toxokinetic pathophysia C/P

(ChEII) INSECTICIDES ORGANOPHOSPHORUS absorption = GIT, skin, conjunctiva, respiratory routes metabolism = oxidation + hydrolysis hepatic activation (parathionparaoxon) elimination = urine/faeces **fat store! IRREVERSIBLE inhibition of acetylcholinesterase (NS +myoneural junction) excess Ach excites ---> paralyze neurotransmission Muscarinic Nicotinic CNS effects DUMBELS 1. neuro-ms jx initial stimulation - diarrhea - ms fasciculation - anxiety, ataxia, - urinary incontinence - cramping, weakness psychosis, - miosis (pin point pupil) - resp failure (resp ms) restlessness - bronchorrhea/spasm/bradycardia 2. Preganglionic Sympa depression - emesis stimulation - convulsion, - lacrimation - dilated pupil, coma, death(card- salivation tachycardia, HTN resp failure) 1. Assay of Anti-Cholinesterase enzyme Erythrocyte ChE activity level Plasma ChE activity level more accurate - affected by OP insecticide - represent amount in NS & RBC - may be disturbed by other disease *toxicity grading (acc to ChE INHIBITION) -20-50% : mild - 10-20% : moderate - less than 10% : severe 1. ABC - patent airway (suction of secretion) - adequate ventilation (full oxygenation) 2. Decontamination - dermal (soap + water alcohol + water) - GIT : lavage 3.Elimination (antidote) ATROPINE OXIMES (pralidoxime, toxogonine) - competitive antagonist of Ach @ - antagonize nicotinic effects of OP insctd. muscarinic receptor - reverse muscarinic , CNS effects - No effect in nicotinic receptors - cross BBB treat OP CNS toxicity - rx of bronchorrhea *with proper oxygenation & cardiac monitoring 2mg IV, repeat 10-15min until Pralidoxime atropinisation (drying of tracheobronchial - 1gm IV in normal saline secretion) followed by gradual Toxogonine withdrawal - 250mg (1amp)IV in 2-3 hrs max 3 amp

Anti-coagulant - WARFARIN *less toxic to human - massive/repeated ingestion

RODENTICIDES Non anti-coagulant (ZINC PHOSPHIDE) - single ingestion = toxic! - dark grey crystalline powder + rotten fish odor reacts with water + HCL in stomach phosphine gas systemic toxicity GIT Resp CVS CNS others N,V,D (black,rotten fish odor) rotten fish breath, tight chest, crepitation, pulm edema hypotension + shock + arrhythmia ataxia + convulsion + coma hypocalcemia + tetany

interference of Vit K-dependent clotting factor inhibition of blood clotting - epistaxis, bleeding gums, hematoma, hemoptysis, hematuria, vaginal bleeding - abdominal pain - subarachmoid, subdural, intracerebral hmrhge death

Inv

1. prolonged PT 2. decreased Vit K dependant factors 3. rodenticide screening 4. CBC, blood group

Rx

1. A,B,C 2. Decontamination - No emesis - lavage + charcoal + cathartics 3. VIT K!!! (sc or oral) - no IV anaphylaxis

1. A, B, C 2. Alkalinization (milk/Na bicarbonate) - alkalinize gastric envi - conversion phosphide to phosphine 3. Activated charcoal - phosphide absorptn 4. Symptomatic - diazepam (seizure) - Ca gluconate (tetany)