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    Poisoning Decontamination

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    adysti
    The document discusses poisoning decontamination, noting that it involves preventing further toxin absorption, enhancing elimination, and increasing detoxification through methods like inducing or inhibiting hepatic enzymes, enhancing excretion, antagonism, and dialysis. It outlines treatment approaches for different routes of exposure like skin, respiration, gastrointestinal, and cardiovascular systems. The key is to provide life support, prevent further absorption, increase elimination and detoxification as soon as possible for acute intoxicated patients.

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    Poisoning Decontamination

    Uploaded by

    adysti
    195 views14 pages
    The document discusses poisoning decontamination, noting that it involves preventing further toxin absorption, enhancing elimination, and increasing detoxification through methods like inducing or inhibiting hepatic enzymes, enhancing excretion, antagonism, and dialysis. It outlines treatment approaches for different routes of exposure like skin, respiration, gastrointestinal, and cardiovascular systems. The key is to provide life support, prevent further absorption, increase elimination and detoxification as soon as possible for acute intoxicated patients.

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    The document discusses poisoning decontamination, noting that it involves preventing further toxin absorption, enhancing elimination, and increasing detoxification through methods like inducing or inhibiting hepatic enzymes, enhancing excretion, antagonism, and dialysis. It outlines treatment approaches for different routes of exposure like skin, respiration, gastrointestinal, and cardiovascular systems. The key is to provide life support, prevent further absorption, increase elimination and detoxification as soon as possible for acute intoxicated patients.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    195 views14 pages

    Poisoning Decontamination

    Uploaded by

    adysti
    The document discusses poisoning decontamination, noting that it involves preventing further toxin absorption, enhancing elimination, and increasing detoxification through methods like inducing or inhibiting hepatic enzymes, enhancing excretion, antagonism, and dialysis. It outlines treatment approaches for different routes of exposure like skin, respiration, gastrointestinal, and cardiovascular systems. The key is to provide life support, prevent further absorption, increase elimination and detoxification as soon as possible for acute intoxicated patients.

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    of 14

    POISONING

    DECONTAMINATION

    DR. Med. dr. Untung Widodo, SpAn.KIC.


    Department of Anesthesiology & Reanimation
    Medicine Faculty of Gadjah Mada University
    Yogyakarta,
    2012
    I. Introduction
     Poison = Toxin : substance that dangers via chemically
    reaction in the body
    (differs to drugs on dosing,
    toxic effect = adverse effect of drug)
     Detoxification : to make no hazard/no harm for life …
    chemically
     Decontamination (= elimination from the body)
    physically (in their process may be involved chemically
    reaction)
     Port of entry : Skin (& mucous parts), resp. system, TGI,
    blood (circulation), like drug : i.c, s.c, i.m, iv., inhalasi,
    topical.
     To make no harm and force elimination from the
    site of contamination and from the body
    Treatment, that we can do for
    the toxin decontamination :
     Prevention of further absorption of a
    poison :
    Emesis (vomiting)
    Gastric lavage
    Chemical adsorption
    Chemical inactivation
    Purgation (Cathartics drug, bowel irrigation)
    For topically : remove from exposure
    Continuing introduction . . . .

     Enhanced Biotransformation and Excretion of


    the poison
    - induction of biotransforming hepatic enzymes
    - inhibit of biotransforming hepatic enzyms
    - enhance availability of conjugating detoxifying
    substrate
    - enhance biliary excretion
    - inhibit reabsorbtion in renal tubulus, with diuretics
    - Dialysis (hemodialysis, plasmaparesis)
    Continuing introduction …

     Antagonism or chemical inactivation of


    an absorbed poison
    - functional and pharmacological antago-
    nism of the effects of absorbed toxicants
    - chelating agents (for metallic poison, etc)
    - Antibodies (anti tetanus, anti snake poison,
    anti digoxin etc.)
    II. Poisoning via skin
     TOPICAL, (SKIN & MUCOUSAL SURFACE)
     WASHING WITH ANTISEPTIC
     INSEC BITE, SNAKE BITE
     CROS INCISION, FORCE ELIMINATE
    FLUIDS FROM THE WOUND,
    DEBRIDEMENT WITH ANTISEPTIC
     ANTIDOTUM or INACTIVATION (eg.SABU)
     CLINICAL SUPPORTIVE DRUGS &
    TREATMENTS
    III. Poison via respiration
    system
     OXYGENATION, AND LIFE SUPPORTS
     ANTIDOTUM IV
     INCREASE METABOLISMS, ANTAGONISM,
    INACTIVATION etc.
     INCREASE EXCRETIONS
     CLINICAL SUPPORTIVE DRUGS
    IV. Poison via cardiovaskular
    system
     FROM : S.c, i.m, iv.
     OXYGENATION, AND LIFE SUPPORTS
     ANTIDOTUM IV
     INCREASE METABOLISMS, ANTAGONISM,
    INACTIVATION etc.
     INCREASE EXCRETIONS, HEMODIALYSIS
     CLINICAL SUPPORTIVE DRUGS
    V. POISONING VIA TGI
     BEFORE GASTRIC EMPTYING,
    STIMULATE VOMITING (no more recommend)
     GASTRIC WASHING WITH NGT (< 1 hour)
     > 1 HOURS : CATHARTICS
     MEDICAL CARBON (activated charcoal), Whole
    bowel Irrigation (with Polyethylene glycol)
     ANTIDOTUM IV
     INCREASE METABOLISMS
     INCREASE EXCRETIONS, HEMODIALYSIS
     CLINICAL SUPPORTIVE DRUGS & TERATMENTS
    ALCOHOL INTOXICATION
     ALCOHOL : ETANOL & METHANOL
     METHANOL WILL BE TRANSFORMED TO FORMIC ACID
    BY ALCOHOL DEHYDROGENASE
    (IT IS MORE TOXIS : ACIDOSIS, INHIBIT CYTOCHROME
    OXYDASE, DIRECT NEUROTOXIS esp. RETINA & OPTIC
    NERVES),
    Tx. : FROM GASTRIC LAVAGE TO GIVING ETANOL TO
    COMPETE IN THIS BIOTRANSFORMATION
     MILD TO MODERATE ETANOL INTOX. REQUIRES NO
    SPECIAL TREATMENT OTHER THAN STOP INGESTION
     GENERAL CLINICAL LIFE SUPPORT
    VI. LIFE THREATENING
    ET CAUSA POISON
     TOXIS FOR : NEUROLOGICAL SYSTEM
     TOXIS FOR RESPIRATION SYSTEM
     TOXIN FOR CARDIOVASCULAR SYSTEM
     TOXIS FOR TGI
     TOXIS FOR KIDNEY
     TOXIS FOR BLOOD (hemolytic etc.)
     TOXIS FOR HOMEOSTASIS OF MILIEU
    INTERNA
    VII. CLINICAL SUPPORTIVE
    TO PRESERVE LIFE
     FOR ALL PATIENTS OF ACUTE INTOXICATION
     SECURE A B C
     CLINICAL PROBLEM SOLVING
    Respiration, Cardiovascular, gastrointestinal tract,
    neurology, acid-base balances, electrolytes etc.
     DEFINITIVE DETOXIFICATION AND
     DEFINITIVE DECONTAMINATION
    VIII. SUMMARY
    IN ACUTE INTOXICATED PATIENTS
    As soon as possible give :
    . General live support
    . Prevent the further absorption,
    . Increase toxin elimination
    . Increase Detoxification
    . Reduce hazardous effect in the body
    References
    1. Goodman & Gilman’s The
    Pharmacological Basis of Therapeutics 8th
    Ed. Vol. 1, 1991, p:49-61
    2. Texbook of Critical Care 5th Ed. 2005,
    p:1587-1606
    3. Oh’s Intensive Care Manual 6th Ed. 2009,
    p:903-912

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