Daily Healthy: Poisoning

Toxicity : Beta Blockers

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<li><span style="font-family: "verdana" , sans-serif;">The common feature of beta-blocker toxicity is excessive blockade of the beta-receptors resulting in bradycardia and hypotension.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">goal of antidote is to restore perfusion to critical organ systems by increasing cardiac output.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">accomplished by improving myocardial contractility, increasing heart rate or both.  <o:p></o:p></span></li>
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<li><span style="font-family: "verdana" , sans-serif;"><span style="background: white; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">high-dose glucagon is considered the first-line antidote.</span></span></li>
<li><span style="font-family: "verdana" , sans-serif;">enhance myocardial contractility, heart rate and atrioventricular conduction; many authors consider it the drug of choice for beta blocker toxicity.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">rapid onset of action and a short duration of effect, rarely longer than 15 minutes.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">The endpoints for discontinuing glucagon infusions are not clear; however, it is reasonable that once a patient is hemodynamically stable for a minimum of 6 hours, a slow taper of a single agent at a time can be employed.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Evidence suggest that once therapy is discontinued, close observation is necessary for a minimum of 12 hours. <o:p></o:p></span></li>
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<span style="font-family: "verdana" , sans-serif;"><b>Insulin</b></span></div>
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<li><span style="font-family: "verdana" , sans-serif;">High-dose insulin has long been reported to be an inotrope.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">As HIET is particularly effective in improving myocardial contractility, the early administration of HIET may avoid the need for vasopressors or allow the use of lower doses, thereby reducing the potential for ischemic consequences. Insulin therapy may be considered if the patient has failed to respond to the traditional antidotes or if hyperglycemia is present.<o:p></o:p></span></li>
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<span style="font-family: "verdana" , sans-serif;"><span style="background: white; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Glucagon <o:p></o:p></span></span></div>
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<li><span style="font-family: "verdana" , sans-serif;">Initial bolus dose of 50–150 mcg/kg should be administered i.v. over 1 to 2 minutes.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">The initial dose should be followed by a continuous i.v. infusion at a rate of 2–5 mg/hr (maximum: 10 mg/hr) diluted in 5% dextrose injection (if benefit is seen).</span></li>
<li><span style="font-family: "verdana" , sans-serif;">If improvement is not seen with the initial bolus dose, consider increasing the initial dose.</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Reconstitution requires adding 1 mL of sterile diluent to a vial containing 1 mg of the drug, to provide solutions containing 1 mg of glucagon/mL.</span></li>
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<li><span style="font-family: "verdana" , sans-serif;">IV bolus of 5-10 mg (adult) or 0.05mg/kg (pediatric) over 1-5 minutes, followed by a continuous infusion of response dose per hour.</span></li>
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<span style="font-family: "verdana" , sans-serif;"><o:p></o:p></span></div>
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<span style="font-family: "verdana" , sans-serif;"><a href="http://www.mdpoison.com/media/SOP/mdpoisoncom/healthcareprofessionals/antidote-facts/glucagon%20antidote%20facts.pdf"><span style="color: windowtext;">http://www.mdpoison.com/media/SOP/mdpoisoncom/healthcareprofessionals/antidote-facts/glucagon%20antidote%20facts.pdf</span></a><o:p></o:p></span></div>
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<span style="font-family: "verdana" , sans-serif;">The bolus dose can be administered using the provided diluent or sterile water for injection.<o:p></o:p></span></div>
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<span style="font-family: "verdana" , sans-serif;">The prepared solution should be used immediately after reconstitution but may be kept at 5° C for up to 48 hours if necessary. <o:p></o:p></span></div>
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<li><span style="font-family: "verdana" , sans-serif;">1U/kg of an insulin bolus followed by continuous infusion of 1-10U/kg /h, but boluses of up to 10U/kg and continous infusions as high as 22U/kg/h has been used with good outcomes and minimal adverse events (<i>Medscape</i>)</span></li>
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<span style="font-family: "verdana" , sans-serif;"><o:p></o:p></span></div>
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<li><span style="font-family: "verdana" , sans-serif;">IV loading dose of 1 U/kg of regular insulin followed by an infusion of 0.5–1 U/kg/hr.The infusion dosage can be increased every 20–30 minutes. Doses of 2.5–3 U/kg/hr have been used depending on the response<span style="color: #2a2a2a;">. <a href="http://www.medscape.com/viewarticle/757588_3">http://www.medscape.com/viewarticle/757588_3</a></span></span></li>
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<span style="font-family: "verdana" , sans-serif;">4 weeks after opening <o:p></o:p></span></div>
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<span style="font-family: "verdana" , sans-serif;"><b>REFERENCES <o:p></o:p></b></span></div>
<ol>
<li><span style="font-family: "verdana" , sans-serif;"><a href="http://www.mdpoison.com/media/SOP/mdpoisoncom/healthcareprofessionals/antidote-facts/glucagon%20antidote%20facts.pdf"><span style="color: windowtext;">http://www.mdpoison.com/media/SOP/mdpoisoncom/healthcareprofessionals/antidote-facts/glucagon%20antidote%20facts.pdf</span></a><o:p></o:p></span></li>
<li><span style="font-family: "verdana" , sans-serif;"><span style="background: white; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><a href="http://www.ajhp.org/content/ajhp/63/19/1828.full.pdf?sso-checked=true"><span style="color: windowtext;">http://www.ajhp.org/content/ajhp/63/19/1828.full.pdf?sso-checked=true</span></a><o:p></o:p></span></span></li>
<li><span style="font-family: "verdana" , sans-serif;"><a href="http://emedicine.medscape.com/article/813342-treatment"><span style="color: windowtext;">http://emedicine.medscape.com/article/813342-treatment</span></a><o:p></o:p></span></li>
<li><span style="font-family: "verdana" , sans-serif;"><a href="http://www.medscape.com/viewarticle/757588_3"><span style="color: windowtext;">http://www.medscape.com/viewarticle/757588_3</span></a><o:p></o:p></span></li>
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Poisoning Toxicity : Beta Blockers

The common feature of beta-blocker toxicity is excessive blockade of the beta-receptors resulting in bradycardia and hypotension. goal o...

Glyophosate Poisoning Management

8:20 AM Meme Art Studio 0 Comment

<br /><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">Glyphosate is a non-selective herbicide, widely used in agriculture, forestry, industrial weed control and aquatic environments. </span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">Proposed mechanisms of glyphosate surfactant herbicide (GlySH) toxicity to mammals include uncoupling of oxidative phosphorylation and glyphosate-or polyethoxethyleneamine (POEA)-mediated direct cardiotoxicity. </span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">It can cause a wide range of clinical manifestations in human beings from skin and throat irritation to hypotension and death</span></span></span></li></ul><div><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="background-color: white;"><b><span style="font-family: inherit;">The sign and symptom of Glyphosate toxicity</span></b></span></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;"><b><i>Gastrointestinal symptoms </i></b>are the most common manifestations after oral ingestion. It causes erosion of the gastrointestinal tract, difficulty in swallowing and gastrointestinal hemorrhage. Eye and skin irritation have occasionally been reported from dermal exposure. Inhalation of spray mist may cause oral/nasal discomfort, tingling and throat irritation.</span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;"><b><i>Cardiovascular, respiratory and renal systems</i></b> may be affected; and signs and symptoms include tachypnea, dysrhythmias, hypotension, non-cardiogenic pulmonary edema, hypovolemic shock, oliguria and respiratory failure</span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">Seizures and depressed level of consciousness may also occur. </span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">Death was often caused by severe hypotension and respiratory failure.</span></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;">Hyperkalemia may occur as a complication of renal failure.</span></span></span></li></ul><div><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b>Confirmation of Poisoning</b></span></span></div></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Glyphosate can be measured in the plasma, with levels above 734 µg/mL being measured in fatal cases</span></span></li></ul></div><div><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: Verdana,sans-serif;"><span style="font-family: inherit;"><span style="background-color: white;">Severity</span></span></span></b></span></span><br /><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit;"><span style="background-color: white;">The assessment of severity of toxicity is determined by dose ingested and clinical grading of toxicity.</span></span></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit; font-size: x-small;">ingested dose- <span style="font-weight: normal;">The ingestions of 5-50 mL may result in no symptoms or minor gastrointestinal symptoms only. </span></span></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="font-family: inherit; font-size: x-small;"><span style="font-weight: normal;">Moderate symptoms occur with 50-100 mL of the concentrate and severe symptoms are likely when 100 mL or more of the concentrate are ingested.</span></span></span></span></li></ul></div><div><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b style="background-color: white;">Clinical Grading of Toxicity</b></span></span></div><div><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"></tbody></table><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"><tr style="box-sizing: border-box;"><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b style="box-sizing: border-box;">Asymptomatic</b></span></span></td><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">No abnormalities on physical or laboratory examination</span></span></td></tr></tbody></table><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"><tr style="box-sizing: border-box;"><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b style="box-sizing: border-box;">Mild</b></span></span></td><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Predominantly gastrointestinal symptoms with stable vital signs and no other organ involvement</span></span></td></tr></tbody></table><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"><tr style="box-sizing: border-box;"><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Moderate</span></span></td><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Gastrointestinal symptoms lasting longer than 24 hours Hypotension, responsive to intravenous fluids Pulmonary dysfunction not requiring intubation Acid base disturbance Evidence of transient hepatic renal damage or temporary oliguria</span></span></td></tr></tbody></table><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"><tr style="box-sizing: border-box;"><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b style="box-sizing: border-box;">Severe</b></span></span></td><td style="border: 1px solid rgb(221, 221, 221); box-sizing: border-box; min-height: 20px; min-width: 5px; padding: 0px; vertical-align: top;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Pulmonary dysfunction requiring intubation Renal failure requiring dialysis Hypotension requiring pressor amines Cardiac arrest Coma Repeated seizures Death</span></span></td></tr></tbody></table><table class="wiki_table" style="background-color: white; border-collapse: collapse; border-spacing: 0px; box-sizing: border-box; color: black; margin: 10px 1px;"><tbody style="box-sizing: border-box;"></tbody></table></div><div><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b>Management of Glyphosate Toxicity</b></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">There is no antidote for Glyphosate toicity and treatment is supportive.</span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">The mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. </span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><span style="background-color: white;"><span style="font-family: inherit;"><b><span style="font-family: inherit;"><1 h after ingestion and who have no evidence of buccal irritation or burns</span> - </b></span></span>Gastric lavage or activated charcoal can be administered <b>.</b></span></span></li></ul><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b>If the ingestion occurs more than 1 hour, the monitoring should be done as follow:</b></span></span></li></ul><ol></ol><span style="font-family: Verdana,sans-serif;"><span style="font-family: inherit; font-size: small;"><span style="font-weight: bold;">Supportiv</span><span style="font-family: inherit; font-size: medium;">e </span></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: inherit;"><span style="background-color: white; font-weight: normal;">Hypotension may develop several hours after ingestion. </span></span></b></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: inherit;"><span style="background-color: white; font-weight: normal;">Cardiac monitoring should be available. </span></span></b></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: inherit;"><span style="background-color: white; font-weight: normal;">Hypotension should be treated initially with intravenous fluids and if unresponsive with pressor amines. </span></span></b></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: inherit;"><span style="background-color: white; font-weight: normal;">There is a risk of pulmonary oedema so aggressive fluid resuscitation is inadvisable. </span></span></b></span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b><span style="font-family: inherit;"><span style="background-color: white; font-weight: normal;">Hyperkalaemia should be corrected.</span></span></b></span></span></li></ul><ol></ol><ol></ol><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;"><b>Respiratory dysfunction</b></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Respiratory function should be monitored closely, oxygenation assured and intubation with assisted ventilation may be required. </span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">If pulmonary oedema occurs positive respiratory pressure may be of value. </span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Urine output should be monitored and prevention of hypovolaemia and hypotension should be a priority. </span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif; font-size: small;">Acidosis usually responds to bicarbonate therapy but may on occasion be resistant.</span></span><span style="font-family: Verdana,sans-serif;"></span><br /><span style="font-family: Verdana,sans-serif;"></span></li></ul><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><b><span style="font-family: inherit;">Elimination enhancement</span></b><span style="font-family: inherit;"> </span></span></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: inherit;">Haemodialysis may be of value for renal failure or acidosis which does not respond to bicarbonate.</span></span></span></span></li></ul><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><b>Severe systemic toxicity</b><span style="font-family: inherit;"> </span></span></span></span></div><div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><span style="font-family: Verdana,sans-serif;"><span style="font-family: inherit;">The mechanism of action of intravenous fat emulsion (IFE) m<span style="background-color: white;">ay be due to the lowering of serum concentration of the free surfactant glyphosate-or polyethoxethyleneamine (POEA)-mediated component of Glyphosate (which are more lipophilic) by dragging into the lipid sink formed by the IFE, thereby blunting its cardiovascular toxicity. </span></span></span></span></span></li></ul><ol></ol></div>