Keracunan

Makanan

SIGIT WIDYATMOKO
Fakultas Kedokteran
Universitas Muhammadiyah Surakarta
Gastrointestinal Decontamination
If more than 60 minutes has passed, induced
emesis and gastric lavage are relatively
ineffective
Emesis
Using syrup of ipecac is a convenient and fairly
effective way to evacuate gastric contents if given
very soon after ingestion
Indications: in conscious, cooperative patients and for
promptness
Contraindications: drowsy, unconscious, or
convulsing patients, and who have ingested kerosene
or other hydrocarbon, corrosive poisons, or rapidly
acting convulsants
 Gastric Lavage
More effective for liquid poisons or small pill
fragments than for intact tablets
Most effective when started within 60 minutes after
ingestion
Indications: removal or ingested poisons when
emesis is refused
Contraindications: stuporous patients or comatose
 Activated Charcoal
Effectively adsorbs almost all drugs and poisons
Indications: used for prompt adsorption of drugs or
toxins in the stomach and intestine. As effective as or
more effective than ipecac or gastric lavage
Contraindications: stuporous, comatose, or
convulsing
technique: 60-100 g orally or via gastric tube
 Catharsis
used by some toxicologist for stimulation of
peristalsis to hasten the elimination of unabsorbed
drugs and poisons and the activated charcoal slurry
Technique: magnesium sulfate 10% 2-3 ml/kg; or
sorbitol 70% 1-2ml/kg.
What is food poisoning??

any illness resulting from the consumption of food

There are two types of food poisoning: food infection
and food intoxication.
1) Food infection refers to the presence of bacteria or other
microbes which infect the body after consumption.
2) Food intoxication refers to the ingestion of toxins contained
within the food, including bacterially produced exotoxins,
which can happen even when the microbe that produced the
toxin is no longer present or able to cause infection
 Overview

Salmonella
Arsen
Clostridium
Staphylococcus
Ciguatera
Scombroid
Japanese Restaurant Syndrome
Chinese Restaurant Syndrome
 Salmonella enteritidis

Outbrakes associated with grade A eggs

Preparation of Poultry
Sources
Chocolate mousse
Ceasar salad
Chicken
Gram - rod
Killed by high temperatures
 Salmonella

Signs and symptoms

5-72 hours
low grade fever
abdominal pain
diarrhea
chills
 Salmonella

Diagnosis
patient history
stool culture
Microscopic examination
leukocytes
occult blood
 Salmonella

Treatment
Supportive
fluid and electrolyte
NO antibiotics
does not alter the severity
prolongs the carrier state
Do NOT give anti-motility drugs
lead to intestinal perforation
 Clostridium botulinum

Four different types

food borne
infant
wound
undetermined
Resistant
heating, freezing, ionizing radiation
Botulism History
Germany (1793) earliest recorded human
outbreak
Organism isolated in 1895
Mortality rate of 5-50%; long recovery
period
Weaponized by several nations including the
U.S., Japan, and Soviet Union, beginning in
the 1930s
Iraq (1980s) produced 19,000 L of
concentrated botulism toxin
Japan (1990s) Aum Shinrikyo cult
 What Makes Botulism
Toxin a Good Weapon?

Botulism toxin is the most poisonous substance

known
High lethality: 1 aerosolized gram could
potentially kill 1 million people
Isolated fairly easily from soil
Could be released as an aerosol or as a
contaminant in the food supply
Expensive, long-term care needed for recovery
 Botulism Microbiology

Toxin produced by the bacterium

Clostridium botulinum
Anaerobic, gram positive, rod-shaped
bacteria
Bacteria are 0.5 to 2.0 mcm in width
and 1.6 to 22.0 mcm in length
Create spores that can remain dormant
for 30 years or more
Spores extremely resistant to
C. botulinum
environmental stressors, such as heat
and UV light
 Clostridium Botulinum

Destroyed by
boiling >120 degrees for >20 min
Botulinum toxin
Very powerful
0.5 nanograms (lethal)
Heat sensitive
80 degrees for 30 min
 Clostridium Botulinum

Signs and Symptoms

12-48 hrs (14 days)
N/V/D
abdominal distention
constipation (as disease progresses)
Neurologic disturbances
dysarthria, dysphagia, dry mouth
 Clostridium

With disease progression

descending paralysis
respiratory weakness
respiratory failure
oculobulbar symptoms
 Clostridium Botulinum

Treatment
stabilization of airway
history
upper and lower GI decontamination
trivalent antitoxin
(ABE)
watch for hypersensitivity
 Botulism:
Differential Diagnoses
Neuromuscular disorders
Stroke syndrome
Myasthenia gravis
Guillain-Barre syndrome (Miller-Fisher variant)
Tick paralysis
Atropine poisoning
Paralytic shellfish/puffer fish poisoning

Diagnosis based on clinical presentation with

subsequent laboratory confirmation
Botulism:
Treatment/Prophylaxis
Ventilatory assistance and supportive care
Botulinum antitoxin
Trivalent equine product against types A,B, and E
available from CDC
Most effective if given early
Antibiotics for wound botulism
Penicillin
Recovery may be prolonged with supportive
care necessary
Vaccine investigational
not available
Keracunan Arsen
Arsen: logam berat valensi 3 atau 5 berwarna
metal, terdiri 3: arsen triklorida, arsen trioksida,
gas arsine.
Sifat: tidak berbau (kadang seperti bawang
putih), tidak berwarna, mudah larut dalam air
(panas)
Penggunaan: tonikum, obat cacing, anti hama
tikus, herbisida, pestisida,racun semut, bahan
cat, penjernih keca, pembersih keris
Tikus terkena racun arsen: gejala muntaber,
kekurangan cairan, meninggal dalam keadaan
kering
Efek toksik arsen
Mempengaruhi respirasi sel dengan cara
mengikat gugus sulfhidril pada dihidrolipoat,
sehingga menghambat kerja enzim yang terkait
dengan transfer energi dinetralisir dengan
dimercaprol (BAL, British Anti Lewisite)
Mempunyai predileksi pada endotel pembuluh
darah, khususnya di daerah splanknik dan
menyebabkan paralisis kapiler, dilatasi, dan
peningkatan permeabilitas yang patologis.
Efek lokal pada kapiler: kongesti, stasis,
trombosis yang menyebabkan nekrosis dan
iskemia jaringan
Gejala Keracunan Arsen
Sindrom Paralitik Akut
Terjadi jika korban menelan senyawa arsen dalam
jumlah besar: kolaps sirkulasi, kejang, stupor.
Kematian terjadi dalam beberapa jam. Mual muntah
tidak nyata
Sindrom Gastrointestinal
Gejala timbul 30 menit s.d. 2 jam setelah paparan
racun: rasa terbakar pada ulu hati,diikuti mual,
muntah, tenesmus, kembung, diare
Kematian didahului gejala takikardi, hipotensi, kejang
dalam 1-2 hari. Kadang dalam beberapa jam
 Intoksikasi Gas Arsen
Gas arsine (AsH3) tidak berbau saat masih
baru tetapi kemudian menjadi seperti bawang
putih
Masa laten sampai 24 jam dilanjutkan nyeri
abdomen, hemolisis, dan gagal ginjal
Gejala lain: mual, muntah, nyeri abdomen
 Gejala Klasik Keracunan Arsen

Kerontokan rambut: tanda keracunan kronis

Bau napas seperti bawang
Gejala gastrointestinal berupa diare
Muntah akibat iritasi lambung
Skin speckling: gambaran kulit seperti tetes
hujan pada jalan berdebu keracunan kronis
Kolik abdomen
Kelainan kuku: garis Mees (garis putih melintang
pada nail bed) dan kuku yang rapuh
Kelumpuhan umum
Tatalaksana
Dekontaminasi usus: pemberian arang aktif
(norit), lavase
Percepatan eliminasi: hemodialisis
Terapi suportif: balans cairan dan elektrolit,
karena arsen menyebabkan vasodilatasi
Antidotum: British Anti Lewisite (BAL)
merupakan antidotum untuk semua kondisi
keracunan arsen akut, kecuali pada intoksikasi
arsine. Dosis: 3-5 mg/kg BB im setiap 4 jam
selama 2 hari, lalu 3 mg/kgBB im setiap 6 jam
selama 1 hari, dilanjutkan 3 mg/kgBB im setiap 6
jam selama 1 hari