Acute Poisoning Question And Answers

Acute Poisoning And Environmental Emergencies Important Notes

Different Poisoning
Fluorosis
- Dental fluorosis is caused by excessive intake of fluoride during tooth development
- Features:
- Dental Fluorosis
  - Mottled enamel
  - Presence of hypoplastic areas
  - Mottled areas may stain yellow/ brown
  - Fluoride occurs symmetrically within dental areas, commonly affecting premolars
- Skeletal Fluorosis
  - Severe pain in
    - Backbones
    - Joints
    - Hips
- Stiffness in joints and spine
- Knock-knee syndrome
  - Outward bending of legs and hands
  - Damage to fetus
  - Blocking and calcification of blood vessels
  - Cripping fluorosis
Effect On Kidney
- May aggravate renal disease

Management of Acute Poisoning

Acute Poisoning Steps Of Management:

Resuscitation and initial stabilization
- Maintain airway, breathing, and circulation
- Blood sample collection for examination
- Rectal temperature is obtained
- Treatment of hypotension with crystalloids
- Administration of a cocktail of 50% dextrose, naloxone, and thiamine
Diagnosis of various types of toxins
- History
  - Reveals type of poison and amount of overdose taken
- Examination
  - Helps to detect a syndrome associated with certain poisons
- Investigations
  - Colour of urine
  - Colour of blood
  - Crystals in urine
  - Ketonuria
  - Anion gap
Nonspecific treatment
- Reduces levels of toxin in the body
- Gastric decontamination- includes
  - Removal of unabsorbed poison from the gut
  - Induction of emesis
  - Gastric lavage
  - Cathartics
  - Use of activated charcoal
  - Whole bowel irrigation
- Enhancement of excretion of absorbed toxins from the body
  - Forced diuresis- alkaline diuresis
  - Use of multiple doses of activated charcoal
  - Peritoneal and hemodialysis
- Dialysis
Specific therapy
- A specific antidote is administered

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Signs, Symptoms, And Management Of Fluorosis

Fluorosis

Excessive intake of fluoride causes fluorosis

Fluorosis Types:

Dental Fluorosis
- Caused by fluoride intake above 2 ppm
- Its symptoms are:
- Mottling of enamel
- Discoloration of teeth
- Teeth become weak and rough
- Brown or yellow patches appear on their surfaces
Skeletal Fluorosis
- Caused by fluoride intake above 20 ppm
- It causes:
- Pathological changes in the bone
- Hypercalcification
- Bone density of limbs, pelvis, and spine increases
- Ligaments of the spine and collagen of bones get calcified
- Neurological disturbances may also occur
Genu valgum
- It is an advanced stage of Fluorosis
- In it, individuals are unable to perform their routine work
- Joints become stiff
- Individuals are crippled

Fluorosis Management:

Vomiting is induced wi a syrup of ipecac or digital or mechanical stimulation the of tongue or throat
Decrease the absorption of fluoride by administering fluoride-binding liquids like warm water, calcium hydroxide, antacids containing aluminum or magnesium hydroxide, or milk
The stomach should be thoroughly washed with additional lime water
Calcium gluconate should be administered intravenously along with lime to prevent shock

Atropine

Atropine is a natural anticholinergic drug

Atropine Mechanism Of Action:

Bind to muscarinic receptors
Blocks the effects of acetylcholine

Atropine Actions

Increases heart rate
Vasodilation
hypotension
Reduces all secretions
Muscle relaxation
Bronchodilation
Relaxes ureter
Produces mydriasis
CNS stimulant

Atropine Uses

Anti-spasmodic
Mydriatric and cycloplegic
Preanaesthetic medication
Organophosphorous poisoning
Bronchial asthma
Peptic ulcer
Parkinsonism
Motion sickness
During labor

Atropine Adverse Reactions

Blurring vision
Dry mouth
Dysphagia
Dry skin
Fever
Constipation
Urinary retention
Skin rashes
Palpitation
Flushing
Restlessness
Delirium
Hallucination
Psychosis
Convulsion
Coma

Acute Poisoning And Environmental Emergencies General Medicine Acute Poisoning

Arsenic Poisoning Features

Gingivitis
Stomatitis
Painful mucosal ulceration
Hyperpigmentation and hyperkeratosis
Excessive salivation
Vomiting
Diarrhea
Neurological disturbances

Symptoms Of Lead Poisoning

Symptoms Of Lead Poisoning Features:

Excessive salivary secretions
Metallic taste in the oral cavity
Swelling of the salivary glands
Development of the dark lead line along the gingival margin
Convulsions
GI upset
Anaemia
Neuritis
Basophilic stippling of the RBC cells

Fluorides in Health and Disease

Importance Of Fluoride In Health:

The kidney excretes it
Fluoride passes the placental barrier
Fluoride prevents the development of dental caries
Fluoride converts hydroxyapatite to fluorapatite
Fluoride is mostly found in bones and teeth
Fluoride is deposited in other calcified tissues also
Fluoride is required for the proper development of bones
Fluoride inhibits the activities of certain enzymes
Sodium fluoride inhibits enolase in glycolysis
Fluoroacetate inhibits aconitase in TCA cycle

Fluoride In Disease:

Excess of fluoride causes fluorosis
Drinking water containing less than 0.5 ppm of fluoride causes development of caries in children

Dental care in mental retardation

Dental Care In Mental Retradation

Familiarise the patient with the office and dental personnel to reduce his/her fear of the unknown before undertaking any treatment
Speech must be slow and simple
Only one instruction at a time should be given
Tell, show, and do technique is used in mild cases and sedation in moderate cases
Carefully listen to the patient
Appointments should be short and scheduled during the early part of the day
Children should be managed with a blend of kindness and firmness
General anesthesia may be indicated in cases where adequate levels of cooperation cannot be achieved