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81 Cards in this Set

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2 Herbicides that when ingested in high doses can produce signs of Neuromuscular involvement
2,4-dichlorophenoxyacetic acid (2,4-D) & 2,4,5-trichlorophenoxyacetic acid (2,4,5-T)
Chlorphenoxy Herbicides are often contaminated with what? What effects may it have on humans?
TCDD = Agent Orange

Large amounts for long periods of time = Reproductive & Carcinogenic effects

Chloracne = almost always
What 2 Herbicides uncouple oxidative phosphorylation & thus increase the Metabolic Rate & temperature? What is the treatment?
Dinitrophenols + Pentachlorophenol

Cool the patient down
This Herbicide under goes redox cycling & causes free radical mediated injury to lungs
What is Paraquat's mechanism of action in causing Lung damage?
1. Reduced by NADPH
2. Reduced Paraquat reacts with molecular Oxygen to produce Superoxide radicals
3. Superoxide radicals form Singlet Oxygen
4. Singlet oxygen reacts with Polyunsaturated cell membrane lipids to produce Lipid Peroxides
5. Lipid free radical = Pulmonary Toxicity
How does one die from ingesting Paraquat orally? Inhalation?
Orally = liver, kidney -> Lung (fatal)

Inhalation = Lung (fatal)
List the Halogenated Hydrocarbons

What are they most often used as?
Carbon Tetrachloride
Methylene Chloride

Solvents for cleaning
What is the mechanism of toxicity for Carbon Tetrachloride?
1. metabolized by a P450 to Trichlormethyl free radical (*CCl3)
2. free radical-induced lipid peroxidation causes an increase in Intracellular Ca++ leading to cell death
What are the symptoms of Halogenated Hydrocarbon (-chlor-) poisoning? (4)
1. CNS depressants
2. Cardiac arrhythmias at high doses by sensitizing myocardium to catecholamine stimulation
3. Liver & Kidney damage
4. Carcinogenicity
What is the treatment for Halogenated Hydrocarbon toxicity?
Remove contaminated clothing to stop further absorption

Treat symptoms & support vital signs
What do all Alcohols & Glycols cause at high doses?
CNS depression
What alcohol is Neurotoxic?
What are the properties of Isopropyl Alcohol (rubbing alcohol)?
1. CNS depression
2. Metabolized to Acetone
3. Renal damage
4. Gastric lavage
5. treat symptoms
What alcohol/glycol is Nephrotoxic?
Ethylene glycol & diethylene glycol
What Alcohol/glycol is used as a vehicle for drugs?
Propylene glycol
Describe the metabolism of Ethanol
Ethanol -1-> Acetaldehyde -2-> Acetate

1. Alcohol Dehydrogenase
2. Aldehyde Dehydrogenase
What drug inhibits Alcohol Dehydrogenase & is used to treat Ethanol & Ethylene Glycol poisoning?
What drugs may cause a Disulfarim effect? (4)
1. 3rd generation Cephalosporins
2. Metronidazole
3. Trimethoprim
4. Chlorpropamide
What are the CNS effects of Ethanol due to?
Stimulation due to inhibition of CNS inhibitory GABA pathways = Disinhibition

Followed by anesthetic-like CNS depression at higher doses = visual impairment, muscular incoordination, slowing of reaction time, euphoria, respiratory depression & coma
What is Ethanol's effect on the kidney?
Diuresis by Vasopressin (ADH) inhibition & temporary positive fluid balance
What would be a reason for telling old people to drink a glass of wine (ethanol) before meals?
causes increased SALIVATION & GASTRIC SECRETION to stimulate appetite
Why does Ethanol predispose to Hypothermia in cold environments?
causes Peripheral vasodilation which results in warm, flushed skin, interfering with normal homeostatic mechanisms responsible for maintaining constant core body temperature
What are the blood alcohol levels of Acute Mild, Moderate, Severe, & Coma poisoning? What symptoms accompany each?
Mild = 50-150 mg% = decreased inhibitions; visual impairment; muscular incoordination; slowing of reaction time

Moderate = 150-300 mg% = major visual impairment; symptoms of mild intoxication are more pronounced; slurring of speech

Severe = 300-500 mg& = approaching stupor; severe hypoglycemia; convulsions; fatalities

Coma = 500 mg% = slowed respiration; complete loss of sensations; deaths are frequent at this blood level
What is the treatment strategy for Acute Ethanol poisoning?
1. Support vital signs
2. avoid depressant drugs
3. Hemodialysis if blood levels are greater than 500 mg%
What are the treatments for Chronic Ethanol poisoning?
Diazepam IV = for seizures associated with withdrawal

Chlordiazepoxide = to prevent withdrawal during treatment program
What is Disulfiram's mechanism of action?
inhibits Acetaldehyde Dehydrogenase causing accumulation of Acetaldehyde in blood resulting in nausea & vomiting
Oral Opioid Antagonist that has shown some promise in treating alcohol addiction
What does acute toxicity from Methanol result from?
its rapid metabolic conversion to Formaldehyde & Formic Acid
Describe the metabolism of MEthanol
Methanol -1-> Formaldehyde -2-> Formic Acid -3-> Formate

1. Alcohol Dehydrogenase
2. Acetaldehyde Dehydrogenase
3. pH dependent
What are the symptoms of Methanol poisoning?
1. Visual disturbances -> BLINDNESS
2. CNS toxicity
3. Metabolic Acidosis
4. Death is usually due to Acidosis & Respiratory failure
What is the treatment for Methanol poisoning?
1. Emesis or Gastric Lavage
2. Antidote = 50% Ethanol IV = competes for Alcohol Dehydrogenase
-or Fomepizole = synthetic Alcohol Dehydrogenase inhibitor
3. Treat acidosis with Sodium Bicarbonate
What are the symptoms of Ethylene Glycol & Diethylene Glycol poisoning?
1. CNS depression

What poisoning causes Kidney damage due to Calcium Oxalate Crystals?
Ethylene Glycol
What is the treatment for Ethylene Glycol & Diethylene Glycol poisoning?
1. Gastric lavage
2. Ethanol IV = Antidote = prevents conversion of Glycols -> Oxalic Acid by competing for Alcohol Dehydrogenase
-or Fomepizole
3. treat symptoms & support vital signs
List some Petroleum distillates
1. Kerosene
2. Diesel fuel
3. Gasoline
4. White spirit
5. Polishes & other household products
What are the symptoms of Petroleum distillates (gasoline, kerosine)?
1. Pulmonary irritation by high concentration of vapor

2. CNS depression

3. SEVERE PNEUMONITIS after aspiration of liquid

"Drink some gasoline from the lawn-mower: lung irritation, pass out due to CNS depression, & pneumonitis from aspirating vomitted gasoline
What is the treatment for Petroleum poisoning?
Treat symptoms & support vital signs

Emesis & Gastric Lavage without Tracheal Intubation are Contraindicated
What causes Severe Pneumonitis after aspiration of fluid?
Petroleum distillates
List the Aromatic Hydrocarbons
1. Benzene
2. Toluene*
3. Xylene*

*found in alot of glues
What are the symptoms of Benzene, Toluene, or Xylene toxicity?
"Glue Sniffers"
1. CNS stimulation at low doses or early in high doses followed by CNS depression in more serious poisonings
2. Kidney & Liver damage may occur after high acute doses or prolonged exposure
3. Cardiac Arrhythmias caused by Catecholamine release can be enhanced by high exposure
What 2 things can long-term exposure to Benzene cause? What drug can cause these same things?
Aplastic Anemia


*so can Chloramphenicol
What is the treatment for Benzene, Toluene, or Xylene poisoning?
1. remove ingested hydrocarbon by gastric lavage only if aspiration can be prevented; DO NOT induce emesis
2. control excitement or convulsions with IV Diazepam
What substance do the corrosives such as bleaches, metal cleaners, & rust removers contain?
Oxalic Acid & Oxalates
What are the symptoms of Oxalic Acid & Oxalate poisoning (corrosive = bleaches, metal cleaners, rust removers)?
1. Local irritation & corrosion of the GI tract
2. Muscle weakness, Convulsions & Collapse due to Calcium Chelation
3. Renal Tubular damage due to Calcium Oxalate precipitation
What is the specific antidote for the Corrosives (bleaches, metal cleaners, rust removers) that contain Oxalic Acid & Oxalates?
Calcium Gluconate IV
What is the treatment strategy for Oxalic Acid & Oxalate poisoning?
1. precipitate Oxalate in GI by giving Calcium in any form (milk, calcium antacids)
2. Monitor Renal fxn & force fluids to prevent Oxalate crystals from depositing in kidney tubules
3. Antidote = Calcium Gluconate IV
4. DO NOT use Gastric Lavage or Emetic Compounds
What are the symptoms of the mineral acid corrosives (Hydrochloric, Sulfuric, Acetic, Nitric, Perchloric acids)?
1. Irritation inflammation &/or necrosis to all parts of the GI tract exposed to corrosive

2. Death is usually due to unresolved Hypovolemic Shock after massive Hemorrhage
What is death usually due to in Hydrochloric, Sulfuric, Acetic, Nitric, & Perchloric acid ingestion?
Unresolved Hypovolemic Shock after Massive Hemorrhage
What is the treatment for ingestion of Mineral Acid Corrosives (Hydrochloric, Sulfuric, etc)?
1. DO NOT use Gastric Lavage or Emesis after ingestion of acids
2. Dilute the acid with water
3. Give Analgesics to reduce pain
4. Non-specific antidote = MILK OF MAGNESIA
5. Treat symptomatically & support vital signs
List some Strong Alkali Corrosives
Hydroxides in:
1. Soaps
2. Cleansers
3. Drain cleaners
What are the symptoms of Stron Alkali Corrosives (hydroxides in soaps, cleansers, drain cleaners)?
1. irritation, inflammation, & tissue damage
2. Alkali are more penetrating than Strong Acids
Which agents are more penetrating, Strong Alkali or Strong Acids?
Strong Alkali
What is the treatment for Strong Alkali Corrosives (hydroxides in soaps, cleansers, drain cleaners)?
1. DO NOT use Gastric Lavage or Emetics

2. Dilute the alkali with Water

3. Treat symptomatically & support vital signs
Generally, how do Arsenic & Arsine cause toxicity?
By binding to Sulfhydryl groups on enzymes & interfering with cellular metabolism
What are the symptoms of Acute poisoning with Arsenic & Arsine?
2. GI disturbances
3. CNS effects where convulsions & coma are terminal signs
4. Ventricular Arrhythmias
5. Vasodilation & increased capillary permeability
6. Hyperpigmentation of skin = Rose color complexion
7. Kidney Tubular damage
What chemical causes Hemolysis & Hemoglobinurea along with a Rose color complexion?
Arsenic & Arsine
What are the symptoms of Chronic toxicity to Arsenic & Arsine? (6)
1. Polyneuritis
2. Nephritis
3. DERMATITIS = MEES' LINES -> best indicator
4. Cardiac failure
5. Cirrhosis of the liver
6. Personality changes

**often sprinkled onto food to slowly kill people
Arsenic & Arsine
What are Mees' lines an indicator of poisoning with?
What is the levels of toxicity of the differenet Arsenics from least toxic to most toxic?
Organic < As(5+) < As(3+) < Arsine (AsH3)
What is the mechanism of As(5+) toxicity?
Substitutes for inorganic phosphate in production of ATP
What is the mechanism of As(3+) toxicity?
binds to Sulfhydryls especially in Lipoic Acid, thus interferes with energy production
What is the treatment strategy for Arsenic/Arsine poisoning?
1. remove ingested Arsenic by lavage or emesis
2. Dimercaprol or Penicillamine can be use to chelate
3. treat symptomatically
One of the most toxic metals because it accumulates in the body; the greatest degree of intoxication occurs in children
Where is Lead primarily stored in the body?
Bones but the symptoms are in soft tissues like Bone Marrow & Nervous system tissue
What are the symptoms of Acute INORGANIC Lead toxicity?
1. GI irritation
2. Kidney damage
What are the symptoms of Acute ORGANIC lead poisoning?
Much more likely to get into the CNS & can even cause CNS problems in adults
What is Chronic Inorganic Lead poisoning referred to as?
What do children usually present with in Chronic Lead poisoning?
Lead Colic
-Abdominal pain
A child presents with Basophilic Erythrocyte Stippling & Microcytic Anemia. What poisoning could this be due to?
What precursor accumulates in Lead poisoning?
Aminolevulinic Acid = hemoglobin precursor due to inhibition of Heme synthesis -> Microcytic Anemia
What CNS effects are prominent in Lead-poisoned children?
1. Hyperirritability
2. Behavior disturbances & intellectual deficits
3. Loss of recently developed skills
4. Finally Coma & intractable convulsions
What Neuromuscular effects can Lead poisoning cause?
1. Weakness
2. Paralysis
3. Incoordination
4. Arthralgia
5. "WRIST DROP" & "ANKLE DROP" due to degeneration of peripheral nerves
What is the treatment strategy for Lead poisoning?
1. Remove unabsorbed lead

2. Chelation produces an organis form of lead which is more likely to cross the BBB; however, in the case of severe CNS toxicity, chelation must be used

3. Treat symptomatically

4. Calcium Gluconate for GI effects

5. Chelate kids above 10 ug/dL
-Calcium DiSodium EDTA = Most effective
-BAL = Dimercaprol
-Penicillamine (Oral)
-Succimer (oral)
What do Mercury compounds have a very high affinity for?
Sulfur groups in enzymes & proteins
What symptoms does Metallic Mercury cause?
1. Acute Chemical Pneumonitis
2. Noncardiogenic Pulmonary Edema

**due to Inhalation of vapors
What are the Acute, Secondary, & Delayed effects of ACUTE INORGANIC MERCURY poisoning?
1. Irritation & superficial corrosion of GI
2. Abdominal pain
3. Vomiting which may be bloody

1. Diarrhea
2. Acute renal tubular necrosis
3. Shock

1. Severe kidney damage leading to Anuria
2. Severe GI damage & hemorrhage
What are the Early , Late, & Continued Exposure symptoms of CHRONIC INORGANIC MERCURY poisoning?
-Stomatitis = swollen, bleeding gums
-rarely: "mercury line"

-Erethism = uncontrollable blushing; emothional instability; tremor
-may lose teeth

Continued Exposure:
-course, jerky movements
-drowsiness, depression
-loss of memory
-hallucinations, delusions
What are the effects of Chronic Organic Mercury (Methyl & Tetraethyl Mercury) exposure?
-Muscle twitching
-Gross constriction of visual fields
Where does Organic Mercury accumulate in nature?
plants eaten by fish (that we may eat, but probably doesn't cause much affect on us in the long run)
What is the treatment strategy for Acute Exposure to Inorganic Mercury?
1. Lavage or induce emesis
2. give Milk, raw eggs, or Charcoal
3. IM Dimercaprol (for more severe) or Oral Succimer (for less severe)
What should not be used for Chronic elemental or organic mercury exposure b/c it redistributes mercury to the brain? What may you give then?

Succimer may help for inorganic mercury