poisoning | MY SPECIAL DOCTOR

Hospitalizations and deaths in England and Wales

15 February 20246 January 2024 by Alessia Giannino

In Britain, the most common type of poisoning is acute poisoning . From the 1970s to the present there has been a gradual increase in poisoning deaths. Although official statistics show most cases to be accidental, a deeper analysis reveals intentionality in many of them. In Britain,murder by poisoning appears to be rare, as most murderers are impulsive. Many of those who decide to commit suicide by poison die before they reach the hospital, as they are often so determined to die that they make sure no one can oppose their plan.

Epidemiological statistics in England and Wales are similar to those in other states such as Scotland. In “developed” states, young children are much better protected from malnutrition, infection and trauma than before. Increased are the cases in which children unwillingly swallow toxic substances. Hundreds of children under the age of 10 die from poisoning every day in England and Wales, and most of them because they ingest carbon monoxide. In contrast to hospitalizations, the mortality rate of these children is very low, especially since only a few stay in the hospital more than one night and therefore not really suffering from poisoning. Of course, as far as young children are concerned, it is normal for them to put anything in their mouths, and it often happens that they ingest medicines left unattended and within their reach.

Accidental poisoning of adults can depend on several factors, including toxic gases and vapors, along with some metals such as lead. When it comes to self-poisoning, the accusation falls on those drugs capable of giving a state of unconsciousness. Some can be purchased freely without a prescription, while others cannot. At present, barbiturates no longer rank first among the most commonly used drugs because their prescription has been restricted. Their place has been taken by antidepressants, sedatives, tranquilizers, hypnotics, and all those drugs that are used every day to treat psychoneurotic afflictions.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Poison elimination

15 February 20246 January 2024 by Redazione My Special Doctor

Logic would have it that in the case of coming into contact with poisons, one should remove from the body any toxic substance that has entered it, but clinical observations have shown that this approach is often practiced by only a few people and with questionable benefits. In addition, impairments in physical state may result from the substances administered for this purpose.

Environmental exposure

Steps must be taken to stop the exposure of toxic substances. Anyone in a polluted atmosphere should be removed and taken to fresh air without endangering rescuers. In case toxic gases and vapors are exhaled or inhaled, ventilation of the room can be encouraged, trying to speed up the removal of the toxic substance.

Skin contamination

If a toxic substance is deposited on the skin , it is possible to see skin reactions; in fact, only some garments are totally impermeable. In this case, the patient should be undressed immediately and the skin washed with soap and water. The eyes also need to be rinsed with plenty of water or saline solution.

Stomach emptying

Many times it happens that poisons enter the body by ingestion. In this case, the toxic substance must be recovered before it advances down the alimentary canal. The simplest way isgastric aspiration and a gastric lavage. This procedure is not without dangers and should not be considered as a method that should always be applied.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

The cardiovascular system during poisonings

15 February 20246 January 2024 by Redazione My Special Doctor

Poisoning can also cause cardiovascular collapse; in fact, antidepressant drugs can trigger cardiac arrhythmias, consequently altering cardiac output.

It is necessary, therefore, to measure blood pressure and heart rate at regular intervals and frequently, so that continuous ECG recording is made. Shock, in the poisoned patient, is almost always an expression of a disproportion between the capacity of the vascular bed and the volume of blood contained in it. Venous return, for this reason, decreases by having a reduction in cardiac output.

Cold, pale, moist skin is the real wake-up call. When the systolic blood pressure value falls below 90 mm Hg, action must be taken. The treatment first involves walking up the bed to increase venous return to the heart. If this measure is not sufficient, it is absolutely necessary to expand the circulatory volume intravenously. If even then the patient tends not to recover, then the use of intropi drugs is justified. Cardiac arrhythmias may disappear once the anoxia and acidosis are corrected. Antiarrhythmic therapy should be used only when rhythm changes are such that cardiac output is seriously impaired.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Initial assessment and patient management: initial care

15 February 20246 January 2024 by Alessia Giannino

A physician grappling with a poisoning does not have a battery of antidotes available, and their use in medical practice is the exception.

Compared with other medical emergencies, acute poisoning is difficult to diagnose. Depressed subjects are often found unconscious with a letter and an empty tablet case next to them. Or a child is found gnawing and chewing on something inedible. Initially perhaps poisoning is not suspected, and only after the patient is resuscitated can the true cause of the condition be understood.

Examination of the patient

The physician must pay attention only to the patient and not to the inconsistent explanations of those who accompanied the victim. In the absence of critical symptomatology , a complete examination should be done by evaluating: level of consciousness, respiration, circulatory status, presence of seizures, pupil diameter, injection marks, body temperature, skin condition, and lesions.

Emergency treatment

Emergency treatment consists of resuscitative measures. If the patient is able to breathe spontaneously, you need to put him on his side, remove any obvious obstruction and intubate him.

If the patient, on the other hand, is unconscious, lateral decubitus is important, preferably with the head slightly down and avoiding tongue drop.

If the pulse is not regular, it is necessary to elevate the feet about 20° to promote venous return to the heart.

If the patient has seizures , intravenous injections of 5-10 mg dizepam should be given immediately. If, on the other hand, he has inhaled toxic gases or vapors, it is necessary to remove him from the polluted environment and ensure adequate ventilation.

Finally, if the patient has eyes, skin and clothes contaminated with toxic material, it is necessary to immediately flush the eyes with saline solution, remove the clothes and wash the contaminated skin, immediately covering it with a clean blanket.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Poisoning: general treatment measures

15 February 20246 January 2024 by Alessia Giannino

Apparatus urinary

There is no good reason to stimulate profuse diuresis or to use diuretics, while treating the poisoned patient. Heavy metals are capable of damaging the kidneys , and in this case hemodialysis or peritoneal dialysis is a must. In addition, fluid balance should be performed for any poisoned patient and electrolyte balance should be monitored.

System nervous

Efforts to stimulate a comatose patient should always be avoided. If, however, the central nervous system is directly stimulated by the toxin and seizures occur, it is necessary to treat the patient with diazepan injections. If the epileptic state continues to persist, there will be a condition of disorientation and physical exhaustion, which can even lead to death.

Temperature

A significant thermal increase is a sign of infection; in fact, few poisons exhibit pyrogenic characteristics. At this point it is necessary to identify the infectious focus and begin treatment with antibiotic. Comatose individuals should have their rectal temperature measured with a thermometer capable of recording even lower temperatures before they are discovered. If the temperature is very low, it is necessary to warm the subject gradually, without exposing him or her to powerful heat sources.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Emergency measures during a poisoning.

15 February 20246 January 2024 by Redazione My Special Doctor

“Dum spiro spero” may be a simple aphorism, but it sets a high bar for the treatment of the poisoned patient, as any deficit in the patient’s oxygenation can impair his or her recovery.

If there is no airway obstruction and the skin and mucous membrane color is good, then there is no reason to intervene. Usually, however, the patient should be placed in an appropriate position without external impediments to breathing and kept under observation. At the point when a respiratory deficit is evident, it is necessary to be sure of airway patency by removing any dentures. If the patient, on the other hand, is comatose, it is best to introduce an endotracheal cannula with an appropriately sized inflatable balloon. If it has secretions they should be aspirated.

Intensive care

A patient, if dyspnoic should be admitted to the hospital and undergo intensive care. The aim is not only to restore adequate oxygenation, but also able to provide for broncho-pulmonary complications that can quickly set in. In the comatose subject, the value of the inflatable balloon endotracheal tube has been emphasized; it is important to take care to prevent the tube from descending into the right main bronchus, giving rise to a pneumothorax in one side and lung collapse in the other. Inhaled air should be humidified and if there is hypothermia, warmed as well. Respiratory complications can be a threat to the ICU patient’s recovery, so efforts must be made to prevent them.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Gastric lavage in case of poisoning

15 February 20246 January 2024 by Alessia Giannino

To perform gastric lavage, it is important to keep a few points in mind:

Be sure that you have ingested a dangerous dose of a toxic substance
That the ingestion Of the substance has been carried out for no more than 4-6 hours
That the patient does not vomited

The procedure to be performed is as follows:

Place a balloon endotracheal catheter to protect bronchi and lungs in the comatose patient;
Place the patient on the left side with the head on the bank or end of the lett
The pipe used must be of appropriate diameter
With the help of a Dakin syringe, aspirate the stomach contents. Administer, then, 300 cc of heated water, and perform other washes, each of 300-600 cc of water, until the aspirated liquid is clear. Tap water or specific preparations such as iron salts, opium, household bleach, axalic acid, oral cyanide can be used as the washing liquid.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Emesis in case of poisoning

15 February 20246 January 2024 by Redazione My Special Doctor

Despite the lavender gastric is undeniably useful, it has many features reminiscent of a barbarian assault, so it is best to avoid using this method with the young children. When it comes to the latter usually induction is used. to vomiting, a very effective measure unless the child lacks consciousness.

Stimulation with the fingers is definitely the easiest way to induce someone’s vomiting, but often proves to be ineffective. Another, sometimes more effective solution is the syrup of ipecacuana, which given to a child, followed by a glass of water or orange juice, almost always causes vomiting in about 20 minutes. If a 15-30 ml dose has no effect, a second dose can be administered. In this case the success rate rises to 95%, replacing in children, aspiration and gastric lavage.

Many times the hypecacuana Is also used in adults, in case they cannot be provided for to gastric lavage.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Forced diuresis during poisoning

14 February 20246 January 2024 by Alessia Giannino

Once a toxic agent has distributed into the tissues and organs of the patient, the harmful action will continue to persist until an antidote to it Will neutralize. Obviously, the use of antidotes is limited, as they do not there are methods to artificially increase metabolic inactivation processes. With filtration, the idea was established that the infusion of greater amount of fluids in the body should lead not only to the formation of more pee, but also to the removal of toxins. All this has been made evident as a result of the forced diuresis of thousands of poisoned people.

For most of the drugs taken in overdose, only a small proportion of them Is eliminated from the kidney in unchanged form. Usually their action ends by metabolic degradation, so diuresis would not change the duration of their effects.

From A therapeutic point of view, forced diuresis can help the patient poisoned only when it comes to overdoses of salicylates, barbital and phenobarbital, quinine and other amphetamine-like drugs.

In addition, urine pH can alter the effectiveness of diuresis in excreting the medication.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Poisonous plants, but not bad ones

12 February 20246 January 2024 by Redazione My Special Doctor

To defend themselves against pests, several plant species have learned in the course of evolution to produce defensive substances of various kinds, which can also create more or less serious problems for humans. Often, these are of “simple” irritating or stinging compounds that, when they enter the contact with skin or mucous membranes, cause allergic or irritative dermatitis, burn-like lesions or diffuse swelling or itchy pomphi. Sometimes, however, these are real plant toxins that act as poisons to the human organism, even endangering life if accidentally ingested (for example, because toxic berries are mistaken for edible fruits or Because a child puts its leaves in his mouth without knowing the dangerousness). Some poisonous plants are very common and used for the purpose of ornamental in homes and gardens: Find out which ones to watch out for.

Methods of poisoning: barbiturates

10 February 20246 January 2024 by Redazione My Special Doctor

Today, compared with years past, barbiturate poisoning has greatly decreased, as they are no longer prescribable as before. Short- and medium-acting barbiturates are more toxic than long-acting ones. The mode of action has not yet been clarified.

Signs and symptoms

With a barbiturate overdose there is a loss of consciousness and a deep depression of breathing. You can also have a cardiovascular collapse that is accompanied by renal failure. They are very pulmonary complications are common, and bullous lesions may appear.

Diagnosis and treatment

The picture of barbiturate overdose is not much different from coma due to other causes. Diagnosis can only be unequivocal through blood samples. Most patients are treated by avoiding stimulants and antidotes. Emptying the stomach can be very helpful if done within 6 to 8 hours of ingestion.

Source: Vadecum of poisoning therapy by Roy Goulding

Methods of poisoning: blockers (propranolol, atenolol, oxprenolol)

10 February 20246 January 2024 by Redazione My Special Doctor

An overdose of such drugs in children may occur accidentally, while in adults it may be voluntary or from therapeutic overdose. By their blocking action on nerve endings, these drugs exert a powerful negative inotropic and chronotropic effect on the heart. The main symptoms are hypotension, convulsion and, in severe cases, coma.

Diagnosis and treatment

Diagnosis is derived from the medical history as laboratory tests are of little help in emergency situations. The stomach can be emptied even many hours after ingestion, and the treatment is directed to clear the body and stimulate the cardiovascular system. If blood pressure does not rise, prenalterol can be administered in a dose of 5-10 milligrams into a vein. As a last resort, application of an intravenous pacemaker may be necessary.

Source: Vadecum of poisoning therapy by Roy Goulding

Poisonings: clinical monitoring

11 February 20246 January 2024 by Redazione My Special Doctor

Laboratory investigations date back more than 150 years, when analysis was first used. quantitative chemistry. The main purpose was to solve cases uncertain legal. The transition from the cautious and demanding approach is not been a simple matter, as the correlations between laboratory findings and clinical status are not very precise. For this very reason, we do not it is surprising that even today the toxicology laboratory does not occupy a place of prominence in the poisoning unit.

Clinical Chemistry

In the treatment of a poisoning it is also necessary to assess the patient’s biochemical status, which can only be safeguarded if the pH of the blood can be recorded and of urine, plasma electrolytes and blood gases.

Chemical Toxicology

When it comes to an emergency, knowing the poison is not an absolute necessity. It should, instead, always collect stool samples, vomit samples, and heparinized blood that does not should ever be destroyed, as they provide invaluable evidence of the value. Even in the ward, most overdose cases are of modest entities, so they can be treated without the need for specific knowledge of toxicology. Of course, there are always situations where an analysis is needed. toxicology.

Screening

Through a screening qualitative chemistry it is possible to have much clarification regarding poisoning. The laboratory chemist can only report the results, while the physician Is up to the interpretation of such. A screening program is never fully comprehensive and a negative answer does not rule out poisoning outside the of the scope of screening capabilities.

Quantitative methods

Ensure the presence of a substance has its limits, in fact you can get more Information from the determination of the concentration of toxic agents. Often procedures can take a long time. For many of the poisons you see In practice, tables have been published showing the levels that are should wait in a therapeutic regimen and those who depose for an overdose of the drug. Of course, the response may vary from patient to patient.

Drug addiction

People addicted to drugs are unreliable in medical history. Moreover, in order to obtain more “generous” prescriptions, they tend to exaggerate the extent of the abuse done. When they fear incurring justice they try to convince of the innocence of what happened. It is difficult to carry out quantitative studies on patients who are dependent toward a drug. It should be kept in mind that even the results of qualitative studies performed on urine cannot be transposed to serum levels and are exposed to criticism from a medico-legal point of view for narrow validity.

Source: Vadecum of poisoning therapy by Roy Goulding

Methods of poisoning: antidepressant drugs

10 February 20246 January 2024 by Redazione My Special Doctor

Today patients with antidepressant drug overdose. represent a large portion. The pharmacological properties of the antidepressants are multiple and include interference with release of adrenaline at the level of brain neuromas, a reduction in the activity of the parasympathetic nervous system and a picture of cardiac disturbances.

Signs and symptoms

Symptoms of poisoning are: numbness, dryness of the jaws, dilated pupils, tachycardia, and heightened tendon reflexes. Subsequently, sudden cardiac arrest is possible.

Diagnosis and treatment

If the patient suffers from depression and has been prescribed antidepressant medication, the diagnosis can be made with some confidence. Many patients take mild overdoses of antidepressant drugs and survive with just assistance. In cases of large overdoses, high mortality is possible. It is necessary that the patient’s stomach be emptied with induction of vomiting or gastric lavage. In the meantime, normal supportive measures should be undertaken, with special attention to breathing. In case convulsions occur, it is important to administer 5-10 mg of Diazepam intravenously. If cardiac arrhythmias persist, antiarrhythmic drugs should be used.

Source: Vadecum of poisoning therapy by Roy Goulding

Methods of poisoning: cardioactive glucosides

10 February 20246 January 2024 by Redazione My Special Doctor

Overdose of these drugs is chronic and is almost always due to careless treatment. The reactions can be seen as an exaggerated expression of their pharmacological properties. Once toxic levels are reached, the subject experiences mental confusion, vomiting, diarrhea and visual disturbances. Subsequently, bradycardia and overlapping arrhythmias occur, which may result in tachyarrhythmias.

Diagnosis and treatment

History and clinical signs are sufficient to make the diagnosis, but at least for digoxin it must be with measurement of plasma levels. Within 18 to 20 hours after acute ingestion, the stomach should be emptied by inducing vomiting, immediately after which a dose of activated charcoal (100gr for an adult, 25 for a child) can be given. IV potassium can be administered for hypokalemia. For individuals with heart disease and those showing atrioventricular blockade, an intravenous pacemaker may be necessary.

Source: Vadecum of poisoning therapy by Roy Goulding

Paracetamol: what to do?

10 February 20246 January 2024 by Redazione My Special Doctor

In some countries, paracetamol is sold in quantities greater than aspirin. Most people, they do not know the differences between the two substances. For this reason, poisoning by paracetamol in children.

There are mainly two therapeutic doses: in small part is eliminated by the kidney, while for the most part it is eliminated always from the kidney, but in the form of inactive metabolites.

Signs and symptoms

Those who take an overdose of paracetamol may remain disappointed by not experiencing any symptoms during the first day. Subsequently, however, the presenting picture is that of acute liver failure. The patient may experience abdominal pain. Histologically, the cellular damage liver is initially centrolobular, so it tends to become confluent.

Diagnosis and treatment

From a clinical point of view, the difficult thing is to decide whether the patient has ingested acetaminophen in such quantities as to require administration of the antidote. The medical history is of great help because if less than 15 grams have been ingested there is little to worry about. If the dose has been exceeded then liver damage is certain and death is almost inevitable. If the history is certain, no further time should be wasted and methionine should be administered immediately orally or intravenously. The side effects of these antidotes are minimal, especially if given within 10 hours of taking acetaminophen. Ancillary measures include gastric lavage, which can be performed within 6 hours.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: salicylates

10 February 20246 January 2024 by Redazione My Special Doctor

The most common type of poisoning is from aspirin, a drug that contains acetylsalicylic acid. Aspirin tablets are very popular among adults intent on poisoning. In the body, salicylates exert complex actions on the breath centers, electrolyte balance, metabolism and stimulation of certain brain structures.

Signs and symptoms

With an overdose during therapy, the toxic effects tend to occur slowly. Even if the patient remains vigilant complains deafness, blurred vision, ataxia and also often shows tremor and irritability. Subsequently, the patient enters hyperventilation and the dehydration can be a sequela.

Diagnosis and treatment

The presence of a very nuanced symptomatology should not reassure, as in a short time it is possible for a serious deterioration of the condition to occur, especially in children. Once the diagnosis is clear, it is important that any kind of imbalance be corrected. An attempt can, therefore, be made to empty the stomach: with children, induction of vomiting can be used, while in adults, gastric lavage is best. It is also necessary to monitor the lungs to prevent the onset of pulmonary edema. Should renal failure occur, hemodialysis is mandatory.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: quinine, quinidine

10 February 20246 January 2024 by Redazione My Special Doctor

The two compounds differ only in their optical isomerism, but toward living systems quinidine is more toxic. Quinine overdose is less common than before, as it is mainly used for abortion. Both drugs are muscle depressants and both are excreted rapidly.

The main symptoms are nausea, headache, vomiting, ataxia, Diarrhea, abdominal pain, and tinnitus. Tachycardia is associated with arrhythmia heart rate and to drop blood pressure. Some subjects may manifest these symptoms even at very low doses.

Diagnosis and treatment

Diagnosis is almost always based on history, and because of rapidity in treatment, plasma-type investigations are excluded. Due to the presence of spontaneous vomiting, active emptying of the stomach is unnecessary. Supportive measures are the basis of treatment, with bilateral stellate ganglion block maneuvers by direct injection of a local anesthetic.

Source: Vadecum of poisoning therapy by Roy Goulding

Tranquilizers as a method of poisoning

12 March 20246 January 2024 by Alessia Giannino

Drugs of this type are divided into 2 groups major: minor tranquilizers and major tranquilizers.

Tranquil minors

These drugs are certainly less dangerous than the barbiturates, whose place they took. Of course, it is possible that taken together with other drugs there is a potentiating effect. Ataxia, the loss of consciousness and respiratory depression generally respond to a symptomatic treatment, whereas if the ingestion occurred a few hours earlier it may gastric emptying be helpful.

Tranquillant majors

They have greater effects than minor tranquilizers and are capable of causing various disturbances in the functions of the body. The presence of these drugs in the urine can be ascertained by colorimetric reaction. The diagnosis is deduced from the history, seen together with the symptom complex. In addition to usual treatment, it may be necessary to quell symptoms with benzotropin. forced diuresis, hemodialysis, and hemoperfusion are unable to promote the elimination of these drugs from the body.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: carbon monoxide

11 February 20246 January 2024 by Redazione My Special Doctor

Carbon monoxide is definitely one of the most frequent occurrences of poisoning. Until recently, a source of monoxide carbon was given by city gas taps. Nowadays in many countries it is been replaced by methane or “natural gas,” which is devoid of constituent toxic. Today, the main source of carbon monoxide it’s due to the exhaust gases from internal combustion engines. Most of these cases of poisoning are accidental, although it is still a method of choice for commit suicide.

Signs and symptoms

Carbon monoxide is odorless and its presence is recognizable only because of the harmful effects it generates in beings living. Early manifestations can be mistaken for hysterical symptoms. The gastrointestinal system may be affected with vomiting and incontinence fecal. The skin and mucous membranes may take on a pinkish tinge, and it is possible that bullous lesions appear at some pressure points.

Diagnosis and treatment

Although the initial symptoms are not characteristic, the history and circumstances often lead to the diagnosis. Confirmation that it is poisoning is by measuring the level of carboxyhemoglobin in the blood. At this point the patient should be removed from the polluted area and oxygen administered. If there is no quick recovery, it is necessary to transfer the patient to a hyperbaric chamber. To cope with possible cardiac complications, the patient should be kept at absolute rest with ECG monitoring.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Chlorine-organic insecticides

6 January 2024 by Redazione My Special Doctor

Chlor-organic insecticides include aldrin, dieldrin, endrin, dicophane and lindane. Because they are substances that resist chemical degradation, they can persist in the environment, and as a result, it is mandatory to withdraw them from use in almost all countries. All chloro-organic insecticides act as central nervous system stimulants. Chronic exposure promotes the accumulation of these substances in adipose tissue, which sequesters the substance. Stimulation of the nervous system leads to excitation, convulsions and muscle fasciculations.

Diagnosis and treatment

A blood sample can be taken to confirm the diagnosis and wait for the objective examination. Exposure almost always occurs parenterally, but if a substance is ingested it is necessary to empty the stomach and administer a saline purgative. As for seizures, it is possible to control them with diazepam.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: alcohol.

10 February 20246 January 2024 by Redazione My Special Doctor

In the case of ethanol poisoning, the central effect is. strictly dose-dependent, with progression of brain structures more specialized. Methanol, on the other hand, exerts less depression on the system central nervous system, but it damages the eye.

As for ethanol, it initially determines. a change in mood, characterizing an empty-headed feeling, excitement and exaltation. The picture evolves with dulling of the sensorium, The slowing of reaction time and obvious incoordination. In the stadium more advanced you will have muscle flaccidity, depression of tendon reflexes, stupor, coma and respiratory depression.

Methanol intoxication, however, is different in that stupor and stupor occur 12-36 hours later, when vomiting, abdominal pain, and ataxia assail the patient.

Diagnosis and treatment

The medical history may be unreliable. Breath testing can be useful as a primary screening to determine whether alcohol introjection is involved. The blood test is simple and reliable, and through it the alcohol level can be measured.

For ethanol intoxication, the basis of treatment is intensive supportive therapy, including gastric lavage. For methanol poisoning, the latter should be done within 4 hours of ingestion, and acidosis should be treated by administration of intravenous sodium bicarbonate.

Source: Vadecum of poisoning therapy by Roy Goulding

Main types of poisoning: ethylene glycol

10 February 20246 January 2024 by Redazione My Special Doctor

Ethylene glycol can be considered an alcohol polyhydroxylated. It appears to be low in toxicity but with the intake of other medication could cause death. A dose of 100 ml is very dangerous, if well some people are also cured by ingesting larger amounts. The clinical picture is the same as ethanol intoxication. After some time appear nausea, vomiting, muscle twitching, depression, convulsion and coma.

Diagnosis and treatment

Apart from the history, confirmation of intoxication is obtained by classical aspiration, through which the presence of a blue-colored liquid can be noted. In fatal cases, autopsy reveals diffuse cerebral edema with deposits of calcium oxalate crystals in the meninges. If the patient presents a few hours after ingesting the ethylene glycol then gastric lavage can be performed and sodium bicarbonate administered to correct the acidosis. When hypernatremia is high, it can be reduced with hemodialysis.

Source: Vadecum of poisoning therapy by Roy Goulding

Pentachlorophenol poisoning

8 February 20246 January 2024 by Redazione My Special Doctor

Pentachlorophenol is used as a protective coating on beams. Occupational exposure occurs mainly through the skin. This substance acts as an uncoupler of oxidative phosphorylation. There are several controversies for chronic pentachlorophenol poisoning , due to the presence of trace amounts of dioxin found as end products during the production process of the substance.

Overexposure to such a substance leads to a state of hypermetabolism similar to that seen with dinitro compounds, but without the Yellowish discoloration of the skin.

Diagnosis and treatment

Chemical tests are of little assistance to the clinician except to identify the type of compound. Treatment follows the same course of action as dinitro-compound poisoning.

Source: Vadecum of poisoning therapy by Roy Goulding