The Mozambique spitting cobra
(Naja mossambica) is a highly
venomous species of spitting
cobra native to Africa.
World’s Deadliest Snakes
The Black mamba (Dendroaspis polylepis) is
a species of highly venomous snake
belonging to the family Elapidae. It is native
to parts of sub-Saharan Africa. A dangerous
African snake named for its black mouth
The king cobra (Ophiophagus hannah) is
the longest venomous snake in the world.
Its bite delivers a tremendous amount of
paralysis-inducing neurotoxins. The snake’s
venom is so strong and so voluminous that
it can kill an elephant in just a few hours.
Death also results in at least 50 to 60
percent of untreated human cases.
The Banded krait (Bungarus fasciatus) is a highly
venomous relative of the cobra. Its venom is
essentially a neurotoxin that induces paralysis.
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22. Signs of Snake Bite
Signs or symptoms of a snake bite may vary depending
on the type of snake, but may include:
 Puncture marks at the wound.
 Redness, swelling, bruising, bleeding, or blistering
around the bite.
 Severe pain and tenderness at the site of the bite
 Nausea, vomiting, or diarrhea.
 Labored breathing (in extreme cases, breathing may
stop altogether).
 Rapid heart rate, weak pulse, low blood pressure.
 Disturbed vision.
 Metallic, mint, or rubber taste in the mouth.
 Increased salivation and sweating.
 Numbness or tingling around face and/or limbs.
 Muscle twitching.
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23. First Aid
 Seek medical attention as soon as possible (dial
16263 or call local Emergency Medical Services
[EMS]).
 Driving oneself to the hospital is not advised
because people with snakebites can become
dizzy or pass out.
 Take a photograph of the snake from a safe
distance if possible. Identifying the snake can
help with treatment of the snakebite.
 Keep calm.
 Remove rings and watches before swelling
starts.
 Wash the bite with soap and water.
 Cover the bite with a clean, dry dressing.
 Mark the leading edge of tenderness/swelling
on the skin and write the time alongside it.
Do's and Don'ts
Do NOT do any of the following:
 Do not pick up the snake or try to trap it.
 NEVER handle a venomous snake, not even a
dead one or its decapitated head.
 Do not wait for symptoms to appear if bitten,
get medical help right away.
 Do not try to suck out the venom.
 Do not apply ice or immerse the wound in
water.
 Do not drink alcohol as a painkiller.
 Do not take pain relievers (such as aspirin,
ibuprofen, naproxen).
 Do not apply electric shock or folk therapies.
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24. Treatment
 Antivenom is the treatment for serious snake envenomation. The sooner antivenom
can be started, the sooner irreversible damage from venom can be stopped.
Antivenom, also known as antivenin, venom antiserum, and antivenom
immunoglobulin, is a specific treatment for envenomation. It is composed of
antibodies and used to treat certain venomous bites and stings. Antivenoms are
recommended only if there is significant toxicity or a high risk of toxicity. The specific
antivenom needed depends on the species involved. It is given by injection.
Side effects may be severe. They include serum sickness, shortness of breath, and
allergic reactions including anaphylaxis. Antivenom is traditionally made by collecting
venom from the relevant animal and injecting small amounts of it into a domestic
animal.
 The antibodies that form are then collected from the domestic animal's blood and
purified.
Snake Venom Antiserum BP
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25. Food poisoning is a common and often uncomfortable or even dangerous condition caused by consuming contaminated
food or beverages. It occurs when you ingest harmful microorganisms like bacteria, viruses, parasites, or their toxins.
Food poisoning
What are the symptoms of food poisoning?
Depending on the cause of the illness, the symptoms may differ. The following are some of the most common
signs and symptoms of food poisoning:
 Vomiting
 Diarrhea
 Abdominal pain and
 Headache

27. REFERENCE:
1. WHO Guidelines for establishing a poison centre. https://www.who.int/news/item/18-01-2021-who-guidelines-for-
establishing-a-poison-centre.
2. General Toxicology | SpringerLink. https://link.springer.com/chapter/10.1007/978-3-030-50409-0_2.
3. Poison - Animal, Zootoxins, Biochemistry | Britannica. https://www.britannica.com/science/poison-
biochemistry/Animal-poisons-zootoxins.
4. Animal protein toxins: origins and therapeutic applications - Springer.
https://link.springer.com/article/10.1007/s41048-018-0067-x.
5. An Overview of Natural Toxins in Food - CFS.
https://www.cfs.gov.hk/english/multimedia/multimedia_pub/multimedia_pub_fsf_11_02.html.