Definitions, Common Drug Poisoning, Drug Overdosage Evaluation, Management, Case Scenario

1. Dr Hemanth S Naik

2. Definitions
Common Drug Poisoning
DO Evaluation
Management
Case Scenario
Drug Abuse
Dr Hemanth S Naik

3. Any substance which when administered in living
body through any route (Inhalation, Ingestion,
surface absorption etc) will produce ill-health or
death by its action which is due to its physical
chemical or physiological properties.
Dr Hemanth S Naik

4. Any substance or product that is used or intended
to be used to modify or explore physiological
systems or pathological states for the benefit of the
recipient.
Dr Hemanth S Naik

5. Analgesics
Dr Hemanth S Naik

6. Barbiturates
&
Benzodiazepines
Dr Hemanth S Naik

7. Narcotics
Dr Hemanth S Naik

8. Motive
Co-Morbidity
Related Drug
CO-Ingestion
Symptoms & Signs
Dr Hemanth S Naik

9. Accidental
Dr Hemanth S Naik

10. Suicidal
Dr Hemanth S Naik

11. Homicidal
Dr Hemanth S Naik

12. Dr Hemanth S Naik

13. Type Time
?
Preparation Dosage
Dr Hemanth S Naik

14. Dr Hemanth S Naik

15. Hyperventilation
Amphetamine
Cocaine
Isoniazid
Anticholinergics
Dr Hemanth S Naik

16. Hypoventilation
Barbiturates
Opioids
Ethanol
Capnograph
Sedative-
hypnotics
Dr Hemanth S Naik

17. Hypothermia Hyperthermia
Ethanol Cocaine
Sedatives Amphetamines
Opioids Anticholinergic
Barbiturates Neuroleptics
Dr Hemanth S Naik

18. Hypotension Hypertension
Antihypertensives Cocaine
Barbiturates Anticholinergics
Diuretics phenothiazines
Dr Hemanth S Naik

19. Bradycardia Tachycardia
Opioids cocaine
Digoxin TCA
Normal: 60-100 bpm
Bradycardia: <60 bpm
Tachycardia : >100 bpm
Dr Hemanth S Naik

20. Blood Glucose Test
SpO2
Serum Chemistry
Drug & Toxin Levels
ECG
Dr Hemanth S Naik

21. GIT
ABC
Decontamination
Enhance
Antidote
Elimination
Dr Hemanth S Naik

22. Oro
Emesis Gastric
Lavage
Whole
Activated
Bowel
Charcoal
Irrigation
Dr Hemanth S Naik

23.  Seldom use, have
Risk
 Acute ingestion of
potentially toxic
substance ( < 1hr)
 Pre-hospital
setting with long
transport time to
medical care
Dr Hemanth S Naik

24. Large-bore fenestrated
Contraindications

•
orogastric tube (36-40 Fr)
Caustic/ Corrosive
 Require protected airway
ingestion

•
Amount of poison
Large foreign bodies
•
ingested is protected life
Airway not potentially
threatening
• Suspected UGI injury
 Within 60 minutes of
• Hypoxia
ingestion (Except anti-
cholinergic < 12 hr ingestion;
salicylate < 24 hr ingestion)
Dr Hemanth S Naik

25. Dr Hemanth S Naik

26.  Large Surface Area
 Binding property
 Interrupts
Enterohepatic &
Enteroentric
Circulation
One gram of activated
carbon has the surface
area (>400 m2) of
approximately two
tennis courts (260 m2) !
Dr Hemanth S Naik

27. • Single Dose: 1g/kg
Dose
• Multiple Dose: 0.5g/kg Q2-6H
• Digoxin;Amitriptyline;Phenobarbitone;
Dozepin;Theophylline;Salicylates;Pheno
Indication barbital;Dapsone;phyentoin;carbamaze
pine;Aspirin
• Ileus
Contraindication • GI perforation
• Loss of airway protection
Dr Hemanth S Naik

28. • Mechanically flushing the ingested
poison out of the GIT before it can
be absorbed into the body
• Iso-osmolar solution of
polyethylene glycol
• Rate: 1-2L per hour (minimally)
• P.O. or R/T, Entire procedure
usually takes 4 to 6 hours
• Till rectal effluent clear
Dr Hemanth S Naik

29. Indication Contraindication
Not well-absorbed
by activated Compromised
charcoal airway
(e.g. Fe, Li, Pb, Zn)
Sustained release/
Enteric coasted GI perforation
preparation
Rising drug level
Ileus
despite GL/AC
Dr Hemanth S Naik

30. • Urinary Alkalinization
• Saline Diuresis
• Haemodialysis and
Haemoperfusion
Dr Hemanth S Naik

31. Drug Antidote
Benzodiazepine Flumazenil
Beta blockers Glucagon
Calcium blockers Calcium
Iron or Aluminum Deferroxamine
Isoniazide (INH) Vit B6
Methemoglobinemia Methylene blue
Methanol Ethanol
Opioid Naloxone
TCA anti-depressants Sodium bicarbonate
Coumarin Vit K1
Acetaminophen N-acetylcysteine
Dr Hemanth S Naik

33. Child aged about 4 years
Nausea & Vomiting
Abdominal Pain
History of ingestion of
unknown white tablets
Dr Hemanth S Naik

34. Motive Accidental
Co-Morbidity None
Paracetamol? <24hrs,
Related Drug
11 tablets??
CO-Ingestion Not Determined
Suggestive of
Symptoms & Signs
Paracetamol Poisoning
Dr Hemanth S Naik

35. •90-95% hepatic
•90-95% hepatic
•t1/2: prolonged
•t1/2: 2-3 hrs
•>90% Non-toxic sulfate & glucuronide
conjugates pathway
•>90% Non-toxic sulfate &
glucuronide conjugates
pathway
•Increase in NAPQI, depletes glutathione
stores->NAPQI accumulates
•<5% by cytochrome P450
2E1 to N-acetyl-para- •Hepatocellular centribular necrosis and
benzoquinoneimine (NAPQI), renal injury
Therapeutic Overdose
Dr Hemanth S Naik

36. •0.5-24h
Phase 2 •72-96h
Phase 4
•Nausea, vomiting, •24-72h •Coagulopathy, •4-14 days
abdominal pain •RUQ pain hepatic necrosis, •resolution of
encephalopathy hepatic
•Elevation LFT
dysfunction
Phase 1 Phase 3
Dr Hemanth S Naik

37. Airway Gastric
Lavage
GIT
Breathing
ABC
Decontamination
Activated
Circulation Charcoal
Urine
Enhance
Alkanization N-Acetyl
Antidote
Elimination Cysteine
Dr Hemanth S Naik

39. Morpheus-God of Dreams
Opiate analgesic
Addiction
Dependence
Dr Hemanth S Naik

40. Narcotic
Latex of opium poppies
Papaver somniferum
Dr Hemanth S Naik

41. Dr Hemanth S Naik

42. F. W. Serturner
1803
Opium War
F. W. Serturner
17 Century
th
Opium War 1803
Hippocrates
17th Century
Hippocrates
460-357 BC
460-357 BC
Sumerians
Sumerians
4000 BC
4000 BC
Dr Hemanth S Naik

43. Opium
Semi Synthetic
Synthetic
Natural Heroin
Meperidine
Morphine Hydromorphone
Methadone
codeine Oxymorphone
Fentanyl, etc
oxycodone
Dr Hemanth S Naik

44. Raw Morphine Heroin
Opium Base Base
Dr Hemanth S Naik

45. Dr Hemanth S Naik

46. Medication Behavioral Therapy
• Methadone • Counseling
• Levo-alpha-acetyl-methadol • Build Self Confidence
(LAAM) • Build Personality
• Buprenorphine
• Naltrexon
Dr Hemanth S Naik

47. Dr Hemanth S Naik

48. Dr Hemanth S Naik