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Toxicology Part 2 Hand Outs

The document discusses various toxins and their treatment, including ethylene glycol, methanol, formaldehyde, hydrocarbons, cyanide, hydrogen sulfide, acids and alkalis, phenol, food additives, heavy metals like cadmium, arsenic, lead, mercury, iron and copper as well as chelating agents used to treat heavy metal poisoning.

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47 views6 pages

Toxicology Part 2 Hand Outs

The document discusses various toxins and their treatment, including ethylene glycol, methanol, formaldehyde, hydrocarbons, cyanide, hydrogen sulfide, acids and alkalis, phenol, food additives, heavy metals like cadmium, arsenic, lead, mercury, iron and copper as well as chelating agents used to treat heavy metal poisoning.

Uploaded by

ekkolord543
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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TOXICOLOGY HAND-OUTS PART 2 INSTRUCTOR: RALPH EPHRAIM S.

PALABRICA

TOXIN ELIMINATION

A. Forced Diuresis

B. Extracorporeal Methods

1. Hemodialysis

Diffusion – movement of solute particles from an area of higher solute concentration to a lower solute
concentration.

Indications for Hemodialysis:


• Acidosis (severe)
• Electrolyte imbalance (refractory hyperkalemia)
• Intoxication (salicylates, lithium, methanol, ethylene glycol)
• Overload (volume)
• Uremia (bleeding, altered mental status) Dialyzable Toxins

Water soluble:
• Volume of distribution <1L/kg
• Protein binding < 50% • MW < 500 Da

2. Hemoperfusion

Non-Dialyzable Toxins

• Lipid soluble
• Volume of distribution >1L/kg
• Protein binding ≥ 50%
• MW ≥ 500 Da

3. Peritoneal Dialysis • Only 10-15% as effective as hemodialysis.


III. INDUSTRIAL AND HOUSEHOLD TOXICANTS

Ethylene glycol
• Antifreeze preparation in car radiators, coolants, deicers
• Common in industrial solvents, detergents, corrosives, lacquer and paints
• Clear, odorless liquid

Treatment:

• Ethanol: competitive inhibition


• Fomepizole: 94-methylpyrazole: alcohol dehydrogenase inhibitor
• Vitamin B1 and B6

Methanol
• Colorless liquid, volatile at room temperature
• Common component of gasoline, antifreeze, perfume, wood alcohol, paint solvents, household cleaners

Treatment:

• Ethanol
• Fomepizole
Aldehydes

Formaldehyde (Formalin)
• Colorless liquid with pungent odor
• Embalming fluid, used in cosmetics, deodorants, detergents, dyes

Presentation Local effects:

mucosal irritation → oral, pharyngeal, conjunctival Metabolic acidosis (Bleeding).

Hydrocarbons

Hydrocarbon and Petroleum Distillates

Presentation:
• Burning sensation, cough
• Pneumonitis, atelectasis
• Benzene: blood dyscrasias
(acute myeloblastic leukemia, hairy cell leukemia)
• Chlorofluorocarbon, butane:
potentiate epinephrine effects → arrhythmia

Treatment:
• Mineral oil: to increase viscosity and ↓ risk of aspiration
• O2 support
• β2-agonists

CYANIDE

Sources:
• Prunus sp. (almond, cherry, apple), cassava, lima beans → cyanogenic glycosides
• Silver jewelry cleaner (SJC)

MOT: inhibits cytochrome oxidase

Presentation:

• CNS and CVS disturbances


• Respiratory depression

Treatment:

• Cyanide Kit
• Amyl nitrite (inhalational) + NaNO2 (IV) → methemoglobinemia + CN → cyano methemoglobinemia + NaS2O3 →
SCN (relatively nontoxic, more polar)
• Hydroxocobalamin → Cyanocobalamin

HYDROGEN SULFIDE
• Highly toxic, colorless gas with rotten egg odor
• MOT: inhibits cytochrome oxidase
Presentation:
• Irritation of mucous membranes
• Respiratory depression
ACIDS AND ALKALI

Acids:

corrosive → coagulation necrosis → forms protective eschar → less penetrating

Alkali:

caustic → liquefactive necrosis → more penetrating

Treatment:
• Wash with amount of running (tap) water 30 minutes
• For acid ingestion: give egg whites

PHENOL

• Carbolic acid
• Component of industrial paint removers
• Once widely used as antiseptic (Joseph Lister)
• MOT: protein denaturation

• Presentation:
• Tingling sensation/ numbness (local aesthetic effect)
• White discoloration of the skin → corrosive burns

• Treatment:
Dilute
• Wash with amount of running (tap) water 30 minutes
• For acid ingestion: give egg whites

FOOD ADDITIVES

Tartrazine (FD&C 5) & Monosodium Glutamate

Treatment: Epinephrine, Antihistamines

IV. HEAVY METALS AND CHELATING AGENTS (CALMIC)

1. Cadmium
2. Arsenic
3. Lead
4. Mercury
5. Iron
6. Copper

Common MOT: bind to –SH group of enzymes → inactivation


• Treated with the use of Chelators/ Chelating agents
• Forms water-soluble complexes with heavy metals
→ easily excreted
• BAL DMSA
• Deferoxamine
• Penicillamine
• CaNa2 EDTA
ARSENIC

• Lewisite metal
• Salvarsan, Compound 606, Arsphenamine

Presentation

Acute
• Garlic odor breath
• Diarrhea, dehydration
• CNS: delirium, seizure, coma

Chronic Treatment: BAL if severe + Penicillamine


• Mee’s lines: white line cross the nails of fingers/ toes
• Milky/ rosy complexion
• Keratosis
• Hair loss
• Abnormal weight gain

LEAD

• Component of:
-leaded paints, newsprint,
automobile exhaust, earthenware
• Half-life (t ½):
• Bones: 32 years
• Kidney: 7 years
• MOT: inhibits enzymes in heme synthesis
• ALA dehydrogenase: important for lab diagnosis
• Ferrochelatase

Treatment:
• BAL
• CaNa2 EDTA
• DMSA

CADMIUM

• Component of anti-dandruff shampoos, stink bombs, batteries


• MOT: binds to bone (compete with Ca) → distortion of bone structures
MERCURY

• Quicksilver
• MOT: Inhibits monoamine oxidase (MAO)

Forms

Inorganic:
HgCl: calomel
HgCl2: corrosive, sublimate, bichloride of mercury

Organic:
Thimerosal: Merthiolate®
Methylmercury: bioaccumulate and bioamplification in fishes.

IRON

• Usual cause of toxicity is ingestion of OTC preparation by children


• MOT: has corrosive effects in the GI bleeding

Treatment: Deferoxamine (Desferal® )

COPPER

• Toxicity usually occurs in Wilson’s disease


• MOT: binds to hepatic enzymes and
serum proteins → free radicals → hepatotoxicity and nephrotoxicity

Presentation
• Liver and Kidney failure
• Kaiser-Fliescher rings: Copper deposits on corneal limbus

Treatment: Penicillamine (Cuprimine®)

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