PHARMACOLOGY

Toxicology
Dra Dando
12 February 2008
Joyce “,.

POISONING  Carbon monoxide

 Opiates (Morphine, Novaine, Heroin, Codeine)
• Overdose of drugs, medicaments, chemicals  Quinine
and biological substances o Anti-protozoal
• “acute” poisoning versus “chronic’ poisoning
 Acute: 24 -48 hrs of exposure RECOMMENDED IV FLUIDS
 Chronic: weeks, months, years of  Hypotensive patients
exposure  NSS
• Father of toxicology: Paracelsus  Adult for maintenance
 NSS
GENERAL PRINCIPLES  D5 Acetated Ringer’s solution
 Emergency stabilization
o First thing to do  Pediatric for maintenance
 Clinical evaluation  D5 0.3% NaCl (hypo)
o Include good Hx taking & thorough PE
 Elimination of the poison POISON COMMONLY ASSOCIATED WITH
 Excretion of the absorbed substance CONVULSIONS
 Administration of antidotes  Aminophylline
o Important for certain specific poisons or  Amphetamines
drugs  Carbon monoxide
 Supportive therapy and observation  Cocaine
 Disposition  Cyanide
 Ethylene glycol
EMERGENCY STABILIZATION  Hypoglycemic agents
 Maintain adequate Airway  Isoniazid – triad of coma, metabolic acidosis,
o Remove obstructions intractable seizures
o Conditions wherein suction cannot be  Lead
done:  MAO inhibitors
- caustic substances (causes  Mefenamic Acid (usual side effect: GI
ulceration of GI mucosa) irritation; overdose: seizures)
- hydrocarbons (causes aspiration)  Opioids
 Ensure adequate Breathing/Ventilation  Organophosphates
o Nasal cannula, intubation  Phenothiazines
 Maintain adequate Circulation (put IV lines,  Salicylates (Aspirin)
fluids)  Strychnine
 Treat convulsions (e.g Diazepam)  Theophylline
o Diazepam: 1st line of Tx for active  Tricyclic antidepressants
seizures and status epilepticus  Withdrawal of narcotics, diazepam or ethanol
 Correct metabolic abnormalities (Electrolytes,  Signs of ethanol withdrawal
glucose, acid-base) o Irritable
o Base: used for severe metabolic o Agitated
acidosis (Tx: Na, bicarbonate) o Seizure
o Glucose: for hypoglycemia (Dextrose
50-50 concentration) CAUSES OF CONVULSION IN POISONED
PATIENTS
 Treat coma (e.g Flumazenil)
 Direct convulsant effect of the poisons
o Flumazenil:
 Cerebral hypoxia from respiratory or
1) Tx for BZD (diazepam) overdose
cardiovascular depressive effect of drugs
2) Tx for coma (but not as first line
agent)  Hypoglycemia
- coma due to overdose of valium  Severe muscle spasm due to spinal o
peripheral effects on the mechanism
COMMON CAUSE OF HYPOXIA controlling muscle tone
 Alcohol  Withdrawal reactions in patients with physical
 Cyanide dependence on abused drugs
o In silver jewelry cleaners  Decreased seizure threshold in an epileptic
patient
 Organophosphates
o In pesticies
TREATMENT OF CONVULSION
apriL aLLain madeL yna raLph tLe jovs pao cess xtian abi edward banana car
jat bambi erika jen roche bam aLex anna sheen jam pau eagleman jeff toni
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 PHARMACOLOGY: Toxicology – Dra. Dando
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• Diazepam • Time exposure

o Adult: 5mg IV  Needs to be very specific
o Children:0.3mg/kg  e.g.: N-acetylcysteine, antidote for
o Only compatible fluid is blood (direct) paracetamol overdose; effective only
• Lorazepam (Ativan) in the first 6 hrs after ingestion
o Adult: 2.5-10mg IV  e.g. lavage of poison is only good for
o Children: 0.05-1 mg/dose the 1st 24hours
o Withdrawn from the marked d/t its • Mode exposure
associated side effects  Rectal
o Short acting, long duration  Transplacental
• Phenytoin  Oral
o LD: 15-20mg/kg IV  Etc
o Adult: 50mg/min • Intake of other substances
o Children: 1mg/kg/min • Circumstances prior to poisoning
o Inducer of CYP450
• Current medications
o Maintenance drug
• Past medical history
• Pyridoxine (B6)
• Any home remedies taken
o Adult: 5g IV
o Children: 80-120mg/kg
*Organophosphate/carbamate poisoning:
o For INH poisoning manifests with DUMBEL
o Tx of convulsions due to unknown
etiology POISONS WITH DELAYED MANIFESTAIONS
Ethylene glycol 6 hours
Hypothermia Hyperthermia o Present in anti-
 Alcohol  Antihistamines freeze 12 hours
 Barbiturates  Amphetamines Salicylates 36 hours
 Carbon monoxide  Isoniazid Paracetamol 48 hours
 General  Phenytoin Paraquat 48 hours
anesthetics  Salicylates Methanol
 Opioids o Toxic alcohol 4 weeks
 Xanthines
 Phenothiazenes Thyroxine
 Anticholinergics:
 Sedative-hypnotics Atropine
 Tricyclic *Vodka
 Cocaine - among alcohols, has the highest alcohol content
antidepressants
 Phenothiazines - converts ethylene glycol and methanol to less
 Quinidine toxic form
 Sulfonamides - amount to be given needs to be computed

TREATMENT OF COMA OF UNKNOWN ETIOLOGY COMPLETE CLINICAL EVALUATION

• Thiamine (vit B1) 100mg IV  Complete physical examination
o Tx of Wernicke Korsakoff Synd in  Evaluate general status
alcoholic px  Examine skin
• Glucose  Characterize odor of patient’s breath
o Adult: 50-100ml D50-50  Auscultate the lungs
o Children:2ml/kg d10  Listen to patient’s heart
o Most pts present with hypoglycemia  Check the abdomen
esp. in alcoholic intoxication  Do a complete neurologic exam
o Wernicke-Korsakoff syndrome  Skin changes in poisoning
 d/t sever B1 deficiency  Bullae: barbiturates, CO
 administer B1 first before  Diaphoresis: OP, salicylate, amphetamine
giving glucose  Jaundice: paracetamol
• Naloxone  Dry and warm: atropine, anticholinergic
o Adult: 2mg IV every 3-5mins  Flushed: anticholinergics, alcohol,
o Children: 10mcg/kg cyanide, atrophine odors
o For opiate overdose (coma)  Brerath odors
o Expensive  Bitter: almonds, cyanide
o Given to newborns whose mothers  Fruity: DKA, isopropanol
underwent CS causing respiratory
 Oil of wintergreen: methylsalicylate
difficult in their babies
 Rotten eggs: sulfur dioxide, hydrogen
sulfide
COMPLETE CLINICAL EVALUATION
 Pears: chloral hydrate
• Good history taking (d/t vulnerability of  Garlic: arsenic, OP
children)
 Mothballs: camphor (like the one in vicks)
INFORMATION TO BE ELICITED DURING HISTORY
Bradycardia Tachycardia
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 Propranolol  Iron  Mydriasis  Miosis

 Anticholinesterase  CO, cyanide  Tachycardia  Bradycardia
 Hypertension  Hypotension
 Clonidine, codeine,  Organophocphate
 Hyperthermia  Hyperventilation
Ca-channel blocker  Phenothiazine  Seizures  Coma
 Ethanol  Ethanol, ethylene
 Digitalis glycol CONDITION OR AGENTS PREDISPOSING TO
 Free-base cocaine METABOLIC ACIDOSIS OR ELEVATED ANION GAP
 Anticholinergics • Methanol
 Antihistamines • Ethylene gycol
 Amphetamines • Theophylline, toluene
 Sympathomimetics • Alcoholic ketoacidosis
 Salicylates, • Lactic acidosis
solvents
• Aminoglycosides
 Theopylline
• Cyanide, CO
Mydriasis Miosis • Isoniazid, Iron
 Antihistamines  Cholinergics, • Diabetic ketoacidosis
 Antidepressants clonidine • Grand Mal seizures
 Sympathomimetics  Opiates, • Aspirin (salicylate)
Organophosphate
 Isoniazid • Paraldehyde, phenformin
 Phenothiazines,
 Anticholinergics pilocarpine,
ELIMINATION OF THE POISON
pontine bleed
• External Decontamination – bathing of pt with
 Sedative-hypnotics
alkaline soap e.g perla, ivory, dove
• Emptying the stomach
*Triad of opiate overdose:
o Emesis – only in adults
 Coma
*pediatrics have risk for aspiration
 Respiratory depression
 Pinpoint pupils
o Gastric lavage – H20, NSS, Na
Bicarbonate, activated charcoal
Clinical Evaluation: • Limiting GI absorption
Check for Toxidromes o Activated charcoal
 Signs and symptoms taken collectively can o Demulcents (watusi) / neutralizing
characterize a suspected toxicant agents (raw egg white: to prevent
 These groups of manifestations are observed absorption)
to occur consistently with particular poisons
o Intractable seizures + Coma + SUBSTANCES NOT ABSORBED BY ACTIVATED
Metabolic acidosis = INH Poisoning CHARCOAL
*Intractable seizures despite  Alcohol – rapid absorption
administration of diazepam  Cyanide
 Iron
o Lavage with NaHCO3
 Lithium - dialysis
Anticholinergic / Antidepressant Toxidrome  Petroleum distillates (hydrocarbons)
 Hyperthermia: “hot as a hare”  Caustic agents
 Dry mucosa: “dry as a bone”
 Flushed skin: “red as a beet” SUBSTANCES WITH EXTRAHEPATIC
 Dilated pupils: “blind as a bat” RECIRCULATION
 Confusion / delirium: “mad as a hatter” • Aspirin
• Cyclosporine
Cholinergic Toxidrome (S&Sx of organophosphate • Digoxin
and carbamate poisoning) • Meprobamate
 Diarrhea, diaphoresis • Paracetamol
 Urination • Phenothiazine
 Miosis, muscle fasciculations • Phenytoin
• Salicylate
 Bradycardia, bronchoconstriction
• TCAD
 Emesis • Anticoagulants
 Lacrimation • Carbamazepine
 Salivation • Dapsone
• Gluthetimide
Sympathomimetics Opiates / Narcotics • Methamphetamine
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• Phencyclidine (Fe3+) state, resulting in the

• Phenobarbital inability to transport oxygen and
• Piroxicam carbon dioxide)
o Sodium Thiosulfate: binds with
• Theophylline
cyanide-methemoglobin complex
• Organochlorines
to detoxify
*Formalin ingestion:
o Used in PGH, a raw material that
is compounded and prepared
 No antidote
whenever it is needed
 Give H2 blockers
 Reduction in conversion to more toxic
 Surgery (cut the part with ulceration) compounds
 Ethanol
ENHANCEMENT OF ELIMINATION OF ABSORBED o For tx of methanol and ethylene
SUBSTANCES glycol poisoning
• Forced diuresis  Competitive inhibition at receptor site
o Mannitol 20% - osmotic diuretic
o Furosemide – loop diuretic  Atropine (physiologic antidote) – for
organophosphate/carbamate poisoning;
• Alkalinization therapy
inhibits the enzyme acetylcholinesterase)
o Sodium bicarbonate – for weak acids:  Pralidoxime (pharmacologic antidote)
INH poisoning  Bypassing the effects of the poison
• Acidification therapy (for weak bases:  Oxygen for CN poisoning
Methamphetamine/shabu)  Pyridoxine for INH poisoning
o Ascorbic acid
 Antibody interacting with poison
o Ammonium chloride
• Dialysis and hemoperfusion  Digoxin antibody fragments (Digibind) –
not available locally
• Multiple dose activated charcoal
*Locally: nadia-nadia
INDICATIONS FOR DIALYSIS  Snake antivernin (available in RITM)
- species of Philippine cobra cause
• Amanita phalloides (mushroom) – very paralysis
dangerous and lethal causing renal failure - Tx: activated charcoal
• Antifreeze (glycol type)
o Tx: ethanol e.g. vodka via NGT; SUPPORTIVE THERAPY
prevents conversion to more toxic from • Essential for poisoning patients, especially for
• Heavy metals in soluble compounds critically ill
o Tx with EDTA or chelators • Problems in the critically ill poisoned patients
• Heavy metals after chelation o Depressed sensorium
• Methanol o Impaired ventilation
o Impaired cough reflexes
ANTIDOTES FOR PATIENTS WITH COMA OF o Prone to aspiration
UNKNOWN ETIOLOGY o Immobility
• Naloxone o Fluid, electrolyte and other ,metabolic
• Glucose problems
• Thiamine • Intravenous fluids: replacement and
maintenance
ANTIDOTE FOR PATIENTS WITH SEIZURE OF • Frequent blood and urine pH determination:
UNKNOWN ETIOLOGY acidification and alkalinization therapy
• Pyridoxine (Vitamin B6) • Prevention of aspiration
• Prevention of decubitus
USE OF ANTIDOTES • Ulcer
Mechanisms: • Treatment of electrolytes, metabolic and
 Inert Complex Formation temperature problems
 Chelating agents (DMSA, NAPA) • Monitoring of vital signs
o Tx of heavy metal poisoning • Monitoring of input and output
 DMSA: suximer?
GOOD SUPPORTIVE AND NURSING CARE IS
 NAPA: N-acetyl-penicillamic acid –
IMPORTANT
mercury, arsenic, lead
 Accelerated detoxification DISPOSITION
 Cyanide antidote kit – available in US • Observation at the emergency room: atleast
only 24hrs may be warranted
 Sodium nitrite and sodium thiosulfate • Frequent reevaluation
o Sodium nitrite: Induce • Psychiatric evaluation: suicidal patients and
methemoglobinemia (a condition substance abusing patients
in which the iron within
• Childhood poisoning: evaluate for possible
hemoglobin is oxidized from the
child abuse or neglect
ferrous (Fe2+) state to the ferric
• Family counseling and education
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• Physical or sexual abuse among women  Acetic acid

• Domestic violence  Benzalkonium chloride
Pathology: Coagulation necrosis
TOP TEN POISONS (All Ages) IN-PATIENT STATISTICS  Others
National Poison Control and Information Service UP-
PGH  Phenol (e.g. Lysol)
YEAR 2006 (N=847) NUMBER PERCENTAGE  Cyanide salts: Silver jewelry cleaner
1. Ethanol – alcohol 95 11.2 - mixed with Na Hydroxide
withdrawal pts
2. Kerosene (Gaas) 87 10.3 PHARMACEUTICAL AGENTS
3. Sodium Hypochlorite 62 7.3  Paracetamol
(Zonrox)
4. Mercury (thermometer) 45 5.3  Toxic dose: 150-200mg/kg
5. Jewelry Cleaner (Cyanide) 35 4.1  Toxic metabolite: NAPQI (N-acetyl-p-
6. Hydrochloric acid (Muriatic) 27 3.2 benzoquinone imine)
7. Methamphetamine (Shabu) 19 2.2  GI, liver and renal damage (4 stages)
8. Paracetamol 16 1.9  Antidote: N-Acetylcysteine
9. Mixed Pesticides (Baygon) 15 1.8
10. Jathropa seeds (cause 15 1.8  Preparation: IV – usual route (e.g.
hemorrhagic gastritis) Hydranap)
Oral – in sachet
*Na Hydroxide: Liquid sosa Inhalation
 Average 50-kh man who ingests 15-20 tablets
TOP TEN POISONS (All Ages) TELEPHONE REFERRALS (500 mg) causes toxic injury
National Poison Control and Information Service UP-
PGH
YEAR 2006 (N=2,682) NUMBER PERCENTAGE
1. Kerosene 192 7.2
2. Sodium Hypochlorite 131 4.9  Iron
3. Mixed Pesticides (Baygon) 118 4.4  Toxic Dose: 20mg/kg
4. Elemental Mercury 90 3.4  GI, CVS, CNS manifestations (4 stages)
5. Paracetamol 64 2.4  EGD
6. Silica gel (shoes) – 62 2.3
nontoxic, causes mild GI  Antidote: Deferroxamine
manifestation  Causes severe bleeding and hypotension
7. Jewelry Cleaner 57 2.1  e.g. Flintstones, Gummy bears – contains iron
8. Ferrous Sulfate 53 2.0 which can cause toxicity
9. Hydrochloric acid 48 1.7
10. Isoniazid 42 1.6  Isoniazid (INH)
 Toxic Dose: 80-100mg/kg
HYDROCARBONS
 Triad of INH toxicity: seizures, coma,
 Kerosene (Gaas) metabolic acidosis
 Chemical pneumonitis  Antidote: Pyridoxine (Vitamin B6)
o Presents with cough  cyanosis  seizures
 Aspiration pneumonia  Aspirin
 Treatment: Pen G or other beta-lactams (for  Acetylsalicylic acid: 100mg/kg (children),
pneumonia) 200mg/kg(adults)
 No antidote  Methylsalicylate: 50-500mg/kg or 4ml
 Easily absorbed (1.4mg/ml)
 Vomiting, tinnitus (first thing to manifest),
 Solvents metabolic acidosis, seizures, coma, renal
 Aliphatic hydrocarbons failure
 Aromatic hydrocarbons
 Activated charcoal / hemodialysis (causes
 Benzene (ADR: Leukemia) coma, seizure)
 Toluene (ADR: Kidney failure due to
chronic exposure)

CAUSTIC AGENTS PESTICIDES

 Alkali (ph > 7) Strong alkali: ph >10  Organophosphates
 No antidote (only supportive): H2 blockers, PPI  Malathione
 Sodium hypochlorite  Chlorpyrifos
 Sodium hydroxide (e.g liquid sosa)  SSx: DUMBELS
 “LIhiya” (pang-green ng suman)
 Main Tx: surgical  Carbamates
Pathology: liquefaction necrosis (esophagus and  SSx: DUMBELS
intestine)
 Pyrethroids
 Acids (ph < 7) Strong acid: ph <4  DEET (diethyltolbutamide)
 Hydrochloric acid - present in insect repellants (e.g. lotions)
 PHARMACOLOGY: Toxicology – Dra. Dando
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- causes seizures esp in children >2 y/o  Organic: contaminated waters from
 Permethrin industrial waste products, air, soil
- anti-pediculosis and scabies: cause seizure (methylmercury)

 Rodenticides Small-scale mining practices

 Zinc Phosphides = residue after panning operation where most of
 Coumatetralyl  bleeding (Tx: vitamin K) the water are removed
= no personal protective device is provided
 Herbicides = route of entry is skin
 Chemical pneumonitis
Mercury in Thermometer
“There is approximately 1 gram of mercury in a
MIIXED PESTICIDES (e.g. Baygon)
typical fever thermometer. This is enough mercury to
 Carbamates
contaminate a lake with a surface area of about 20
 Propoxur acres, to the degree that fish would be unsafe to eat”
 Pyrethroid *Mercury is not actually absorbed if GI is intact but
 Cyfluthrin can cross BBB after 24-48 hrs
 Transfluthrin *Tx: cathartics
 S/Sx: DUMBELS
 Treatment: Atropine, Activated Charcoal  Organic Chemicals: Methylmercury

Effects of Pesticides:
- Endocrine disruption (cause problems in
reproduction and immune system)
- Neurodevelopmental effects (e.g autism,
cerebral palsy, mental retardation)
- Immune system (can cause cancer)

NON-PHARMACEUTICALS
 Silica gel – gastric irritant
 Chinese herbal meds (e.g. Ma-Huang – has
pseudoephedrine and ephedrine: precursor of
methamphetamine)
 Button batteries
- in <7 y/o, the diameter of intestine is >1.5
cm
- can obstruct trachea, pyloric sphincter *Mercury vapor – amalgam fillings are chief sources
- endoscopy is done to get it manually of exposure to mercury vapor
 Watusi
 Yellow phosphorus – most dangerous Minamata Disease (d/t high levels of methyl
(protoplasmic: cause severe hypotension and mercury in big fishes, e.g. tuna)
hypoxia) In 1932, Nippon Chisso Hiyu started to operate an
acetaldehyde acetic venyl chloride manufacturing
 Trinitrotoluene (present in dynamite and
plant using mercury as a catalyst. The plant had
bombs)
been directly discharging its industrial waste into
 Potassium nitrate
Minamata Bay for 36 years with no adequate
 Potassium chlorate facilities.
 Moth balls
 Naphthalene – causes hemolytic anemia in In 1958, Chisso redirected the outlet drainage canal
G6PD deficiency pts from Minamata Bay into the tributary of the
 Camphor – most toxic Minamata River which resulted in the contamination
of a wider area of Yatshushiro Sea.
 Para-dichlorobenzene – deodorizer (e.g.
Albatross) Increase in number of vaccines
- least toxic, causes recommended for routine use in infants
slight gastric irritation

HEAVY METALS
 Mercury (a.k.a Asoge)
 Sources:
 Elemental: “quicksilver” metal, cinnabar
ore, dental amalgam, apparatus, Potential increased exposure of infants to mercury
thermometers from thimerosal in vaccines
 Inorganic: antiseptics, vaccines
(merthiolate) Ethyl Mercury
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= in children receiving thimerosal in vaccines, the

half-life of ethyl mercury in blood was 7-10 days or CYANIDE
1/7 to 1/5 as long as that of methyl mercury - inhibits cytochrome oxidase
= a WHO advisory committee recently concluded that - CNS Effects: shock, profound lactic acidosis
it is safe to continue using thimerosal in vaccine - Toxic blood level: >0.5 mcg/ml

Mercury (Pink Disease)  Cyanogen-containing plants

Acrodynia  Linamarin in cassava cake – associated Sxs:
- Acrodynia is a rare idiopathic chronic toxic DUMBELS
reaction to elemental or inorganic mercury
exposure, which occurs mainly in young  Cyanide salts
children. It is characterized by pain in the
extremities and oink discoloration with
 Metal polishing (jewelry cleaners)
desquamation of the skin
 Cyanide Antidote Kit
Uncommon Syndrome “Pink Disease”  Amyl nitrite, sodium nitrite, sodium
thiosulfate
 Pain in the extremities
 Pinkish discoloration and desquamation RED TIDE POISONING
 Hypertension  Diarrheic shellfish poisoning
 Sweating  Okadaic acid (OA) and its derivatives
 Insomnia, irritability, apathy
 Considered as idiosyncratic reaction  Amnesic or encephalopathic shellfish
poisoning
Adverse Effects of Mercury  Domoic acid
 Elemental
- acute necrotizing bronchitis pneumonitis,  Paralytic shellfish poisoning
insomnia, forgetfulness, loss of appetite,
tremor, erethism, renal toxicity  Saxitoxin and gonyautoxin (GTX)
 Inorganic
- corrosive effects: GI ulceration, perforation,  Neurotoxic shellfish poisoning (NSP)
hemorrhage, acrodynia, renal toxicity  Brevetoxin
 Organic
- CNS: paresthesia, ataxia, muscle spasticity Department of Health
- Infants: psychomotor retardation, blindness, Criteria for Detecting PSP
deafness, seizure, cerebral palsy  Ataxia +
- Behavioral and learning delays: deficits in  Additional 2 Motor Distrubances +
language, attention and memory - Dysphagia
- Inability to stand
- Vomiting
 Lead (a.k.a tingga) - Dyspnea
 Pregnant women and their developing - Paralysis
fetuses are at high-risk because lead readily
 Additional 2 Sensory Disturbances
crosses the placenta
- Dizziness
 For every 10mcg/dl increase in BLL, children’s - Headache
IQ dropped by 4-7 points - Lightheadedness
 A higher proportion of learning disabilities - Paresthesias
was found among school-aged children with - Dysthesia
biological parents who ere lead poisoned as - Hot flashes
children 50 years previously - Numbness
 Source: paints, lipstick, gasoline, hair dyes

 Arsenic Poisoning
 Keratotic lesions  cancerous
 Patients from Bangladesh dig a well

PLANT TOXINS
 Jathropa Seeds
 Contents: toxalbumins = ricin (toxic content
causing hemorrhagic gastritis), curcin, tannic
acid
 Effects: abdominal pain, nausea, vomiting,
hepatic injury, muscle twitching, weakness,
salvation, sweating, dehydration,
hemorrhagic gastritis
 Tx: activated charcoal Specific Treatment
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With known or suspected toxin

 Give raw egg whites in cases of corrosive

ingestion
(-) Respiratory Distress (+) Respi Distress 8-12 egg whites (adult)
4-6 egg whites (children)

Observe for 24 hrs  Give 1-5% baking soda solution in cases of

shellfish and iron poisoning
1 teaspoon + 100mL water
Asymptomatic (-) Respi Failure (+)
Respi Failure PREVENTIVE MEASURES
• Wash vegetables / fruits thoroughly
• Support integrated pest management
Discharge NaHCO3 q 5 hr NaHCO3 q 5 • Avoid use of mercury thermometers
hrs x 24h
• Flush cold water tap before use
• Dispose chemical containers properly
Observe x 24 hrs
Ventilatory support • Promote healthy lifestyle: “Say no to drugs”
• Do regular inventory of drugs and chemicals
in the house
Respi Distress Test dose of • Proper storage or labels
edrophonium
National Poison Management and Control
Center
UPCM – Philippine General Hospital
With Response Hotline Numbers: 5241078 or 5218450 loc.
2311
Public Health Issues
 Reporting to DOH
 Shellfish / Fish Advisory
 Monitoring of other possible patients
 Monitoring of levels of toxins in the area (BFAR)

SUBSTANCE ABUSE
Sedatives
 Diazepam (Valium)
 Lorazepam (Ativan)
 Flunitrazepam (Rohypnol)
 Sleeping Pills (Stinox, Unisom)

*Ecstasy
- side effect: bruxism
- causes seizure, severe dehydration
- more toxic than shabu

Smoking and Alcohol

FIRST AID MANAGEMENT OF POISONING CASES

GOAL OF TREATMENT:
- to limit absorption of poison
- remove from toxic environment
- decontamination Maneuvers

REMEMBER THE DONT’S:

 Do not induce vomiting in the following
situations:
- drowsy and comatose patients
- poor gag reflex
- ingestion of corrosive and hydrocarbon
- if the ingestion has occurred for more than
one hour
- late pregnancy (last 3 months of pregnancy)
- presence of heart disease

 Do not give milk or vinegar

:milk is not a universal antidote