Topic Review Intoxications

HOSPITAL GENERAL DOCENTE DE
CALDERÓN
INTERNAL MEDICINE
CLINICAL ACADEMY PROJECT
REVIEW TOPIC: INTOXICATIONS

EXPONENT: MD. Daniel Zurita V. MR.
DR. RICARDO BEDÓN MT.

DR. SILVANO BERTOZZI MT.
INTRODUCTION
- Poinsoning is a frequent causa of consultation in

the emergency room.
- The true incidence is unknown due to

underdiagnosis and underreporting.
- Low global mortality; 1-2% in hospitalized patients.

INCIDENCE
- Serious/fatal injury: 0,90/0,07%
- 90% fatal cases: drugs
ETIOLOGY
- 79% ACCIDENTAL
- 17% INTENTIONAL
- 4% OTHERS
American Academy of Clinical Toxicology & European Association of Poisons Centres and Clinical Toxicologists. Position paper: Gastric Lavage. J Toxicol Clin
Toxicol 2004; 42:933-943 .

INCIDENCE
- Three peaks of incidence
1. 1 to 5 years
2. adolescence
3. 18 to 45 years
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED
2003 /EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
GOLD RULES IN TOXICOLOGY
• Treat the patient NOT to the toxic

• Provide support measures
• DO NOT DAMAGE: Risk vs. Benefit
intervention.
DIAGNOSIS IN CLINICAL
TOXICOLOGY
The diagnosis is based on anamnesis, physical examination, the first two being
the ones that are usually the key to a diagnostic suspicion that will be
subsequently confirmed or excluded through complementary tests.
The Anamnesis is the basis of diagnosis in 95% of poisonings

DIRECTED INTERROGATORY:
1. What?
2. Quantity
3. Time elapsed
4. Route of entry
5. Previous rescue measures
6. Personal history
INITIAL HANDLING OF THE
INTOXICATED PATIENT
The first A B C D E
- Maintain a patent airway
- Ensure good ventilation
- Stabilize hemodynamically
- Evaluation and support of vital functions
- Neurologic evaluation
- Exposure and Decontamination
Keep the Patient Living

Initial evaluation:
10 points to integrate toxic syndromes
1. Heart rate 6. Skin

2. Breathing frequency 7. Mucous
3. Blood pressure 8. Peristalsis
4. Temperature 9. Urinary Retention
5. Pupils 10. Neurological
DECONTAMINATION
Therapeutic measures designed to:
- Reduce the exposure to toxins

- Prevent the lesión
- Reduce absortion
Eyes
-¡Do not forget that the ocular exposure time is

reflected in the impact on the eyesight!
- On exposure to corrosives, try to bring
conjunctival pH to 7.0
- The pH of saline is 4.5
CUTANEOUS DECONTAMINATION
- Remove clothes, store in airtight bag and label.
- Washing by dragging with water
- Protection of the staff

GASTROINTESTINAL
DECONTAMINATION
-Gastric decontamination
• VP
• LG
-Administration of adsorbent substances

• C.A.
- Intestinal decontamination
• Purifyng saline (magnesium hydroxide)
• Osmotic purge (Sorbitol-Mannitol)
• Intestinal irrigation ( Polyethyleneglycol)
GASTRIC LAVAGE
- It is most effective after 30 minutes of ingestion

- Study support up to 1 to 2 hours postingestion.
- As a rule, gastric lavage should be performed before the
administration of activated charcoal
- Caliber 16 to 28 French children, and 36 to 40 french
adults.
- Left lateral decubitus position (proper technique).
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003
/EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
GASTRIC LAVAGE
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG
PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
Indications for gastric lavage
•“In some cases where the procedure has an

important theoretical benefit (for example,
recent intake of a very toxic product), the
substancial risk must be carefully evaluated
against the scant evidence that the procedure
results in any benefit”
American Academy of Clinical Toxicology & European Association of Poisons Centres and Clinical Toxicologists. Position paper: Gastric Lavage. J Toxicol Clin Toxicol 2004;
42:933-943.
•Contraindications
 Non – toxic intake
 Unconscious patient (except if intubated)
 The toxic binds well to activated charcoal
 Restless patient
 Pills or tablets of large size
 Toxic not present in the stomach
 Lack of protection of the airway
 Corrosives and hydrocarbons with significant risk of aspiration.
 Risk of gastrointestinal bleeding or perforation.
•Complications
Aspiration
Injury to pharynx, airway, esophagus, stomach
Mediastinitis
Endotracheal placement
Disrrhythmias
Commitment airway during washing
ACTIVATED CHARCOAL
TREATMENT
GASTRIC DECONTAMINATION
“UNIVERSAL ANTIDOTE”
1 G/ KG.. QUOTIENT CARBON/TOXIN 10:1
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED
2003 /EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
ACTIVATED CHARCOAL
DOSE:
ADULTS: 0.5 TO 1GR/KG/DOSAGE
ADMINISTER EVERY 4 HRS POR 24 A 48 HRS
USING NASOGASTRIC PROBE
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003
;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
CONTRAINDICATIONS:
- INTESTINAL OCCLUSION
- EPILEPTIC STATUS
- PATIENTS WITHOUT AIRWAY PROTECTION
- INTAKE OF CAUSTIC OR HYDROCARBONS
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE 2001
VOL 3 No 8/Am J Emrg Med 2001;19;337-395
Cathartic
• Its effectiveness has not been proven

poisoning.
• Linked in some cases with serious or lethal
side effects.
- Magnesium toxicity of hypernatremia
- Dehydration
:Example: Sodium sulfate, magnesium sulfate, sorbitol, mannitol

Catárticos
• In general, they are not recommended

• It can be administered together with
activated charcoal to avoid constipation
(sorbitol, mannitol)
• Polysaccharides derived from the

hydrogenation of sugars (polyols)
•Mannitol: derivative of mannose sugar.

Total Intestinal Irrigation
• Polyethylene glycol isotonic solution

• Not absorbed
• Iso-osmotic
• Does not produce alterations significant levels
of electrolytes still with large doses.
- Do not use routinely

- Has not shown its benefit through controlled
clinical studies:
Ingestion of prolonged – release drugs
Ingestions of more than 2 hours
American Academy of Clinical Toxicology & European Association of Poisons Centres and Clinical Toxicologists. Position paper: Whole bowel irrigation. J Toxicol Clin Toxicol
2004;42:843-854.
-Potential benefit in iron intakes.

- Possible benefit in cases of ingestion of “body packing”
drug packages.
American Academy of Clinical Toxicology & European Association of Poisons Centres and Clinical Toxicologists. Position paper: Whole bowel irrigation. J Toxicol Clin Toxicol
2004;42:843-854.
Contraindications:
 - Airway not protected or compromised.
 - Incoercible vomiting
 - Bleeding or perforation of the gastrointestinal tract
 - Functional or mechanical intestinal obstruction
 - Hemodynamic inestability
Complications:
- Sicknees , vomit
- Bloating and abdominal pain
- Rectal Irritation
- Regurgitation and aspiration
Ionization of the Toxic
-Favors the renal excretion of the toxic by altering the urinary
pH.
-Ionized molecules are not reabsorbed from the renal

tubules.
- The degree of ionization is dependent on the pH of the

toxic and urinary pH.
-Altering the urine increases the ionization of the toxic

Weak acids – alkalize urine
Weak bases – acidify urine
METHODS OF EXTRACORPORATE
DETOXIFICATION
• DIALYSIS
• HEMODIALYSIS
• HEMOPERFUSION
• HEMOFILTRATION
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED
URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE
2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
TOXIC SYNDROMES
1. Anticholinergic
2. Sympathomimetic
3. Cholinergic
4. Opioid
5. Sedative - hypnotic
6. Hallucinogenic
7. Serotoninergic
8. Neuroleptic malignant
SITUATION IN EMERGENCY
Two male patients, 19 and 22 years old, brought by family members. They present severe
psychomotor excitement. After physically restraining them both and medicating them
with diazepam 10 mg EV, a physical examination is carried out.
Both present remarkable mydriasis without reaction to light, hyperthermia, tachycardia

and facial ruddiness. After questioning the family members, they were both drinking a
tea or infusion.
A 52-year-old man who is found in the street with an incoherent speech (he
says he is in the university laboratory and is working hard) and is brought by
ambulance to the emergency room.
The only information we have about him is that he is being treated with
quetiapine and venlafaxine.
To the physical examination:

Hyperthermia T: 38.9 C, Mydriatic pupils, blurred vision, anhidrosis, facial
ruddiness, vasodilation, visual hallucinations and delirium,
ANTICOLINERGIC SYNDROME
CLINICAL SIGNS:
Dryness and redness of the skin, hyperthermia,
tachycardia, arrhythmias, urinary retention, ileus,
Myoclonus, seizures, delirium, mydriasis.
ANTICOLINERGIC SYNDROME
AGENTS :
-antihistamines,
-antiparkinsonians,
-atropine,
-spasmolityc,
-antipsychotics,
-antidepressants,
-muscle relaxants,
-amanita muscaria,
-floripondio.belladonna
PROOF TO BE PERFORMED
- Blood biometry, blood chemistry, electrolytes, blood gases.

- Toxicological plasma.
-Electrocardiogram
-Rx standard of the thorax
INITIAL HANDLING AND TREATMENT
1. Physical containment
2. Stabilization of airway, respiration and Circulation
3. Via Peripheral
4. 02 Supplementary
5. Continuous Cardiac Monitoring
6. Thermal curve
7. Intake and Excreta Control
SPECIFIC TREATMENT
- Gastrointestinal decontamination
- If prolongation of QRS interval or tachyarrhythmias
Amiodarone AMP 150mg: 2 amp + 50CC Dx in H20 at 5% 30min)
- Agitation and seizures
Initial treatment with BDZ (security threshold)
- Diazepam 5MG EV, Lorazepam 1-2 mg EV
- Hyperthermia
- Antitérmicos Paracetamol 1 gr EV, Metamizol EV 500mg every
8h.
- Evaporative cooling (moderate - severe cases)
Antídote:
- Physostigmine
Adults: 0.5 - 2 mg EV 5 to 10 minutes
Children: 0.02 mg / kg EV 5 to 10 minutes
Not when it is due to tricyclic antidepressants = asystole.
It is a guard by police personnel, male patient of 25 years. He presents severe
psychomotor excitement. After performing the physical restraint, TA 200/120,
FC 160x 'and mydriasis with pupils reactive to light are observed.
SIMPATICOMIMETIC SYNDROME:
CLINICAL SIGNS:
- Sweating
- Pilo erection
- hyperpyrexia
- tachycardia,
- hypertension,
- Arrhythmias
- hyperreflexia
- seizures
- mydriasis
- hallucinations
- paranoia.
SIMPATICOMIMETIC SYNDROME:
AGENTS:
cocaine, amphetamines,
nasal decongestants,
Caffeine, theophylline.
-Biometry-Hematics, Blood Chemistry, Electrolytes, Blood Gas

-Toxic in the urine
-Electrocardiogram
-Rx standard of the thorax
1. Physical containment
3. Via Peripheral
4. 02 Supplementary
6. Thermal curve
SPECIFIC TREATMENT
- If supraventricular tachycardia: use of
Verapamil 2.5 - 5mg EV 2minutes
Diltiazem 0.25mg / kg EV 2 minutes
- Agitation and seizures
Initial treatment with BDZ (safety threshold), avoid neuroleptics.
Diazepam 5MG EV, Lorazepam 1-2 mg EV
Hypertension
Controversial use of beta-blockers (could induce myocardial
ischemia)
Nitroprusside sodium (0.5-5 μg / kg / min i.v.) or phentolamine (3-5
mg i.v.)
Nifedipine orally or sublingually (10-20 mg)
Differences between anticholinergic syndrome
and sympathomimetic syndrome
- Gastrointestinal motility inhibition
- Dry skin
- Urinary retention
- Pupillary reactivity
He enters a 39-year-old patient guard with respiratory distress, vomiting and
incontinence of sphincters. It presents intense sialorrhea, bronchorrhea and
profuse sweating. FC 48 x 'and miosis.
COLINERGIC SYNDROME:
CLINIC SIGNS :
- Bradycardia or tachycardia, pulmonary edema,
- Vomiting, intestinal spasms, fecal and urinary
incontinence.
- Hypersalivation, tearing, sweating, fasciculations,
- Convulsions, confusion, miosis, decreased level of
consciousness.
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART
I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
MUSCARINICOS:
Miosis, bradycardia, bronchorrhea, bronchospasm, vomiting
and diarrhea, sialorrea, tearing, incontinence.
NICOTINES:
Mydriasis, tachycardia, bronchodilation, hypertension,
diaphoresis, weakness, Fasciculations.
CENTRAL:
Agitation, confusion, lethargy, coma, convulsions.
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART
I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE 2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
AGENTS :
Organophosphorus and carbamated insecticides,

physostigmine, neostigmine, amanita phalloides,
Edrophonium, donepezil.
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE
2001 VOL 3 No 8/Am J Emrg Med 2001;19;337-395
-Blood Biometry, Blood Chemistry, Electrolytes, Arterial Gasometry

-Toxic
-Electrocardiogram
-Rx standard Thorax
- Hepatic and pancreatic profile: there is a risk of pancreatitis due to
increased secretions and pancreatic duct spasm.
1. Stabilization of the airway, breathing and circulation.

2. Via Peripheral
3. 02 Supplementary
5. Thermal curve
7. Vesical Probe
SPECIFIC TREATMENT
- Skin, Physical and Gastrointestinal Decontamination

- Reactivation of Cholinesterase inhibition by Organophosphorus:
OXIMAS (Pralidoxime)
Dosage: 25-50 mg / Kg / dose in slow infusion in 30-50 minutes diluted in 100-200ml
of glucose solution, repeat in 1-2 hours
Sodium Bicarbonate: In intoxication occurs with moderate to severe acidosis: Dose
1mEq / kg
- Treatment with BDZ (management of seizures and agitation)
Magnesium Sulfate: Decreases the toxicity of organophosphates by controlling
hypertension and ventricular tachycardia (torsades) and correcting hypomagnesemia
(resistance to atropine).
Diphenhydramine: Dosage: 25mg EV every 8 hours in adults and 5mg / Kg / day in
children, (it has been recommended as a coadjuvant.) It reduces the need for
atropine. Contraindicated in patients with long QTc.
INITIAL HANDLING OF THE INTOXICATED
PATIENT
• ANTIDOTE:
- ATROPINE
0.5 to 1mg IV dose response,
0.01mg / kg IV in children
Repeat every 15-20 min, until symptoms of atropinization:

Mydriasis, tachycardia, dry mouth, fever..
1. A 2-year-old child enters a peripheral hospital in a coma, being immediately
referred to pediatric therapy at this hospital. Intubation patient, GCS 5/15,
hypothermic, miotic. At admission serum glucose 48 mg / dl.
Samples of urine and blood are taken from the patient, confirming the clinical
diagnosis
2. Interconsultation is performed in the hospitalization room. A 66-year-old

patient admitted with diabetic foot and renal failure. It is found with deterioration
of the state of consciousness (5/15), bradypnea and punctate miosis.
Residents are consulted for medication received by the same.
OPIACEOUS/ SEDATIVES-HIPNOTIC SYNDROME
CLINICAL SIGNS :
Bradycardia, hypotension, pulmonary edema,

hypothermia, ileus, hyporeflexia, seizures,
coma, miosis, respiratory depression
Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003;123:577-592 PART I/CLIN MED URG NORT 1994 VOL 2 /TOXICOLOGY GOLFRAN ED 2003 /EMERG PRACTICE 2001 VOL
3 No 8/Am J Emrg Med 2001;19;337-395
OPIACEOUS/ SEDATIVES-HIPNOTIC
SYNDROME
AGENTS :
Opiates, barbiturates, benzodiazepines, ethanol,
clonidine.
Tintinally, Med Urg 5ta ed. 2000
Rosen Emer Med 4ta ed. 2000

-Biometry, blood chemistry, electrolytes, blood gases.

-Toxicology in plasma and urine.
-Electrocardiogram
-Rx standard of the thorax.

2. Via Peripheral
3. 02 Supplementary
5. Thermal curve
7. Vesical Probe
SPECIFIC TREATMENT
- Seizures:
- Hypotension:
Critstaloid solutions
Vasopressors (Dopamine 200mg + 250 cc Dextrose in H20 5% 10gts / min)
- Antidotes and antagonists:

Naloxone 0.4-2 mg IV (opioids)
Flumazenil 0.01 mg / kg / min IV, 0.2 mg (2 ml) IV (benzodiazepines)
Thiamine 100 mg IV / IM
Female patient and 90 years old, with a history of hypertension and depressive
syndrome. In treatment with enalapril 10 mg / day and mianserin 30 mg / day.
In the last 7 days he presented worsening of the depressive symptoms, in the
context of the recent death of a daughter, and began treatment with
escitalopram 20 mg / day.
In the interrogation, the person in charge of their usual care reported irregular,
non-prescribed use of excessive daily doses of escitalopram, according to the
immediate subjective state; and with this information the diagnostic hypothesis
was formulated
SEROTONINERGICAL SYNDROME:
CLINICAL SIGNS :
- Alteration of the level of consciousness.

- Increase in muscle tone.
- Hyperthermia.
- Hyperreflexia
- Intermittent tremors of the whole body.
SEROTONINERGICAL SYNDROME:
1. INITIAL HANDLING OF THE INTOXICATED

PATIENT
AGENTS :
- Meperidine or dextromethorphan + MAO
inhibitors
- Tricyclic antidepressants, amphetamines.
-Biometry, blood chemistry, electrolytes, blood gases.

-Toxicology in plasma and urine.
-Electrocardiogram
-Rx standard of the thorax.

2. Via Peripheral
3. 02 Supplementary
5. Thermal curve
7. Vesical Probe
SPECIFIC TREATMENT
1. Gastrointestinal decontamination.
2. Initial treatment with BDZ (safety threshold), avoid neuroleptics.
3. Hyperthermia
Antitérmicos Paracetamol 1 gram EV, Metamizol EV 500MG every
8h.
Evaporative cooling (moderate - severe cases)
4. TREATMENT:
Antagonist:
Ciproheptadine
: 4-20 mg / day orally, normally 4 mg 3-4 times a day, up to Maximum
dose of 0.5 mg / Kg / day.
A 49-year-old male patient with a history of chronic alcoholism was admitted.
The previous night while drunk he manifested blurred vision. In this day he is
found stuporous for what is brought.
On admission: comatose, hypotensive, tachycardic, tachypneic, mydriatic

patient. IOT is done. EAB: metabolic acidosis, methanol levels in blood> 0.5gr/ l.
METHYL INTOXICATION
CLINICAL SIGNS :
- Alteration of the level of consciousness

- Tachypnea, blurred vision and / or
photophobia, mydriasis
- Hypoglycemia
Complementary:
- Metabolic acidosis
- Methanol in blood> 0.2 gr / l.
- Biometry, blood chemistry, electrolytes, blood gases.

- Toxicological plasma.
- Electrocardiogram
- Rx standard of the thorax.
- Capillary blood glucose
1. Stabilization of the airway, breathing and circulation.

2. Via Peripheral
3. 02 supplementary
4. Continuous cardiac monitoring
5. Intake and control of excreta
DONT FORGET
- Gastrointestinal decontamination.
- Management of hypoglycemia
INITIAL HANDLING OF THE INTOXICATED
PATIENT
• TREATMENT:
Ethyl alcohol:
Enteral route: place a nasogastric or orogastric tube
Loading Dose: 40% Ethyl Alcohol. Administer 1.8 - 2ml / kg enterally, dilute
in the same amount of dextrose in 5% water and pass in 30 minutes.
Maintenance dose: AE iv 40% for 72 hours. In Dextrose in Water 5%,
0.40ml / kg / hour, Up to methanol concentrations below 0.2g / l or pH> 7.3.
Sodium bicarbonate:
Load Dose: 1-2meq / kg IV bolus, Maintenance 1-2meq / kg / hour
according to patient's clinical condition and until pH> 7.35.
Folic Acid: 50-200mg enteral route every 4 hours, first 24 hours.
Complex B: 3ml diluted in each hydration solution.
“El fracaso en el diagnóstico de las
intoxicaciones se debe a que no se
piensa en ellas”

Topic Review Intoxications

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HOSPITAL GENERAL DOCENTE DE

CLINICAL ACADEMY PROJECT

REVIEW TOPIC: INTOXICATIONS

DR. RICARDO BEDÓN MT.

- Poinsoning is a frequent causa of consultation in

- The true incidence is unknown due to

- Low global mortality; 1-2% in hospitalized patients.

Toxicol 2004; 42:933-943 .

- Three peaks of incidence

• Treat the patient NOT to the toxic

The Anamnesis is the basis of diagnosis in 95% of poisonings

5. Previous rescue measures

- Ensure good ventilation

- Evaluation and support of vital functions

- Exposure and Decontamination

Keep the Patient Living

1. Heart rate 6. Skin

Therapeutic measures designed to:

- Reduce the exposure to toxins

-¡Do not forget that the ocular exposure time is

- Remove clothes, store in airtight bag and label.

- Washing by dragging with water

- Protection of the staff

-Administration of adsorbent substances

- It is most effective after 30 minutes of ingestion

•“In some cases where the procedure has an

Montoya, Toxicología clínica. 2002, 2da ed., CHEST 2003

• Its effectiveness has not been proven

:Example: Sodium sulfate, magnesium sulfate, sorbitol, mannitol

• In general, they are not recommended

• Polysaccharides derived from the

•Mannitol: derivative of mannose sugar.

• Polyethylene glycol isotonic solution

- Do not use routinely

-Potential benefit in iron intakes.

-Ionized molecules are not reabsorbed from the renal

- The degree of ionization is dependent on the pH of the

-Altering the urine increases the ionization of the toxic

Both present remarkable mydriasis without reaction to light, hyperthermia, tachycardia

To the physical examination:

- Blood biometry, blood chemistry, electrolytes, blood gases.

-Biometry-Hematics, Blood Chemistry, Electrolytes, Blood Gas

- Gastrointestinal motility inhibition

Organophosphorus and carbamated insecticides,

-Blood Biometry, Blood Chemistry, Electrolytes, Arterial Gasometry

1. Stabilization of the airway, breathing and circulation.

- Skin, Physical and Gastrointestinal Decontamination

Repeat every 15-20 min, until symptoms of atropinization:

2. Interconsultation is performed in the hospitalization room. A 66-year-old

Bradycardia, hypotension, pulmonary edema,

Tintinally, Med Urg 5ta ed. 2000

Rosen Emer Med 4ta ed. 2000

-Biometry, blood chemistry, electrolytes, blood gases.

1. Stabilization of airway, respiration and Circulation

- Antidotes and antagonists:

- Alteration of the level of consciousness.

1. INITIAL HANDLING OF THE INTOXICATED

-Biometry, blood chemistry, electrolytes, blood gases.

1. Stabilization of airway, respiration and Circulation

On admission: comatose, hypotensive, tachycardic, tachypneic, mydriatic

- Alteration of the level of consciousness

- Biometry, blood chemistry, electrolytes, blood gases.

1. Stabilization of the airway, breathing and circulation.