- OPC (organophosphate compound) poisoning is a major cause of death by poisoning in India, commonly caused by pesticide and insecticide exposure. It works by inhibiting acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of muscarinic, nicotinic, and CNS receptors.
- Clinical features include cholinergic crisis within hours, intermediate syndrome in 1-4 days characterized by neck and respiratory muscle weakness, and delayed neuropathy in weeks characterized by distal muscle weakness.
- Treatment involves decontamination, atropine as an antidote to compete with acetylcholine at muscarinic receptors, pralidoxime as a reactivating agent,
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
INTRODUCTION:
Kerosene is a low viscosity flammable liquid.
Three types of kerosene mainly available in the market:
Commercial Kerosene ( Colourless)
PDS (Public Demand Supply – Blue dyed)
Aircraft fuel
Kerosene is known to cause harm to various body organs and systems.
Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes.
Kerosene poisoning is a very uncommon mode of poisoning.
EXPOSURE AND TOXICOKINETICS :
MECHANISM OF TOXICITY :
Toxicity is:
Due to exposure of un-combusted row kerosene.
Due to fuel performance additives.
Due to its exhaust emission
Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics.
CLINICAL SYMPTOMS:
Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma.
Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation.
Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis.
Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation.
TREATMENT:
In the case of acute exposures, the first step is to remove the patient from exposure.
In the case of ingestion of kerosene, Gastric lavage should not be undertaken.
Broad-Spectrum antibiotics like amoxicillin should be given through intravenously.
In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral.
Ceftriaxone is also included in the treatment system in combination with cefuroxime.
In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline.
HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION:
Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon.
On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity.
In the stomach, petechial hemorrhages with congested mucosa are found.
Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms.
In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis.
ANALYSIS:
Kerosene in biological material is isolated by steam distillation.
The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl.
The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether.
The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer.
On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm.
A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).
As this herbicide poisoning is frequent with poor outcomes so its management needs to be discussed and awareness should be raised among farmers about its use and pre-hospital treatments.
Corrosive poisoning is a common emergency as corrosive agents are easily available for household use. this ppt. covered the management of corrosive poisoning. Available now.
David Collins gives an excellent lecture on Toxicology at the Sydney Intensive Care Network meeting for the Intensive Care Network (www.intensivecarenetwork.com). The podcast to go with this can be found on iTunes (Oli Flower's ICU Podcasts) or on www.intensivecarenetwork.com
As this herbicide poisoning is frequent with poor outcomes so its management needs to be discussed and awareness should be raised among farmers about its use and pre-hospital treatments.
Corrosive poisoning is a common emergency as corrosive agents are easily available for household use. this ppt. covered the management of corrosive poisoning. Available now.
David Collins gives an excellent lecture on Toxicology at the Sydney Intensive Care Network meeting for the Intensive Care Network (www.intensivecarenetwork.com). The podcast to go with this can be found on iTunes (Oli Flower's ICU Podcasts) or on www.intensivecarenetwork.com
Clinical symptoms and management of poisoningschiragmarwah1
This presentation contains relevant and genuine information regarding clinical symptoms and management of different types of poisonings such as Barbiturate poisoning, Morphine poisoning, Arsenic Poisoning, Organophosphate poisoning, and Lead Poisoning. Hopefully the contents in presentation will help the pharma students to understand the concept of poisoning in a better and appropriate way.
Regards:
Chirag Marwah
A good read for undergraduate students in Pharmacy studying at the University of Mumbai. I will highly recommend Essentials of Medical Pharmacology by KD Tripathi. All copyright to the original authors and publishers.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
4. MECHANISM OF ACTION
OPC & Carbamates
↓
AChE inhibitors
↓
binds with AChE irreversibly with time
(Ageing)
↓
More for Diethyl compounds
↓
5. Inhibits both RBC and plasma AChE (
pseudocholinesterase)
↓
Accumulation of ACh at synapses
↓
Overstimualtion and disruption of ACh
receptors
↓
Muscranic , Nicotinic ,CNS sites
↓
Toxic effects on CNS , PNS
8. CHOLINERGIC CRISIS
• Within 30 mins to 3 hours of exposure
• Depends on type , quantity and route of
exposure
• Initial cholinergic crisis last for 24 - 72
hours
• Lipid soluble drugs (diazinon , fenthion ,
methyl parathion) - delayed cholinergic
symptoms (d/t late release of toxin from fat
stroage )
• Type 1 respiratory paralysis
9. Receptor based features
Receptors site clinical features
Muscranic ACh Parasympathetic Bradycardia
Bronchospasm
Bronchorrhea
Diarrhoea
Hypotension
Lacrimation
Miosis
Salivation
Urination
Vomiting
Nicotinic acetylcholine Sympathetic Hypertension
Mydriasis
Sweating
Tachycardia
13. INTERMEDIATE SYNDROME
• 10-40% of patients
• 24 - 96 hours after exposure
• d/t susceptibility of AChR, prolonged
action of ACh in Nicotinic AChR,
inadequate treatment
• Not seen in carbamte poisoning
14. • Signs - Pharyngeal weakness
Neck flexion weakness
↓DTR
Cranial Nerve abnormalities
Proximal muscle weakness
Type II respiratory paralysis ( lasts
for 4- 18 days )
• Mortality - respiratory depression
15. DELAYED NEUROPATHY
• TOCP , TCP - produce type lll respiratory
paralysis
• Organophosphate Induced Delayed
Neuropathy ( OPIDP )
• 2-3 weeks after exposure
• Distal muscle weakness
• Wrist drop & Foot drop
• Lasts for months - slow recovery
• d/t inhibition of neuropathy target esterase
16. DIAGNOSIS
• History
• Clinical signs
• Pungent or garlic like odour from breath
and stomach wash contents
• Obtain the exact pesticide
• pseudo (plasma) or true (RBC) choline
esterase levels
• CBC, RFT, LFT, ECG , CXR
17. DD
Poison Similarities Differenciating features
Mushroom Cholinergic toxicity Delayed manifestations
Botulism Diarrhoea
Muscle weakness
Respiratory weakness
Bulbar and Facial palsy
Descending paralysis
Pyrethroid Pesticide smell
Excess salivation
Tremors
Fasciculations
No other cholinergic
symptoms
Normal RBC AChE
Organochloride Pesticide smell Pulmonary edema
Seizures
Opioid Pinpoint pupils
Respiratory failure
Early LOC
Response to Naloxone
Cholinergic drug
toxicity
Respiratory failure
Pinpoint pupils
Salivation
H/O drug intake for MG /
Alzhemier's
18. MANAGEMENT
• Initial resuscitation
• Removal of unabsorbed poison
• Antidote therapy for absorbed poison
• Rx of complications
• Prevent poisoning in future
19. EMERGENCY RESUSCITATION
• Medical emergency
• Supplemental O2 + tracheal intubation
• Excess poison , excess secretions , LOC ,
hypoventilation - needs Mechanical Ventilation
• IV access
• Elderly - cardiac toxicity & Hypotension - (
crystalloids and inotropes )
• Urinary catheter - to avoid urinary retention with
atropine
• Antidote
