SA toxicology

SA toxicology

1. The four principles... Warfarin eg

   • Limit exposure to the toxin/ prevent absorption
     • Emetic
       • @ home: NA bicarb, dish liquid in soapy water
       • In clinic: Apomporphine within 4h
     • Gastric lavage within 2h. Intubate, head down, saline
     • Carbosorb
       • Consider contradindications and expect black stools/ electrolyte imbalance
   • Treat the clinical signs
     • Anticoagulant: Vit K and symptomaic case fluids, admin of clotting factors or blood in long life toxin (Talon) which may also require Vit K for 3-4w
       • Use oral Vit K with a fatty meal if 2nd generation poison
         • Decontamination/ emesis can be used in first 4h- w/ CS's
   • ID the posion
     • Anticoagulant sources: Short and long acting rodenticides (Warfarin 15h VS Taln 6d) , Indanediones and flucoumefab
       • Dx: OSPT (one stage prothrombin) in a citarte blue tube, APTT can also be used
   • Give antidote where possible
     • OP: atropine, Paracetomol: acetyl cysteine, 1080: Acetamide, Ethylene gly (ethanol), Ethylene- 4-methypyrazole and Vt for Warfarin
     • Chelating agents
       • Lead and arsenic (BAL), Calcium EDTA (lead and zinc), d-penicillamine for many metals- Pb, Zn, Copper and Iron. DMSA for aresneic, copper and Pb

2. OTHER MAJORS

   • Cholinergic blockers
     • atropine, hyoscone, deadly night shade, belladonna, potatoes and mushrooms
   • Cholinesterase inhibitors
     • Blue-green alage, NMB, OP'S: Insecticides, dips pour-ons, flea collars etc
       • OPS inhibit binding of ACH at cholinergic receptors
         • SlUDDE: Salivation, lacrimation, urinations, defecation, dyspnoea, emesis... other signs: pinpoin pupils, nasal discharge and off HR
           • In SA the CNS signs may include: hyperactivity, hyperflexibility, ataxia, convulsions etc. CLONIC-TONIC seizures
             • OPIDN: The induced, delayed neuropathy: long nerve wallerian- myelin and axon death
               • DX: garlic odour, atropine response test after seeing SLUDDE signs, with hx of exposure: 0.02mg/kg
                 • TMT: Decontaminate from ORAL or DERMAL exposure. Atropine sulphate given- some oral, some SQ. 2-PAM protopamm chloride can be given. Supportive care is crucial- fluid therapy, oxygen, seizure control with diazepam or valium
                   • Aging of complexes exacerbates the potency... Need to avoid sedation for 30d after, use of aminoglycoside IG's
   • Nch agonists
     • Tobacco, hemlock, sophora, LEVAMSOLE
   • Carbamates
     • The carbamyl found in these is a common insecticide- Slug and Snail bait
       • Same Ach inhibtion of ACH as seen in OP's but there is a reversible bind to the acetycholinesterase. The clinical signs are similar (SHAKE AND BAKE) but 2=PAM should not be used