General principles of toxicology in the treatment of poisoning

Toxicology is the branch of sciences which deals with study and treatment of poisons. Earlier toxicology was an integral part of Pharmacology but with the increase in poisoning incidents in the recent past has resulted in emergence of Toxicology as a separate branch. In this article I will enlighten the basic principles of Toxicology involved in the treatment of various cases of poisoning.

Definition of Toxicology

Toxicology is the branch of science which deals with the study of poisons, including their mechanism of action, adverse effects on the body and treatment of the various conditions produced by the poisons.
These poisons can be from environment, industry, home or pharmacological substances. Branch of Toxicology is further divided into following branches-
1. Experimental Toxicology-It is the branch of Toxicology which studies the toxic effects of various chemicals on the biological systems.
2. Clinical Toxicology- Clinical Toxicology involves the diagnosis and treatment of poisoning in human beings.
3. Environmental Toxicology- This is a new branch of Toxicology and deals with the identification and elimination of environmental poisons.

Poisons are unwanted substances which produce harmful effects on the body and sometimes can be fatal. Antidotes are the substances used to reverse the harmful effects of the poison. Antidotes act by either by preventing absorption or by inactivating or antagonizing the actions of poisons.

General principles employed for the management of poisoning

Toxicology provides the basic guidelines to treat both acute and severe poisoning. Here I am providing you these principles serial wise to for better understanding of the topic-

Identify the cause poisons

The first step of the treatment is to identify the poisons. Cause of poison can be known from the relative of the patient or by the parent himself if he is conscious. This step helps in deciding the specific treatment to the poisoning.

Preventing the further absorption of the poison

This is an important step in controlling the further spread of the poison in the body. General rules include-

1. Induction of vomiting- Syrup of Ipecac is the preferred emetic for inducing vomiting. Dose of Ipecac syrup is 15 ml for children less than 6 months and 30 ml for adults.
Emesis is contraindicated in the following cases-
  • Vomiting should not be induced in comatose patients.

  • Emesis is contraindicated in caustic poisoning and in Petroleum distillates poisoning.

  • Emetics should also be not given to those where is a risk of convulsions in the patient.

  • 2. Gastric lavage- Gastric lavage is an important measure to control poisoning when it occurs due to some aromatic substances such as perfumes. It is also helpful when emesis is contraindicated.

    3. Use of activated charcoal- Activated charcoal adsorbs the poisons and delays the gastrointestinal absorption of the poison. It is helpful in the treatment of poisoning from aromatic and alkaloid compounds.

    Hastening the elimination of poison

    This is also an important aspect in treating the poisoning. Following general rules are applied for increasing the elimination of poison from the body-

    1. Altering the pH of urine- In poisoning from basic substances such as amphetamine or quinine urine of the patient should be made acidic to hasten the elimination of these substances. In case of acidic substances poisoning such as salicylates or phenobarbitone, urine should be made alkaline to speed the elimination of the poison.

    2. Dialysis- Peritoneal dialysis is very popular nowadays and used in the treatment of methanol poisoning and in Snake bite. Haemodialysis is more superior technique but requires highly sophisticated unit for care. Peritoneal dialysis and haemodialysis have limited use in the treatment of intoxication with chemicals.

    3. Cathartics- Cathartics are used to hasten the removal of a toxic substance and are useful in ingestion of hydrocarbons and enteric coated tablets. Sodium Sulphate is a frequently used cathartic.

    4. Uses of Antidotes- There are certain specific antidotes for treating the specific cases of poisoning. Here is the list of some commonly employed antidote for the treatment of certain poisoning.
  • Atropine- It is used in the treatment of organophosporous poisoning.Suicidal attempts in India due to these substances is highest in India.

  • Calcium edetate- It is used in the lead poisoning.

  • Ethyl alcohol- Ethyl alcohol is the antidote used methanol poisoning.

  • Dimercapol- Dimercapol is used in heavy metal poisoning such as Arsenic, Copper, Lead, gold and Mercury.

  • Oxygen gas- Oxygen gas is used to treat in carbon Monoxide poisoning.

  • Pencillamine- Pencillamine is an antidote for heavy metals like copper, Lead, Mercury and Zinc.

  • Pralidoxime- It is used in organophosphorous poisoning.

  • Milk- Milk is a universal antidote. Its antidote property is attributed to Calcium and magnesium present in it which act as chelating agents.

  • General supportive measures for improving the condition of patient

    General supportive measures are meant to ensure the wellbeing of the patient and for the fast recovery from the poisoning. General measures includes following steps-
  • Use of Oxygen therapy when there is hypoxia or probability of the same in the patient.

  • Correction of the Blood Pressure of the patient by fluid therapy; Dopamine may be required for correcting the BP.

  • If there is cardiac arrhythmia in the patient then safety measures should be taken under the supervision of the expert.

  • Correction of plasma biochemistry like, acidosis or alkalosis in the blood.

  • Airways should be cleared with the help of suction apparatus.

  • Monitoring of the patient after the episode of poisoning is over

    After the patient is recovered from the adverse effects it is important to monitor the patient for some time. This step is necessary and performed to ensure that there are no other complications in the case. After ensuring that patient is fully recovered he is allowed to go home.

    This article is intended for the purpose of knowledge only and should not be treated for medical purpose.

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    Guest Author: muniyappan m17 Apr 2016

    Really superb article on toxicology. I got lot of information from this.

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