18. Toxicology
Terms
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- What is Toxicology?
- The science of poisons and their effects on people.
- What are 3 factors that make a toxin worth testing for?
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-Whether antidoe is available
-If detection can exclude a medical condition
-If quantifying toxin will affect management of overdose - What are 6 toxic drugs that have antidote available?
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1. Acetaminophen
2. Ethanol
3. Lithium
4. Opiates
5. Propoxyphene
6. Salicylates - Which 5 toxins are important to quantify for management?
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1. Acetominophen
2. Salicylates
3. Amphetamines
4. Lithium
5. Tricyclic Antidepressants - What are 9 classes of toxic agents?
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1. Analgesics
2. Cardiacs
3. Stimulants
4. Depressants
5. Volatiles
6. Metals
7. Noxious gases
8. Pesticides
9. Drugs of abuse - What are the analgesics?
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-Acetaminophen
-Salicylate - What cardiac drug is toxic?
- Digoxin
- What stimulant is toxic?
- -Tricyclic Antidepressants
- What depressant is toxic?
- -Lithium
- What are the 5 volatiles?
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1. Ethanol
2. Methanol
3. Isopropanol
4. Acetone
5. Ethylene Glycol - What are 8 toxic metals?
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1. Chromium
2. Manganese
3. Colbalt
4. Cadmium
5. Mercury
6. Aluminum
7. Lead
8. Arsenic - What noxious gas are we mainly concerned with?
- Carbon monoxide
- How is acetaminophen toxic?
- Causes glutathione depletion resulting in hepatic toxicity
- How are salicylates toxic?
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-Dpress the respiratory centers in the medulla
-Can cause respiratory alkalosis resulting in metabolic acidosis. - What is the treatment for SSA toxicity?
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-Hemodialysis
-Charcoal - How is Digoxin toxic?
- Can cause cardiac, gastrointestinal and visual abnormalities
- What are the most common life-threatening drugs?
- Tricyclic antidepressants.
- What methods are used to measure TCAs?
- TLC, HPLC, and Immunoassays
- What is the antidote for TCA overdose?
- Flumenazil
- What are the general symptoms of TCA overdose? (3)
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Seizures
Cardiac changes
Respiratory changes - How is iron toxic when overdosed? (4 changes)
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-Damages GI mucosa
-Decreases cardiac output
-Hemoconcentration causes cardiac overload
-Alters Kreb's cycle - What is the treatment for iron overload?
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-Ipecac
-Saline levage
-Bicarbenate
-Polyethylene Glycol - How is lithium toxic?
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-Renal toxicity because it undergoes renal clearance.
-Dehydration - is a diuretic - What is the therapy for lithium overdose?
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-Volume replacement
-Hemodialysis - How are the Volatiles measured?
- Via Gas chromatography
- How is Ethanol toxic?
- Causes intoxication - by drinking too much; common.
- How is Methanol toxic?
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It metabolizes to formic acid, resulting in:
-metabolic acidosis
-optic nerve damage - What is the treatment for Methanol overdose?
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-Lavage
-Ethanol to 100 mg/dl
-Hemodialysis
-Folate - What is the metabolite of isopropanol?
- Acetone
- What is ethylene glycol in that makes it toxic?
- Antifreeze
- What makes ethylene glycol toxic?
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-Causes metabolic acidosis
-Renal damage by forming oxalate crystals - Can ethylene glycol be analysed by GC?
- No; it is not volatile
- Which alters serum osmolality the most; EtOH, Isopropanol, or Methanol?
- Isopropanol > MetOH > EtOH
- What is the toxic mechanism of LEAD?
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-Inhibits amino levulinic acid dehydratase
-Result: altered heme synthesis - What does lead toxicity manifest in?
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Anemia
Protoporphyrin buildup - How is lead toxicity treated?
- Chelation
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What are toxic lead levels in
-Children
-Adults -
Children <10 mg/dl
Adults <30 mg/dl - When should chelation take place (for what levels)?
- at >60 mg/dl
- What samples are used for lead analysis?
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-Whole blood
-Urine
-Hair
-Bone - What type of assay is done for lead?
- Atomic absorption spec
- Why is Carbon Monoxide toxic?
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-Binds heme and decreases its O2 capacity
-Increases the remaining O2's affinity for Hb too. - What is the toxic effect of CO poisoning?
- Hypoxia
- What 2 methods are used for CO detection?
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-GC
-Spectrophotometry