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PARACETAMOL POISONING:

PARACETAMOL POISONING:. Hepatic damage: more than 150mg per kg Clinical feature : Nausea , vomiting , abdominal discomfort

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PARACETAMOL POISONING:

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  1. PARACETAMOL POISONING: • Hepatic damage: more than 150mg per kg Clinical feature : • Nausea , • vomiting , • abdominal discomfort • In untreated patient`s developing liver damage , vomiting continues beyond 12 hrs and there is tenderness over the liver , jaundice ,hepatic encephalopathy , loin pain , haematuria , proteinuria suggest renal failure. • Investigation :LFTs, liver enzyme ,INR(international normalised ratio) • LFT : Alaninetransaminase(ALT), also called Serum GlutamicPyruvateTransaminase (SGPT) or Alanineaminotransferase (ALAT)  • Aspartatetransaminase (AST) also called Serum GlutamicOxaloaceticTransaminase (SGOT) or aspartateaminotransferase (ASAT) •  Alkaline phosphatase (ALP) • Bilirubin (direct and total) 

  2. Management : • Paracetamol antidotes: • Acetylcysteine :is given by iv infusion in 5 % dextrose . • Initial dose :150mg per kg body weight in 200 ml dextrose over 15 mins , • Than 50 mg per kg in 500 ml over 4 hrs , • Then 100 mg per kg in 1L over 16 hrs • Methionine :if acetylecysteine is not available • 2.5g every 4 hrs to a total of 10 g.

  3. IRON POISONING: • Serious toxicity: more than 60 mgper kg body weight, • Lethal dose :150-300 mg per kg. C / F: • Nausea , • vomiting , • diarrhoea , • abdominal pain Severe poisoning : • haematemesis , • drowsiness , • convulsion , • coma • metabolic acidosis and shock

  4. Management: • Check serum iron ,FBC ,glucose • Gastric lavage if more than 20 mg iron per kg body weight • Use supportive measures if required • In serious : Desferrioxamine : • iv infusion (15 mg per kg per hr , max 80 mg per kg in 24 hr)

  5. Salicylate poisoning(Aspirin): Mild toxicity :150mg per kg body weight Severe and fatal dose :500 mg per kg body weight

  6. NSAIDS

  7. Clinical features Acid-base status :- • Stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis • Interfere with the Krebs cycle, limit production of ATP, and increase lactate production, leading to ketosis and metabolic acidosis Respiratory system effects : - • Causes stimulation of respiration • level of 35 mg/dL or higher causes increases in both rate (tachypnea) and depth (hyperpnea) Glucose metabolism : - • Hypoglycemia (increased cellular metabolic activity)

  8. Cont.. Fluid and electrolyte effects : - • dehydration because of increased GI tract losses (vomiting) and insensible fluid losses (hyperpnea and hyperthermia). • Renal clearance of salicylate is decreased by dehydration. CNS effects : - • Salicylates are neurotoxic, which manifests as tinnitus, and ingestion can lead to hearing loss at doses of 20-45 mg/dL or higher. • CNS toxicity is related to the amount of drug bound to CNS tissue. • Other s: disorientation, seizures, cerebral edema, hyperthermia, coma and death.

  9. Cont.. GI tract effects : - • Nausea and vomiting are the most common effects. Hepatic effects : - • Hepatitis • Reye syndrome (characterized by nausea, vomiting, hypoglycemia, elevated levels of liver enzymes and ammonia, fatty infiltration of the liver, increased intracranial pressure, and coma)

  10. Cont.. Hematologic effects : - • Hypoprothrombinemia and platelet dysfunction are the most common effects. • Bleeding (either by inhibition of vitamin K–dependent enzymes or by the formation of thromboxane A2). Musculoskeletal effects : - • Rhabdomyolysis can occur because of dissipation of heat and energy resulting from oxidative phosphorylation uncoupling.

  11. Management • Gastric lavage Mild poisoning : plasma salicylate less than 350 mg per L than increase oral fluids Moderate : • more than 350 mg per L than IV fluids to correct dehydration , sodium bicarbonate 1.26% alkalinises the urine Severe :haemodialysis

  12. KEROSENE OIL POISONING: • C / F : age between 1 and 3 years of age , common symptoms: • chemical pneumonitis , • fever , • cough , • breathlessness , • abdominal distention Rarely : • Convulsion , Coma ,cyanosis • Radiological changes: right basal infiltrates. • Emphysema ,pleural effusion and pneumatoceles have also been observed.

  13. Management: • Supportive and symptomatic : • Gastric lavage :if amount ingested is massive (within 30 mins of ingestion) • Oxygen if respiratory involvement • Antibiotic • Observation for at least 24 hrs is essential even in an asymptomatic child

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