This chapter describes the analytical toxicology part of toxicology course

1. Analytic Toxicology
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2. Principles ofAnalytic Toxicology
Analytical toxicology is the detection, identification, and
measurement of foreign compounds in biological and other
specimens.
Toxicological analyses can play a useful role
 If the diagnosis is in doubt
The administration of antidotes or protective agents is
contemplated
 The use of active elimination therapy is being considered.
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3. Cont.….
At a minimum, the ordering requisition for a toxicology screen
should contain the following information.
Suspected agent(s)
Suspected dose
Time of ingestion and sampling
Clinical presentation
Location of the victim
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4. Steps in undertaking an analytical toxicological
investigation
The analysis dealings with a case of poisoning are usually
divided into
pre-analytical
analytical and
post-analytical phases
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5. Pre-analytical phase
Pre-analytical phase
Obtain details of current admission, including
 any circumstantial evidence of poisoning and results of
biochemical and hematological investigations.
Obtain victim's medical history, if available,
ensure access to the appropriate sample(s), and
decide the priorities for the analysis.
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6. Cont.…
• Analytical phase
 Perform the agreed analyses.
• Post-analytical phase
Interpret the results and discuss them with the clinician
looking after the victim.
Perform additional analyses, if indicated, on the
original samples or on further samples from the victim.
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7. Forensic toxicology
Forensic toxicology is the use of toxicology disciplines such
as analytical chemistry, pharmacology and clinical chemistry to
aid medical or legal investigation of death, poisoning, and drug
use.
The primary concern for forensic toxicology is the obtainment
and interpretation of results.
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8. Cont.…
In the United States, forensic toxicology can be separated into 3
disciplines:
Postmortem toxicology (an examination of a dead body to
determine the cause of death.)
Human performance toxicology
Forensic drug testing (FDT).
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9. Cont.…
Postmortem toxicology includes the analysis of biological
specimens taken from an autopsy to identify the effect of drugs,
alcohol, and poisons.
A wide range of biological specimens may be analyzed to determine the
cause and manner of death.
forensic drug testing (FDT) is the detection of drug use among
individuals in the workplace, sport doping, drug-related probation,
and new job applicant screenings.
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10. Cont.…
In human performance toxicology, a dose-response relationship
between a drug(s) present in the body and the effects on the body
are examined.
This field of forensic toxicology is responsible for building and
implementing laws such as driving under the influence of alcohol
or drugs.
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11. Management of poisonING
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12. General considerations in the mgt of poisoning
The following general steps represent important elements of the initial clinical
encounter for a poisoned patient:
1. Stabilization of the patient
2.Clinical evaluation (history, physical, laboratory, radiology)
3.Prevention of further toxin absorption
4.Enhancement of toxin elimination
5.Administration of antidote
6.Supportive care and clinical follow up
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13. Cont.…
Clinical Stabilization:
The first priority in the treatment of the poisoned patient is Clinical
stabilization. This is the so-called ABCs
Airway,
Breathing
Circulation
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14. prevention of further absorption
1. Topical decontamination
Generally; achieved by; undressing patients and washing them
thoroughly with copious amounts of water.
Pt. should initially be in isolated area.
All towels and clothing should be put into hazardous waste bags .
Rapid decontamination is needed specially if the poison is a
corrosive or is easily absorbed from the skin.
Wash contaminated areas as well as exposed areas with warm water
or saline , with careful washing of the skin, behind ears, under nails,
and skin folds
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15. if the toxin was ingested
Three general methods involve removing toxin from stomach via the
mouth, binding it inside gut lumen, or mechanically flushing it
through GIT.
1. Dilution: By using water & milk immediately after poisoning.
This reduce the gastric irritation induced by many ingested poisons
and Milk provides dilution and is also a demulcent
2. Emesis: induced by Syrup of Ipecac: orally administered and
Apomorphine: given by s.c. injection (most rapid).
N.B. Do not induce vomiting if the patient is Unconscious or comatose
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16. CONT….
3. Gastric lavage: Gastric lavage is only effective when ingestion of the poison
is discovered within 1 hours except salicytates may be within 4-6 hours (it sticks
to the mucous membrane). Eg. bicarbonate, saline
Often reserved for patients with impaired consciousness and uncooperative
Indicated for:Heavy metals, Iron, Lithium, Sustained or delayed release
formulations.
4. Adsorbents:- Activated charcoal:
is administered orally to adsorb or bind toxins and allows them to pass from
the GIT without being absorbed into the systemic circulation.
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17. ENHANCEMENT OFEXCRETION
There are several methods available to enhance the elimination of
specific poisons or drugs once they have been absorbed into the
systemic circulation.
The primary methods employed for this use today include:
alkalinization of the urine,
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18. Alkalization of the urine
Forced Diuresis: its useful to enhance renal elimination of
poisons. Saline to expand fluid volume and furosemide may be
used to enhance diuresis.
Acid Diuresis: with ammonium chloride can enhance the
elimination of weak bases e.g. amphetamine, strychnine and
quinidine.
Alkaline Diuresis: with Sodium bicarbonate can remove weak
acids (e.g. salicylates and Phenobarbital).
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19. SPECIFICANTIDOTE
Poison Antidote
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Drug and chemical Antidote
Acetaminophen N-acetylcysteine
Lead, Arsenic EDTA ,Dimercaprol
Iron Deferoxamine
Opioids Naloxone
Organophosphates Atropine, Pralidoxime
Warfarin Vitamin K1
Methanol femopizole
Cyanide nitroprusside

20. VI-Supportive therapy & Observation
• VI-Supportive therapy & Observation
• -I.V. fluids
• -Frequent blood and urine pH adjustment.
• -Intensive nursing care.
• -Avoid unnecessary drugs.
• -Treatment for hypo-or hyperthermia.
• -Management of hypotension.
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