MNJ17-001
A 22-year-old boy brought in by neighbor after grandmother stated he was "not acting right". Grandmother is on antihypertensive agent medication. Examination shows a lethargic toddler with no other physical findings; pupils, 1 to 2 mm. Vital signs: HR: 70; RR: 20; BP: 80/palpable; T: 37°C; weight: 13 kg:

1. Whats the likely substance ingested by this toddler?
2. What 1s treatment of respiratory depression induced by this agent?

Answer

MNJ17-002
A 4-year-old child has accidentally swallowed his grandfather's low dose aspirin tablets. A couple of partly used strips were found near him but parents are unsure how many tablets were ingested. You admit the child for observation.

1. What 1s pathophysiology?
2. What are toxic effect on body?
3. Whatis therapeutic and toxic dose?
4. What are the further steps of management?

Answer

MNJ17-003
** Mention 3 poisonings (for each drug), for which the following drug can be used as antidote:

1. Glucagon
2. Pyridoxine
3. N-Acetyleysteine
4. EDTA (disodium calcium edetate)
5. Dimercaptosuceinic acid

Answer

MNJ17-004
A 7-year-old child was prescribed imipramine for nocturnal enuresis. Accidentally he consumed more tablets than was prescribed:

1. What climeal features will you look for?
2. How will you manage?

Answer

MNJ17-005
A 4-year-old deaf girl swallowed a disc battery from her hearing aid, which she informed to her mother immediately:

1. What 1s its toxic effect?
2. How will you manage?

Answer

MNJ17-006
A 2-year-old child swallowed some amount of kerosene:

1. Kerosene belongs to which type of poisoning agents?
2. What symptomatology will you expect?
3. How will you manage?

Answer

MNJ17-007
A 2-year-old male child is admitted with ingestion of dishwasher detergent solution:

Toxicology 233

ANSWERS

• Ans. 1. 1. Clonidine: Central-acting antihypertensive: Stimulation of alpha 2a receptors in medulla—decreased sympathetic outflow
  • 2. Naloxone may reverse the respiratory depression.
• Ans. 2. 1. Pathophysiology uncoupling of oxidative phosphorylation
  • Hepatotoxicity, direct stimulation of respiratory centre causing hyperventilation and respiratory alkalosis metabolic acidosis and dehydration hyperglycemia and hyperpyrexia
  • Therapeutic dose = 10 to 15 mg/kg Toxic dose is more than 150 mg/kg
  • 4. Serial serum salicylate concentrations

    • 70: life-threatening

    • 90 hemodialysis—dialysis

Urine output with urine pH (maintained 7-7.5)

Plasma pH, plasma glucose, electrolytes

LFT and clotting studies

Treatment, multiple dose activated charcoal urinary alkalization, hemodialysis.

• Ans. 3. 1. Glucagon: β blockers, CCBs, hypoglycemic agents
  • 2. Pyridoxine: INH, gyromitra mushrooms, ethylene glycol
  • 3. NAC: Acetaminophen, CCl4, chloroform
  • 4. EDTA: Pb, Mn, N1, Zn, Cr
  • 5. DMSA Pb, Hg, arsenic, other heavy metals
• Ans. 4. 1. 3 As agitation: CNS anticholinergic effects—mydriasis, dry mucous membrane, fever, decreased gastric emptying, urinary retention arrhythmias—sinus bradycardia, wide QRS, depressed ST segment.
  • Management vigorous gastric lavage even several hours after ingestion because of reduced gastric motility delays emptying activated charcoal after lavage:
    • NaHCO₃—mainstay of treatment—alkalinize to maintain pH 7 45 to 7 5 This increases binding of TCA to plasma proteins which decreases free compound that exerts toxic effects
    • Lidocaine, phenytoin, magnesium if arrhythmias
• Ans. 5. 1. Disc batteries contain potentially toxic substance like mercury, lithium and potassium hydroxide They have corrosive action on mucosa.
  • 2. Urgent X-ray chest
    • If located in esophagus—remove immediately
    • If in stomach or beyond follow it by repeated abdominal X-ray every 2–3 days to ensure evacuation
    • If it remains in one position >7 days—surgical removal
• Ans. 6. 1. Kerosene is an aliphatic hydrocarbon with high volatility and low viscosity.
  • GI irritation, vomiting pulmonary injury due to aspiration—excreted through lungs
    —chemical pneumonia
  • No emesis since chances of aspiration lavage if large amount ingested or in CCl₄ poisoning as it is absorbed and is toxic to liver. Done only after protecting the

airways with a cuffed ET. Humidified oxygen, fluids, electrolyte balance antibiotics to prevent secondary infection due to aspiration if fever and leucocytosis corticosteroids are to be avoided.

• Detergents are caustic alkalies or acid substances
  • . Oropharyngeal burns, oral and retrosternal pain, salivation, drooling, nausea, bloody vomitus and diarrhoea later, esophageal and gastric perforation.
  • . Hospitalise for observation CBC, electrolytes, CPK (raised due to muscle damage), X-ray chest and abdomen vomut and stool for blood, if positve—esophagoscopy no emesis, lavage, activated charcoal or cathartics no neutralisation of acid with base or vice versa because of exothermic reaction rmse external burns with plenty of water supportive treatment Endoscopic evaluation for esophageal burns after 24 hours prophylactic antibiotics if perforation.

1. What type of agent 1s it?
2. What will be the signs and symptoms?
3. How will you manage?
4. Naloxone may reverse the respiratory depression.
5. Serial serum salicylate concentrations
6. Pyridoxine: INH, gyromitra mushrooms, ethylene glycol
7. NAC: Acetaminophen, CCl4, chloroform
8. EDTA: Pb, Mn, N1, Zn, Cr
9. DMSA Pb, Hg, arsenic, other heavy metals
10. Urgent X-ray chest

Answer