Ppt 3.4.1- General Approach to Poison Management

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• Poisoning refers to the development of dose-related adverse effects following exposure to chemicals, drugs, or other xenobiotics. WHAT IS POISONING? COMMON SUBSTANCES USED FOR POISONING IN INDIA Organophosphorus poisoning Organochlorides – Endosulphan poisoning Examples of pesticides include malathion, parathion, diazinon, chlorpyrifos, and dichlorvos. Nerve agents like sarin, soman, tabun, and VX also DDT, lindane, chlordane, and endosulfan.

[Audio] Common Substances Used For Poisoning In India Rat poisons Thallium, sodium monofluoroacetate (SMFA, fluoroacetate), strychnine, zinc phosphide,, elemental phosphorus, arsenic, and barium carbonate. Aluminum phosphide poisoning -QuickPhos, Salphos and Celphos. Oduvanthalai poisoning(Odukku) /Oleander poisoning –Chevarali BarbituratePhenobarbital, pentobarbital, amobarbital, butalbital, and secobarbital..

[Audio] General Approach ABC(Airway,Breathing &Circulation History taking Physical Examination Toxidrome recognition Decontamination Specific Antidotes Symptomatic and Supportive Care Referral if needed Ref:National Health Systems Resource Centre.

[Audio] toxidromes These syndromes are usual best described by a combination of vital signs and clinically obvious end organ manifestations. The signs that prove most clinically useful are those involving the Central nervous system -(mental status); Ophthalmic system (pupil size); Gastrointestinal system (peristalsis); Dermatologic system: skin (dryness against diaphoresis) Mucous membranes (moistness against dryness); Genitourinary system (urinary retention against incontinence) Ref:National Health Systems Resource Centre.

[Audio] Goals Of Therapy Support of vital signs Prevention of further absorption Enhancement of elimination Administration of specific antidotes Prevention of re exposure Ref:National Health Systems Resource Centre.

[Audio] Gastric Decontamination Modes of decontamination are Gastric emptying Gastric lavage Emesis Activated charcoal Whole bowel irrigation Ref:National Health Systems Resource Centre.

[Audio] ANTIDOTE An antidote is a drug, chelating substance, or a chemical that counteracts (neutralizes) the effects of another drug or a poison. universal ANTIDOTE Activated charcoal If the nature of administrated poison is not known and it is suspected that two or more poisons have been taken..

AMAZING FACTS OF ACTIVATED CHARCOAL 50-g Dose of Activated Charcoal has an Adsorptive Surface Area Equivalent to About Seven Football Fields! Charcoal has been used for Medical Purposes for Thousands of Years Activated Charcoal has been used for more than a Century for Acute Intentional Self - Poisoning Time Tested Choice in Treatment of Acute Intentional Self-Poisoning.

Systernatic Review and Meta-AnaIysis Therapeutic Effectiveness and Safety of Activated Charcoal in Poisoning Management in Emergency Settings: A Systematic Review and Meta-analysis Raz Harnd•n AE Rakan Aref Nhaccan', Neuf Obaidunah Bin Razeel Ali m•mad Ahaa•, Hu.i Saud Nayef Of Surgery. Univerz±y. Saud Suvz-y. Norah Univercry. Riy.±. Arabia 'Departrnent Of A&ouf LJr+.erciM Sakakah- Saue *Departnert cf Surgery. 8t Saue Ar±ia. Svez-y. Co&gec. Riyadh. Saue ArØiA. Sure—y. Medical Ccae*. Of —keddah. Jeddah Saud Ar±ia. Co•ege. Ki-.g Faizal Ihiverz±y. Hcfuf- Saue cf cf Medical *CÄg Saud Abdulei: LÄi.erz*y Heahh A1—haa- •King medical A&hc•. S•vdi Svezy. Medical Ahza. Savdi Arabia Abstract Background Objectives: The zzazagezz.ezt Of is crucial iz ezuergezcy necessitating prouzpt and effective interveneons to and enhance patient outcoaxes- Activated charcoal (AC) has long been utilised fir its ablliry to adsorb toxins the tract- Despite its .tid.espread use, debates persist its emcacy and safety- This study to comprehensively evaluate the therapeutic effectiveness and safety profile Of AC iz coateazporary porsoa.ing Inazagezneut through a systematic review and Methods: A systezzatic search was conducted PubMed, Central Register of Controlled Trials and Scopus databases until Deceu:ber 202.3. controlled trials (RCTs) AC tuterveutiou poisoned were included the Data Of bias were perforazed Preferred Report:ug Itezzxs for Systeu:atic aud Meta—analysis guideuues- EScacy outcozzes included drug plaszza concentratioa, area under the curve (A CT), to peak level and hospital stay. Safety outcou:es conaprised u:ortaliry, and cardiac Results: 5059 patients iz study. Meta—analysis revealed a decrease drug p Ias.u:a concentration (P = 0.002) (P c: 0.0001) favourrng AC Intervezt:ioz. NO s iæificazt differences observed to peak drug Level (P = 0-59) hospital Stay (P = 0-34)- Safety analysis LO uzorta.lity (P = 0.25), whereas cardiac arrhyt.h.21ia weas sigu.zficaztly AC (P = 0.004). izci&Ee did significantly difference groups (P = 0-33)- Cozcl.usiou: study provides evidence emcacy and safety of AC poisoned patients- AC a&uiuistratioz led to re.&zced drug plasu:a concentration and AVC, sip:ificazt unpact oz hospital stay Mortality rates did not significantly, but AC a Of cardiac caz AC into po zzazageaxezt protocols to patient Further should focus exploring reg:izzezs for-azuLaa.ou.s- Keyw•ords: Activated charcoal- erzergency tzedicine. poisoning.

[Audio] Conclusion:HealthcareproviderscanconfidentlyintegrateActivatedCharcoalintopoisoningmanagementprotocolstoimprovepatientoutcomes. Ref:JryedRH,AlshangiSA,AlhassanRA,AlanaziNO,MahfoozHAB,AlfarsiRK,AbhaliAA,AlawadFH,AlMohainiM,AldanyowniSN.TherapeuticEffectivenessandSafetyofActivatedCharcoalinPoisoningManagementin EmergencySettings:ASystematicReviewandMeta analysis.Cureus.2024Jul25;16(7):e66891.doi:10.7759/cureus.66891.PMID:39072472;PMCID:PMC11252662..

[Audio] ACTIVATED CHARCOAL Is charcoal that has been treated with oxygen at very high temperatures to make it more porous. The charcoal’s porous texture has a negative electrical charge which causes it to attract positively charged molecules, such as toxins and gases. plus ve toxins CHARGED They bind to it through a process known as adsorption VE.

[Audio] How Activated Charcoal Works. HOW ACTIVATED CHARCOAL WORKS.

Every Minute Counts in In Acute Intentional Self-Poisoning Toxigon Activated Charcoal 250 mg I.P Tablets Emergency 1 Works Effectively when given only within 1-2 h of Poison Ingestion New Optimal Dose: 40: 1 Ratio (by Weight) of Charcoal to Drug / Conventional Dose: 10:1 Ratio lgm / Kg up to IOOgms Caution: To use Toxigon when (1) the ingestion is potentially toxic, (2) the substance is adsorbed by AC, (3) the substance is likely to still be in the GI tract when AC is given, (4) the patient is expected to be able to maintain a patent airway or is already in tubated, and (5) the GI tract is functionally and anatomically intact; and there is no safer or more effective alternate treatment Rof Activated charcoal for acute overdose: a reappraisal gr J Clin Pharmacol 2016 2 Activated charcoal—past. present and futuw West J Med 1986 3 Activated charcoal tor acuto overdose: a reappraisal. Br J Clin Pharmacol 2016 Time Tested Choice in Treatment of Acute Intentional Self-Poisoning.

[Audio] TreatmentProtocols. Treatment Protocols.

[Audio] Insecticide Poisoning Treatment Activated charcoal 1 g/kg as a single dose for poisoning with significant toxicity, if ingestion less than 1-2 hours. Multiple dose activated charcoal 1 g/kg q4 hours Poison Poison Caution Danger . W-H-O colour code on container Red lable Extremely toxic Monocrolophos. zinc phosphide. ethyl mercury acetate Yello lable Highly toxie Endosulfan, carbaryl. quinalphos and others Source: Blue lable Moderately toxic Malathion. thiram. glyphosate. and others. Tamil Nadu Accident & Emergency Care 8îCò µôõwp¾ Þò‚è‹ îdpµw´ Initiative T-A-E-I Toxicology Green lable Slightly toxic Mancozeb. oxyfluorfen. mosqui to repellant oils and hiquides, and most other household insecticides..

[Audio] CASE STUDY Case Presentation: Patient: 28-year old male farmer, brought to ER 1 hour after intentional ingestion of an organophosphorus insecticide (chlorpyrifos). Symptoms: Vomiting, abdominal cramps, sweating, salivation, frothing at mouth. On Examination: Pulse: 48/min, BP: 90/60 millimetersHg Pupils: Pin point, reactive Chest: Bilateral crepitations (bronchorrhea) Neurology: Fasciculations present, GCS 13/15 Treatment Procedure with Activated Charcoal Initial Stabilization:Airway protection (high aspiration risk). If consciousness is reduced, intubation is done before charcoal.Oxygen support, 4 line secured, cardiac monitoring. Gastric Decontamination: Activated Charcoal: Dose: 1 g/kg (max 50 g) orally/NG tube, within 1 hour of ingestion. Multiple Doses: 0.5 g/kg every 4 hours may be used since some OP compounds undergo enterohepatic circulation. Specific Therapy: Atropine: IV, titrated to dry secretions and adequate heart rate. Pralidoxime (2-PAM): 1–2 grams 4 over 30 minutes, repeated 12-hourly (reverses nicotinic effects if given early). Supportive Care:IV fluids for hypotension.Mechanical ventilation if respiratory failure develops.Sei zures → 4 diazepam. Monitoring: Cholinesterase levels (if available). Continuous E-C-G--, oxygen saturation. Watch for intermediate syndrome (24–96 hrs after poisoning). Specific antidotes (Atropine plus Pralidoxime) are life saving..

[Audio] PLANT POISONING Decontamination a)Gastric lavage: May not be useful. b)Activated Charcoal: Activated charcoal (1gm/Kg) should be considered in patients who present within an hour of ingestion. Source: Tamil Nadu Accident & Emergency Care 8îCò µôõwp¾ Þò‚è‹ îdpµw´ Initiative T-A-E-I Toxicology.

[Audio] Oleander Seed, Oduvanthalai, Datura, Poisoning Source: Tamil Nadu Accident & Emergency Care 8îCò µôõwp¾ Þò‚è‹ îdpµw´ Initiative T-A-E-I Toxicology.

[Audio] Case Study Case : Plant Poisoning (Yellow Oleander – Thevetia peruviana) Case Presentation:Patient: 18-year old female, brought to the ER after consuming 6 crushed yellow oleander seeds (intentional ingestion). Symptoms: Multiple episodes of vomiting, dizziness, palpitations. On Examination: Pulse: 42/min, irregular.BP: 90/60 millimetersHg. E-C-G--: Bradyarrhythmia with varying AV block. Treatment Procedure with Activated Charcoal Stabilization:Airway, breathing, circulation checked.IV access secured, cardiac monitoring started. Gastric Decontamination:Activated Charcoal: Initial Dose: 1 g/kg body weight (up to 50 g) orally/NG tube, given within 2 hours of ingestion. Repeated Doses: 0.5 g/kg every 4 hours — indicated here, since oleander glycosides undergo enterohepatic recirculation, and multiple dose charcoal enhances toxin clearance. Supportive & Specific Measures: 4 Atropine for bradycardia.Digoxin specific Fab fragments (if available) — main antidote for oleander poisoning. Correction of electrolyte imbalance (especially potassium). Avoid calcium, as it may worsen toxicity. Monitoring:Serial E-C-G's for conduction defects.Serum potassium, renal function, and digoxin levels (if measurable)..

[Audio] Weed Killer Poisoning Source: Tamil Nadu Accident & Emergency Care 8îCò µôõwp¾ Þò‚è‹ îdpµw´ Initiative T-A-E-I Toxicology.

[Audio] Cell Oil Poisoning Source: Tamil Nadu Accident & Emergency Care îdpµw´ Initiative T-A-E-I Toxicology 8îCò µôõwp¾ Þò‚è‹.

[Audio] Artifical Cow Dung Powder Poisoning Source: Tamil Nadu Accident & Emergency Care îdpµw´ Initiative T-A-E-I Toxicology 8îCò µôõwp¾ Þò‚è‹.

[Audio] rodenticide POISONING Oral activated charcoal to help remove the ingested poison Patients presenting within four hours of ingestion of rodenticide should be given activated charcoal (25–100 grams, mixed with 150 to 200 ml water), orally. Activated charcoal is given as 1g/kg within 1 hour. Multiple dose every four to six hours for 24 hours may be given. Oral activated charcoal should be avoided after 3 days of ingestion. Source: Tamil Nadu Accident & Emergency Care îdpµw´ Initiative T-A-E-I Toxicology 8îCò µôõwp¾ Þò‚è‹.

[Audio] Tablet overdose Source: Tamil Nadu Accident & Emergency Care îdpµw´ Initiative T-A-E-I Toxicology 8îCò µôõwp¾ Þò‚è‹.

[Audio] Case Study Case 1: Tablet Overdose (Tricyclic Antidepressant Overdose) Case Presentation: Patient: 30-year old female with history of depression, ingested ~20 tablets of Amitriptyline (T-C-A--) 2 hours ago. Symptoms: Confusion, tachycardia, dilated pupils, dry mucous membranes. History: Family reports ingestion about 1.5–2 hours before hospital arrival. Treatment Procedure with Activated Charcoal: Stabilization: Airway, breathing, and circulation ensured.Continuous cardiac monitoring (risk of arrhythmias). Gastric Decontamination:Activated Charcoal: Initial Dose: 1 g/kg (max 50 g) orally/NG tube. Repeated Doses: 0.5 g/kg every 4 hours may be given, as T-C-A's undergo enterohepatic recirculation, so multiple dose AC helps. Additional Management: 4 Sodium bicarbonate if Q-R-S widening (>100 ms) on ECG.IV fluids for hypotension. Avoid antiarrhythmics like procainamide. Monitoring:ECG, electrolytes, C-N-S status.Repeat AC until clinical improvement..

[Audio] Toxins For Which Multiple dose Activated Charcoal May Be Useful 1g/kg; 6 to 8 hourly For drugs with entero hepatic and enteroenteric circulation : Carbamazepine Dapsone Digitoxin Diisopyramide Nadolol Phenobarbital Phenylbutazone Phenytoin Piroxicam Quinine Salicylates Sotalol Sustained release and enteric coated medications Theophylline.

[Audio] Toxins Not Bound By Activated Charcoal Iron Heavy metals Hydrocarbons Lithium, potassium, and other small ions Lead.

[Audio] Adverse Effects ➤ Common Side Effects:  Vomiting: Occurs in 6.9–23% of patients, increased with sorbitol use.  Constipation or Diarrhea: May occur with or without cathartics.  Taste/Compliance Issues: Especially in children; flavoring has inconsistent impact. ➤ Serious Risks:  Pulmonary Aspiration: o Can occur during vomiting or improper nasogastric tube placement. o May lead to pneumonitis, respiratory failure, or death. o Particularly dangerous in:  Unconscious patients  Those with seizures  Patients not intubated.

Every Minute Counts in In Acute Intentional Self-Poisoning Toxigon Activated Charcoal 250 mg I.P Tablets Emergency 1 Works Effectively when given only within 1-2 h of Poison Ingestion New Optimal Dose: 40: 1 Ratio (by Weight) of Charcoal to Drug / Conventional Dose: 10:1 Ratio lgm / Kg up to IOOgms Caution: To use Toxigon when (1) the ingestion is potentially toxic, (2) the substance is adsorbed by AC, (3) the substance is likely to still be in the GI tract when AC is given, (4) the patient is expected to be able to maintain a patent airway or is already in tubated, and (5) the GI tract is functionally and anatomically intact; and there is no safer or more effective alternate treatment Rof Activated charcoal for acute overdose: a reappraisal gr J Clin Pharmacol 2016 2 Activated charcoal—past. present and futuw West J Med 1986 3 Activated charcoal tor acuto overdose: a reappraisal. Br J Clin Pharmacol 2016 Time Tested Choice in Treatment of Acute Intentional Self-Poisoning.

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