SALAZAR KARL ANGELO TOXICOLOGY

2. Clinical Toxicology

• Study of interrelationships between

TOXICOLOGY
xenobiotics and disease states
The scientific study of poisons, their source, 3. Environmental Toxicology
chemicaland physical properties, actions, • Evaluation of environmental chemical
detection, and thetreatment of conditions pollutants with their impact on human
produced by them. health
•Includes the following concepts: DEFINITION OF TERMS
biologicalavailability, distribution, penetration
into organs,elimination, accumulation, • Poison – any substance, be it biological or
relationship between doseand effect, synthetic
mechanisms of action, and factorsinfluencing that can cause disturbance to an organism
the effects of toxic drugs. • Venom – toxins that are delivered/injected by
one
Three Principles of Toxicology
species to another either through a bite or sting
1. Mechanistic Toxicology • Threshold limit value – the amount of exposure
• Defines the mechanism of toxic action of to a given agent that is deemed safe for a stated
poisons and toxic chemicals period. (border line) • Dose – the chief criterion
2. Descriptive Toxicology regarding the toxicity of a
• Provides necessary information for safety chemical
evaluation and regulatory requirements • Antidote – any substance which can counteracts
3. Regulatory Toxicology a
• Interprets the combined data from form of poisoning
mechanistic and descriptive studies • Toxin – biologically produced poison that has a
• Establish standards that define the level of function in nature
exposure that will not pose a risk to public • Toxoid – a toxin that has been rendered less
health and safety. injurious but that is still immunogenic (antigenic)
Used to produce antitoxins (e.g. Tetanus toxoid)
Areas of Toxicology
1. Induces active immunity
1. Forensic Toxicology • Antitoxin - antibodies directed against toxins;
• Concerns in medico-legal consequences of these are administered to a susceptible individual
exposure to drugs to
SALAZAR KARL ANGELO
provide passive immunity following exposure or
suffering from the early stages of disease caused
bytoxins.
• Corrosives - substances that destroy tissue but
do not absorb in the body (acids, alkalis)
• Bioaccumulation - accumulation of substances,
such as pesticides, or other organic chemicals in an
organism the longer the biological half-life of the
substance the greater the risk of chronic
Poisoning E.g. mercury, lead, nicotine, vitamin A
Mercury poisoning - Pink disease/acrodyma
• Lead poisoning - Basophilic
ROUTES OF POISONING
• ingestion (mouth)
• inhalation (lungs)
• inoculation (rectum, vagina, urethra, bladder,
ureter)
• intravenous (hypodermic injection)
• absorption (intact skin, wounds)
Outcomes of Poisoning
1. Detoxification and elimination after injury – no
or minimal structural or functional damage to the
tissue with essentially full recovery
2. Tissue damage with repair/cellular adaptation –
restoration and recovery based on the type of
tissue and extent of tissue damage
3. Chronic long-term injury – persistent morbidity
and potential carcinogenesis
4. Death - can occur at any of these stages
depending on the agent
Brain tissue – di kayang magregenerate
TOXICOLOGY
Liver tissue – kayang magregenerate hangga’t kaya
nya
Rapidity - Depends on the solubility of the poison
and administration
• Poison may harm the individual in two ways:
• Local reaction – irritation of the tissues
without involvement of the circulatory system
• Generalized/Remote reaction –
disseminated tissue and organ damage after a
poison enters the bloodstream
• Most frequently influenced organs:
• Liver, kidney, brain, lung,OF ACTION
MECHANISM
intestine, and other
1. Direct physical or chemical injury – tissue and
cells directly destroyed or damaged by the poison
itself
• Corrosives: cell lysis
• Venom of the brown recluse spider:
causes severe focal necrotizing lesion at the site of
the bite
2. Indirect – disturbance of function of cells, tissue
and organs that debilitates the organism
Factors modifying the action of poisons
• Dose: As a general rule small dose usually
produce no toxic effects, whereas large doses
produce toxic effects on the body.
• Method of administration: A poison acts most
rapidly when inhaled in gaseous or vapors form or
when injected intravenously.
• Condition of the body
• Age- Children are more susceptible than
adults to toxins. In old age poisons have
SALAZAR KARL ANGELO
greater effects
• Gender- male can better tolerate.
• Condition of the body
• Sleep and intoxication: The bodily
functions are lowest during sleep, so the
poisons are absorbed slowly during sleep
• Diseases: the optimum dose to which a
person respond favorably is altered
• Form of poison
• Physical state- Gases and vapors act more
quickly than fluid poisons because they are
absorbed immediately.
• Fluid poisons act faster than solid
ones.
• Chemical combination. Some substances
in certain combination become inert like
AgNO3 and Hydrochloric acid, and certain
other combinations becomes poisonous
• Mechanical combination. the action is
altered when combined
Diagnosis of Poisoning
HISTORY
• Most important indicator of toxic
ingestion
• toxins, amount of drug and timing
• Information regarding prescription
medication, over the counter drugs and
illicit substances of abuse
TOXICOLOGICAL SCREENING
• Provides direct evidence of ingestions and
determines the approximate amount and
type of legal or illegal drugs that a person
taken.
TOXICOLOGY
PHYSICAL EXAMINATION
• Rapid assessment of mental status,
temperature, pupil size, muscle tone,
reflexes, skin and peristaltic activity, airway
patency, respiration, circulation.
• Laboratory evaluation: includes assessment of
the three gaps of toxicology:
• Anion Gap: refers to the difference
betweenmeasured cations and measured anions
• Osmolal gap: measured osmolality –
calculated osmolality
• Oxygen saturation gap: >5% difference
between saturation calculated from ABG
determination and saturation measured by
cooximetery
Classification of poisons according to the
mode of action:
1. Corrosive Poisons:These are highly active
irritants which produce both inflammation and
ulceration of tissues. This
group consists of strong acids and alkalis.
2. Irritant poisons: These produce symptoms of
pain in the abdomen, vomiting and purging.
A. Inorganic poisons: Metallic (Arsenic,
antimony, mercury, lead and copper) and Non
Metallic (Phosphorus, chlorine, bromine and
iodine)
B. Organic Poisons: Vegetable (Castor oil)
and Animal (Snakes, scorpions, spiders).
C. Mechanical Poisons: Powder glass,
diamond dust.
3. Neurotic Poisons - These chiefly act on the
central nervous system. Symptoms usually consist
SALAZAR KARL ANGELO
of headache, drowsiness, giddiness, delirium,
stupor, coma, and convulsion.
A. Cerebral Poisons – Opium, alcohol,
sedatives,
hypnotics, anesthetics
B. Spinal Poison – Strychnine.
C. Peripheral – Curare.
4. Cardiac Poisons – Digitalis, tobacco.
5. Asphyxiants – Coal gas, CO, CO2 and war gases.
6. Miscellaneous – Analgesics, antipyretics,
tranquillizers, antidepressants.
GASEOUS POISONS
Atmosphere contains
• 21% - Oxygen (Most important)
• 78% - Nitrogen
• 0.95% - Argon
• 0.04% carbon Dioxide
Traces of the atmosphere:
• Helium, Xenon, Niton, Krypton, and Nitrogen
Nitrogen and Argon - Inert substances which dilute
the oxygen; induce asphyxia
Asphyxia
• the failure or disturbance of the
respiratory
process brought about by the lack or
insufficiency of oxygen in the brain.
1. CARBON MONOXIDE (CO)
• A product of incomplete combustion of organic
matter that is an odorless, colorless, tasteless gas
that is slightly lighter than air and highly toxic
 Sources: Cars or trucks, small engines,
stoves, lanterns, grills, fireplaces, gas
TOXICOLOGY
ranges, or furnaces
• Combines with CO2 to produce ozone
• Physiologically, CO acts as a neurotransmitter
and a blood vessel relaxant
• Competes avidly with oxygen for hemoglobin.
• Has affinity for hemoglobin 210-fold greater than
that of oxygen
Toxicity: TISSUE HYPOXIA due to:
• Shift to the left secondary to the presence
of carboxyhemoglobin (dyshemoglobin)
• Thus, cells and tissues of the body
become
hypoxic due to low oxygen delivery
Symptoms of CO poisoning:
Headache, confusion, decreased visual
acuity, tachycardia, syncope, coma,
convulsions and death
Treatment:
Oxygen therapy
2. CARBON DIOXIDE (CO2)
• Colorless, odorless, non-flammable gas that is a
product of complete combustion of organic matter.
• Sources: manholes, caves, wells,
decomposition, ocean release, respiration,
volcano eruption, cement production,
deforestation burning of fossil fuels like coal,
oil and natural gas, exhaled breath
• Hypercapnia/hypercarbia – increased CO2
concentration caused by increased retention.
• Which may result to respiratory acidosis.
• Treatment: Oxygen therapy, proper ventilation
3. SULFUR DIOXIDE (SO2)
• Colorless, irritating gas formed from the
combustion of fossil fuels.
SALAZAR KARL ANGELO
• Effects: Forms sulfurous acid on contact
with moist mucous membranes
• This acid responsible for most of the
pathologic effects
• Toxic effects: Conjunctival and bronchial
irritation (primary signs of exposure)
• Heavy exposure may lead to delayed
pulmonary edema, while Chronic low level
exposure may aggravate cardiopulmonary
disease.
4. NITROGEN OXIDES
• Principal member: Nitrogen dioxide
(NO2), a brownish irritant gas
• Formed in fires and in silage on farms
• Pathology:
• Once inhaled, NO2 causes deep lung
irritation and pulmonary edema
• Exposure to higher concentrations of the
gas in an enclosed compartment is rapidly
fatal due to acute pulmonary edema
• Irritation of the eyes, nose and throat is
common
5. OZONE (O3)
• A bluish irritant gas produced in air and
water purification devices and in electrical fields
• Pathology:
• It may cause irritation and dryness of the
mucous membranes
• Impairment of pulmonary function on
higher concentrations
• Chronic exposure leads to bronchitis,
bronchiolitis, pulmonary fibrosis and
emphysema
TOXICOLOGY
• Treatment: no definitive treatment, only
supportive treatment
6. HYDROGEN SULFIDE
• Colorless transparent gas with a distinct
rotten egg odor that is formed by the
decomposition of organic matter containing sulfur
• Soluble in water, can be ignited, giving a
blue flame and is explosive when mixed half of its
volume on oxygen.
• Sources: naturally on volcanic regions and
waters of mineral springs, sewers, cesspools,
tannery vats, glue factories, Fat, rendering plants
and privy vaults
• Toxic effect: CNS paralysis; Inhaled or breathed
in a pure state causes rapid death (overwhelming
respiratory centers – respiratory arrest and
failures)
7. AMMONIA
• A strong colorless gas found in household
cleaners, fertilizers, and liniments.
• Poisoning occur when inhaled, swallowed
or touched
• Never mix ammonia with bleach because it
causes
the release of toxic chlorine gas, which can be
deadly
• Toxic effects: Headache, Gastric colic,
Constipation, Malaise, Nausea, Abdominal pain,
Collapse, Labored breathing, Delirium, Convulsions,
Coma, Death
Treatment:
Oxygen therapy
SALAZAR KARL ANGELO TOXICOLOGY
8. CHLORINE GAS-- chemical that is used to
prevent bacteria from growing in water, as well as
for sanitation for sewage
• an ingredient in several household
cleaning products • a pulmonary irritant with
intermediate water solubility that causes acute
damage in the upper and lower respiratory tract
9. PHOSPINE
• A lung damaging agent that has an odor
of garlic or decaying fish but odorless when pure
• extremely flammable and explosive.
10. CHLOROPICRIN
• “vomiting gas”
• not really a gas but a liquid but the
inhalation of its mist or fumes causes projectile
vomiting in humans