The document provides information on the treatment of various types of poisonings and overdoses. It discusses the general principles of poisoning treatment which include stopping the source of poison, limiting absorption, supportive therapy, and specific antidotes. It then covers the treatment of specific types of poisonings and overdoses, including barbiturate poisoning, morphine overdose, organophosphate poisoning, and heavy metal poisoning. For each, it discusses symptoms, causes, diagnosis, and standard treatment approaches.

1. POISONING
Ms. Alka Malik
Assistant Professor
M. Pharma (Pharmacology)

2. • Toxicology is the science that deals with the
study of poisons, their source, properties,
actions, detection and treatment of poisoning.

3. General principles of treatment
• Stop the source of poison
• Limit the absorption of poison
• Supportive therapy – ABC and coma cock tail
– Naloxone 2 mg
– Thiaine 100 mg
– Dextrose 50% 50 mL
• Specific therapy with antidotes
• Other measures

4. Other measures are
– Forced alkaline diuresis : Frusemide, Sodium
bicarbonate and IV fluids
– Forced acid diuresis : Frusemide, Ascorbic acid
and IV fluids
– Hemodialysis

5. General management
• Gut decontamination
• Management of respiratory failure
• Management of circulatory failure
• Management of fluid and electrolyte
imbalance
• Metabolic acidosis
• Convulsions
• Antidotes

6. Gut decontamination
• Emesis : Ipecac syrup 20-30 ml or Strong salt
solution or freshly prepared mustard powder
solution
• Do not induce emesis : Corrosive agent or
petroleum product or unconscious patient
• Stomach wash
• Activated charcoal / Medicoal
• Purgatives: MgSO4 20-30 g or Sod. Sulphate
20-30 g

7. Management of respiratory failure
• Oxygen
• Mechanical ventilation
• Sitting position

8. Management of circulatory failure
• Plasma expanders : Dextran or whole blood
• Vasopressors : Dopamine 2-10 mcgr/kg or
phenylephrine 5-20 mcgr/kg or methoxamine
or mephenteramine

9. Management of fluid and electrolyte
imbalance
• Hyponatremia : Normal saline
• Hypernatremia : Frusemide
• Hypokalemia : KCl 4-6 mEq/L
• Hyperkalemia : Frusemide or thiazide or 10%
calcium gluconate
• Hypocalcemia : 10% calcium gluconate

10. Metabolic acidosis
• Sodium bicarbonate 1-2 mEq/L IV for 30
minutes

11. Convulsions
• Diazepam 10 mg slow IV
• Phenytoin 10 mg/kg IV
• Phenobarbitone 10 mg/kg

12. Antidotes
• Physical antidote : Activated charcoal adsorbs
alkaloids
• Chemical antidote : acetic acid reacts with
alkalis, chelating agents bind heavy metals like
lead, arsenic, copper, mercury, etc.
• Pharmacological antidotes

13. Pharmacological antidotes
Toxic agent Antidote
Paracetamol N-Acetyl cysteine
Morphine and other opioids Naloxone
Heparin Protamine sulphate
Cyanide Sodium nitrate + Sodium thiosulphate
Organophosphates Atropine, Pralidoxime
Atropine Physostigmine
Copper D-Penicillamine
Iron Desferrioxamine
Arsenic Dimercaprol
Lead Calcium disodium edetate
Insulin Glucose
Methanol Ethanol
Carbon monoxide Oxygen
Warfarin Vit K1 oxide

14. Barbiturate Poisoning
Barbiturate poisoning is due to excessive doses of barbiturates. If death
occurs this is typically due to a lack of breathing.
Barbiturate overdose may occur by accident or purposefully in an attempt
cause death. The toxic effects are additive to those
of alcohol and benzodiazepines.
The lethal dose varies with a person's tolerance and how the drug is taken. The
effects of barbiturates occur via the GABA neurotransmitter. Exposure may be
verified by testing the urine or blood.
Treatment involves supporting a person's breathing and blood pressure. While
there is no antidote, activated charcoal may be useful. Multiple doses of
charcoal may be required.
Hemodialysis may occasionally be considered. Urine alkalinisation has not
been found to be useful.
While once a common cause of overdose, barbiturates are now a rare cause.

15. Symptoms
difficulty thinking, poor coordination, decreased level of
consciousness, and a decreased effort to breathe
(respiratory depression)
Mechanism
Barbiturates increase the time that the chloride pore of
the GABA receptor is opened, thereby increasing the
efficacy of GABA. In contrast, benzodiazepines increase
the frequency with which the chloride pore is opened,
thereby increasing GABA's potency

16. Treatment
Treatment involves supporting a person's breathing and blood pressure.
While there is no antidote, activated charcoal may be useful.
Multiple doses of charcoal may be required. Hemodialysis may occasionally be
considered. Urine alkalinisation has not been found to be useful.
If a person is drowsy but awake and can swallow and breathe without difficulty,
the treatment can be as simple as monitoring the person closely.
If the person is not breathing, it may involve mechanical ventilation until the
drug has worn off.

17. Morphine
Morphine is a pain medication of the opiate family.It can be
taken orally or injected; it is also often smoked. It acts
directly on the central nervous system (CNS) to increase
feelings of pleasure and warm relaxation and reduce pain,
and is often abused for this purpose. It can be taken for
both acute pain and chronic pain and is frequently used for
pain from myocardial infarction, kidney stones, and
during labor. Morphine can be administered by mouth,
by injection into a muscle, by injection under
theskin, intravenously, injection into the space around
the spinal cord, or rectally.

18. Symptoms
decreased respiratory effort, vomiting, nausea,
and low blood pressure. drowsiness, vomiting, and
constipation.
Adverse effects
Constipation
Hormone imbalance

19. Morphine Toxicity
A large overdose can cause asphyxia and death by respiratory
depression if the person does not receive medical attention
immediately.
Overdose treatment includes the administration of naloxone. The
latter completely reverses morphine's effects, but may result in
immediate onset of withdrawal in opiate-addicted subjects.
Multiple doses may be needed as the duration of action of
morphine is longer than that of naloxone.
The LD50 for humans of morphine sulphate and other
preparations is not known with certainty. One poor quality study
on morphine overdoses among soldiers reported that the fatal
dose was 0.78 mcg/ml in males (~71 mg for an average 90 kg
adult man) and 0.98mcg/ml in females (~74 mg for an average
75 kg female).

20. Organophosphate poisoning
Organophosphates are a common class of insecticides. But large doses
of organophosphates can also harm people and other animals.
Organophosphate poisoning can occur when you’re exposed to them
for too long or at high levels.
Organophosphates are typically colorless-to-brown liquids at room
temperature. Some may be unscented, while others have a fruit-like
smell.
ResearchersTrusted Source say as many as 25 million agricultural
workers across the developing world have at least one episode of
organophosphate poisoning per year. It’s being seen with more
frequency in areas where there is limited access to insecticide safety
gear, such as suits and breathing apparatuses.
Terrorist use of organophosphates is rare, but it has occurred. Sarin, an
organophosphate poison, has been intentionally used twice in terrorist
attacks in Japan.

21. Symptoms of organophosphate poisoning
Organophosphate poisoning can be short- or long-term. It can be caused by
large or small doses. The longer the exposure and the larger the dose, the
more toxic the effects. Symptoms can occur within several minutes or hours of
exposure.
MILD ORGANOPHOSPHATE EXPOSURE MAY CAUSE:
•narrowed, pinpointed pupils
•impaired, blurry vision
•stinging eyes
•runny nose
•watery eyes
•excess saliva
•glassy eyes
•headache
•nausea
•muscle weakness
•muscle twitching
•agitation

22. MODERATE SIGNS OF ORGANOPHOSPHATE EXPOSURE INCLUDE:
•very narrowed pupils
•dizziness
•disorientation
•coughing and wheezing
•sneezing
•difficulty breathing
•drooling or excessive phlegm
•muscle twitching and tremors
•muscle weakness
•fatigue
•severe vomiting and diarrhea
•involuntary urination and defecation
EMERGENCY SIGNS OF ORGANOPHOSPHATE POISONING INCLUDE:
•very narrowed pupils
•confusion
•agitation
•convulsions
•excessive body secretions, including sweat, saliva, mucus, and tears
•irregular heartbeat
•collapse
•respiratory depression or arrest
•coma

23. WHAT ARE THE COMPLICATIONS OF ORGANOPHOSPHATE
POISONING?
Organophosphate poisoning can cause several serious complications. These
include:
•metabolic disorders, such as hyperglycemia (high blood sugar) and glycosuria
(excess sugar in urine)
•diabetic ketoacidosis, in which your blood produces excess blood acids
•pancreatitis, or inflammation of the pancreas
•Cancer
•neurological problems, such as muscle weakness and twitching, poor
concentration, poor memory, and post-traumatic stress disorder
•fertility problems
•paralysis

24. What causes organophosphate poisoning
The people most at-risk for unintentional organophosphate
poisoning are those who live or work on or near farms. You
can also get organophosphate poisoning by consuming
contaminated food or water.
The most common unintentional exposure routes are
through breathing and contact with the skin.
People who intentionally expose themselves to
organophosphates tend to inhale and ingest it. These
concentrated, high doses are often fatal.

25. organophosphate poisoning Treatment
The first goal of treating emergency cases is stabilization.
Emergency care workers will:
•decontaminate your body to prevent further exposure
•stabilize your breathing
•use intravenous fluids to flush your system of toxins
In non-emergency cases, healthcare providers will still
administer some supportive therapy. They’ll pay close
attention to your breathing. Respiratory function is
weakened by organophosphate exposure.
Doctors may administer a drug called atropine to stabilize
your breathing. They may also administer pralidoxime,
which can help relieve neuromuscular problems.

26. In severe cases
doctors often prescribe benzodiazepines to prevent or stop seizures.
If you have been exposed to organophosphates in small doses and don’t need
to be hospitalized, you may administer a low dose of atropine to yourself using
a commercially prepared injection.
An injection of 10 mg diazepam is recommended for people exposed to
chemical attacks of organophosphates.
Age and weight Dose
adults and children who weigh more
than 90 pounds (41 kilograms)
2 milligrams (mg)
children weighing 42 to 90 pounds (19 to
41 kilograms)
1 mg
children weighing less than 42 pounds
(19 kilograms)
0.5 mg

27. •Heavy metal poisoning(Lead,Mercury and Arsenic)
Heavy metals are are elements that are naturally found in the earth.
They’re used in many modern-day applications, such as agriculture,
medicine, and industry.
Your body even naturally contains some. Zinc, iron, and copper, for
example, are necessary for regular body function, as long as they aren’t
present in toxic amounts.
Heavy metal poisoning occurs when your body’s soft tissues absorb too
much of a particular metal.
The most common metals that the human body can absorb in toxic
amounts are:
•mercury
•lead
•cadmium
•arsenic

28. You might be exposed to high concentrations of these
metals from food, air or water pollution, as well as
medicine, food containers with improper coating,
industrial exposure, or lead-based paint.
In the United States, heavy metal poisoning is very rare.
It only occurs when you’ve been exposed to a significant
amount of heavy metal, usually over a long period of
time.
But the popularity of over-the-counter (OTC) products
that claim to detoxify your body of heavy metals can
make it seem more common than it is.
.

29. Symptoms of heavy metal poisoning?
Common symptoms across several types of heavy metal poisoning include:
•diarrhea
•nausea
•abdominal pain
•vomiting
•shortness of breath
•tingling in your hands and feet
•chills
•Weakness
MERCURY POISONING SYMPTOMS:
•lack of coordination
•muscle weakness
•hearing and speech difficulties
•nerve damage in your hands and face
•vision changes
•trouble walking

30. Lead poisoning symptoms:
•constipation
•aggressive behavior
•sleep problems
•irritability
•high blood pressure
•loss of appetite
•anemia
•headaches
•fatigue
•memory loss
•loss of developmental skills in children
Arsenic poisoning symptoms:
•nausea, vomiting, and diarrhea
•red or swollen skin
•spots on your skin, such as warts or lesions
•unusual heart rhythm
•muscle cramps
Cadmium poisoning symptoms:
•fever
•breathing problems
•muscle pain

31. Causes of heavy metal poisoning
Heavy metals can enter your body in different ways. You might consume them
in the food you eat or absorb them through your skin, for example.
Here’s how you might be exposed to various heavy metals. Keep in mind that
heavy metal poisoning occurs with heavy or frequent exposure, usually over a
long period of time. Occasional exposure won’t lead to heavy metal poisoning.
Arsenic
•working near a hazardous waste site
•living in an area that has high levels in rocks, water, and soil
•ingesting insecticides, pesticides, or herbicides
•eating contaminated seafood or algae
•drinking contaminated water
Mercury
•mining, producing, or transporting mercury
•mining and refining gold and silver ores
•consuming contaminated fish or water
•manufacturing mirrors, X-ray machines, incandescent lights, or vacuum pumps

32. Lead
•living in a home with high levels of lead-based paint
•doing industrial construction work, radiator repair, or smelter operations
•being in firing ranges
•using kohl cosmetics
•applying progressive hair dyes, though the U.S. Food and Drug
AdministrationTrusted Source (FDA) is working to change this
•using foreign digestive remedies, calcium products, kohl, surma, kajal, or
progressive hair dyes

33. Diagonsis of heavy metal poisoning?
Doctors can usually check for heavy metal poisoning with a simple blood test
known as a heavy metals panel or heavy metal toxicity test.
To do the test, they’ll take a small blood sample and test it for signs of heavy
metals. If you have symptoms of heavy metal poisoning, but your blood test
only shows low levels, you doctor might do some additional testing.
These may include:
•kidney function tests
•liver function studies
•urine analysis
•hair analysis
•fingernail analysis
•electroardiograms
•X-rays

34. heavy metal poisoning treatment
For mild cases of heavy metal poisoning, just eliminating your exposure to
heavy metals can be enough to treat the condition. Depending on the
underlying cause, this might mean taking some time away from work or
changing your diet.
Your doctor can give you more specific recommendations on how to reduce
your exposure.
For more severe cases, the standard treatment is chelation therapy. This
involves giving medication, either through a pill or injection, that binds to the
heavy metals in your body.
These medications are known as chelators. As they bind to the metals,
chelators help to usher them out of your body as waste.