This document summarizes the clinical features and management of several types of poisonings, including organophosphate and carbamate insecticides, benzodiazepines, paracetamol, salicylates, opioids, snake bites, and alcohol. It describes the mode of action of organophosphates and carbamates as inhibiting acetylcholinesterase, leading to increased acetylcholine activity and muscarinic and nicotinic effects. The management involves atropine, pralidoxime, and ventilation. Benzodiazepine poisoning causes CNS depression and respiratory depression, and is managed with activated charcoal and flumazenil. Paracetamol poisoning can cause hepatotoxic

1. ORGANOPHOSPHATE & CARBAMATE
INSECTICIEDS POISONING
These are widely used in agriculture (for Crop
sprays) & at home as insecticides for rodents,
cockroaches etc.
Examples are: - Parathion, DDT, Finis, Baygon, and
Coopex.
MODE OF ACTION:-
These compounds inhibit the Anticholinesterases
resulting in ↑ Acetylcholine activity at Muscarinic &
Nicotinic receptors.
CLINICAL FEATURES:-
Muscarinic Effects:-
GIT: - Nausea, Vomiting, Diarrhea, Abdominal Colic,
Tenesmus, Sweating, hyper salivation & Fecal
incontinence.
RESPIRATORY: - Dyspnea, Cough, Wheezing,
↑ Bronchial Secretions, Pulmonary Edema,
Respiratory Arrest in severe cases.
EYE: - Pupil Constriction (Miosis), BlurredVision
CVS: - Bradycardia, Hypotension, Heart Block in
severe cases.
URINARY: - Frequency, Incontinency etc.
Nicotinic Effects: -
Muscle twitching, Fasciculation & Muscle Weakness.
In severe cases Paralysis of Limb, Respiratory & Extra
ocular Muscles.
Hypertension & Tachycardia
CNS Effects: -
Anxiety, Restlessness, Tremor, Convulsions,
Confusion & Coma.
DIAGNOSIS: -
Usually diagnosis is clinical. It may be confirmed by
measuring RBC & Plasma Cholinesterase activity
which is less than 50% of normal confirms the
diagnosis.
MANAGEMENT:-
 Oxygen
 Gastric Lavage & Give Activated Charcoal if
recently ingested
 Atropine at 2mg every 15mins until
bronchial & other secretions controlled then
continues infusion at the rate of 0.02-
0.08mg/kg/hour. If Atropine causes
tachycardia then give IV Verapamil or
Propranolol.
 Parlidoxime (Inj.Contrathion) in case of
Nicotinic Effects at the rate 5-10 vials of
Inj.Contrathion in 100ml of water for
injection & repeated after every 4-6 hours or
start continue infusion at the rate of
10mg/kg/hour.
 Mechanical Ventilation if condition
worsens.
BENZODIAZAPINES POISONINGS
These drugs are used as tranquilizers & as sleeping
pills .e.g., Alprazolam, Lorazepam, Bromazepam,
Midazolam etc.
CLINICAL FEATURES:-
Dilated Pupils, Nystagmus, Dysarthria, Ataxia,
Confusion, Drowsiness, Weakness and minor
Hypotension.
Coma & Respiratory depression
MANAGEMENT: -
 Activated Charcoal should be given
repeatedly.
 Pulse Oximetry requires to monitoring
Oxygen saturation.
 Flumazenil (Inj.Anexate 0.1mg) given as
incremental dose of 0.2, 0.3 & 0.5mg at 1min
intervals until desired effects are achieved.
PARACETAMOLPOISONING
Paracetamol is usually absorbed by Glucuronidation,
Sulfation & small fraction metabolized via P450 to
highly toxic reactive intermediates. These
intermediates are detoxified by cellular Glutathione.
With Paracetamol over dose ˃140mg/kg or 7g in an
average adult, the hepatocellular glutathione is
depleted 7 reactive intermediates attacks
hepatocytes 7& causes cell lysis.
CLINICAL FEATURES: -
There is Nausea, vomiting & Pallor shortly after
ingestion but the signs of Hepatocellular toxicity
appear after 24-48 hours by Right Upper Quadrant
tenderness.
DIAGNOSIS: -
↑ PT time, ↑ ALT & AST, ↑ Bilirubin
A 2-fold prolongation of PT & Bilirubin ˃4mg/gl on
3rd-5th day indicates Hepatotoxicity.
MANAGEMENT: -
 Activated charcoal is given within 4 hours of
ingestion.
 Acetylcysteine is given with loading dose of
140mg/kg orally followed by 70mg/kg every
4 hours, continues for 72 hours.
SALICYLATE (ASPIRIN) POISONING
Salicylates uncouple cellular oxidative
phosphorylation resulting in anaerobic metabolism
& excessive production of Lactic Acid & Heat.
CLINICAL FEATURES: -
 Mild Intoxication: - Nausea, Vomiting with
Gastritis.

2.  Moderate Intoxication: - Deep & Rapid
breathing, Tachycardia, Tinnitus & ↑ Anion gap
Metabolic Acidosis
 Severe intoxication: - Agitation, Confusion,
Seizers, Coma, Collapse, Pulmonary Edema,
Hyperthermia & Death.
ABGs show Respiratory Alkalosis with underlying
Metabolic Acidosis.
MANGEMENT: -
 Gastric Lavage followed by Activated Charcoal
given every 2-4 hours.
 Inj.NaHCO3 to treat Metabolic Acidosis
 Alkalinization of urine by 2amp of NaHCO3 in
1000ml of 5%D/W, 0.2% Saline.
 Hemodialysis may be lifesaving in severe
poisoning
OPIOIDS POISONING
Morphine, Heroin other opioids ↓CNS activity &
Sympathetic outflow by acting on opiate receptors
in brain.
CLINICAL FEATURES: -
CNS: - Constricted Pupils, Euphoria, Drowsiness,
Hypothermia and Coma.
Respiratory & CVS: - Hypotension, Bradycardia,
Pulmonary edema, Apnea & Pulmonary aspiration
may occur.
MANAGEMENT: -
 Protect Airways ( to prevent aspiration)
 Assist Ventilation (WithO2 & Mechanical
Ventilation)
 Naloxone (Inj.Nalox 0.4mg) is given IV at the
dose of 0.4-2mg repeated at the interval of 2-3
hours.
SNAKE BITE POISONING
Common types of poisonous snakes are:-
1. Viperideae: e.g., Russel Viper, Pit Viper etc.
2. Elapidae: e.g., Cobra, Krait, Coral snake etc.
3. Hydrophidae: e.g., sea snakes
MANGEMENT: -
 Immobilize the bitten area.
 Apply the firm bandage to occlude lymphatic
drainage.
 Pain & Vomiting (Symptomatic Treatment)
 Hypotension (Saline & Dopamine)
 Antivenin
 Inj.Adrenaline 0.5ml of 1:1000 should be
in hand to prevent Anaphylaxis Shock. If
occur give S/C.
 Test dose of 0.02ml saline diluted
antivenin should be given to check
reaction.
 Before starting antivenin give IV
Inj.Antihistamine & Inj.Ranitidine
 Antivenin should be given in 1000ml of
Saline, 5%D/W or R/L at the rate of 20-
30ml/kg.
ALCOHOLPOISONING
SIGNS AND SYMPTOMS
The sign & symptoms of Alcohol poisoning include:
• Confusion
• vomiting
• Dangerous Anger
• Seizer (Fits)
• Slow Breathing
• Pale, Bluish skin
• Cold & Clammy skin
MANAGEMENT
 O2 Inhalation if necessary
 Protect Vital signs by monitoring Airway,
Breathing & Circulation. If the patient is at the
risk of severe Respiratory depression then
consider endotracheal tube & assist with
breathing.
 Treat Hypoglycemia with 50ml of 50% Dextrose
solution & Flush Saline.
 Administer Vitamin Thiamine to prevent
Wernicke-Korsakoff Syndrome Which can cause
severe seizure.
 Check Urea & Electrolytes for Fluid
Replacement.
 Apply Hemodialysis if Blood concentration is
dangerously high (˃400mg %) & specially if there
is Metabolic Acidosis.
 Treatment of Nausea, Tremor & Anxiety
(Symptomatic)