Professional Documents
Culture Documents
poisoning
?? Blessing to developing nations.
-Common poisoning agent
•Suicidal
•Accidental
•Homicidal
-300000 people die every year
Pharmacology
• OPs are highly lipid soluble
• Primary target: “Acetyle choline
esterase”
• Inhibit AChE: increases Acetyl choline
at cholinoceptors
• Increased acetyle choline act on –
Muscarinic
Nicotinic
CNS synapses
Pharmacology
3 types of choline esterase enzyme
inhibitors
Simple alcohol bearing quaternary
ammonium group e.g. edrophonium
Carbonic acid esters of alcohol e.g.
carbamate (Baygon)
Organic acid derivatives of
phosphoric acid e.g. all OPS
Clinical features
• Depends upon principle site of action
• Usually develops over 15mins-2hrs
A: Muscarinic effect:
• Rhinorrhoea,bronchorrhoea,bronchconstri
ction,wheezing,pulmonary edema
• GI symptoms:
salivation,nausea,vomiting,abd
cramps,tenismus,diarrhoea
• CVS:Bradycardia,Hypotension
• Urogenital: Urinary incontinence and
frequency
• Eyes: constrited pupils,blurred
Clinical features
B: Nicotinic Features:
• Muscle
fasiculation,weakness,cramps,paralysi
s
• Respiratory muscle weakness and
paralysis
• Ocular,bulbar.neck,proximal muscle
of limb paresis
C: CNS effects:
Anxiety,restlesness,ataxia,insomnia,co
Diagnosis
History
Signs and symptoms
Charcteristic smell from
mouth,cloths and gastric lavage
Atropin test: 0.6-3mg i.v ;look for
signs of atropinisation
Estimation of Acetyl choline esterase
level in blood < 50% of normal
(3000-6000IU/lt)
Management
Non Pharmacological
ABC
Removal of soiled clothes
Thorough cleaning of whole body with
soap water
Gastric lavage till returning fluid is
clear
Airway clearing
If needed intubation and ventilatory
support
Management
Pharmacological management:
Atropin Sulphate: start with 0.6mg-
3mg i.v. and access every 5-15 mins
for signs of atropinisation
Clear chest on auscultation with no
wheezes
Heart rate >100
Pupil no longer pin point
Dry axilla
Systolic pressure>90 mm of Hg
(Over atropinisation leads to fever
dellirium,Psychosis)
Management contd……
OXIMES:
• Pralidoxime chloride(PAM)
• -30mg/kg loading over 10-20mins followed
by 10mg/kg i.v.6-8 hrly for at least 48 hrs
(not useful for carbamate poisoning)
At ward daily assess for
• Consciousness
• Pulse/HR
• Blood Pressure
• Pupil
• Muscle power
• Dryness of lungs
Complications
Acute:
• Aspiration Pneumonia
• Pulmonary edema
• ARDS
• Acute pancreatitis
• Hypoglycemia
• Lactic acidosis
• Acute renal failure
• Cardiac arrhythmias-
bradycardia,tachycardia,AV
dissociation,Torsades de pontis
Complications
Chronic:
• Intermediate syndrome
• Delayed neuropathy
• Depression