Introduction to toxicologyIntroduction to toxicology

Prof. Dr. Enas El TaftazaniProf. Dr. Enas El TaftazaniProf. of forensic med. And toxicology Ain shams Prof. of forensic med. And toxicology Ain shams

UniversityUniversity

General toxicologyGeneral toxicology

• ILOsILOs : By the end of this lecture you : By the end of this lecture you must be able to : must be able to :

• Define what is meant by the science of Define what is meant by the science of toxicology.toxicology.

• Describe different areas of toxicologyDescribe different areas of toxicology• Classify toxic agents in groups.Classify toxic agents in groups.• Explain factors affecting toxic responses.Explain factors affecting toxic responses.• Discuss medicolegal aspects of Discuss medicolegal aspects of

poisoningpoisoning..

What is toxicologyWhat is toxicology??

• Is the study that relates the poison with its Is the study that relates the poison with its effects on the living.effects on the living.

• What are the areas of general toxicology?What are the areas of general toxicology?

• Forensic toxicology- environmental-Forensic toxicology- environmental-occupational- experimental- developmental- occupational- experimental- developmental- Laboratory- etc,Laboratory- etc,

• What is clinical toxicology?What is clinical toxicology?

• It is the science that deals with nature, action , It is the science that deals with nature, action , symptoms and treatment of poisoning.symptoms and treatment of poisoning.

Factors affecting toxic Factors affecting toxic responsesresponses

Factors related to the Factors related to the poisonpoison

Factors related to the Factors related to the patientpatient

1.1. Amount takenAmount taken

2.2. Route of Route of administrationadministration

3.3. Form of the poisonForm of the poison

4.4. CumulationCumulation

1.1. StomachStomach

2.2. AgeAge

3.3. ToleranceTolerance

4.4. Hypersensitivity.Hypersensitivity.

Medicolegal aspects of Medicolegal aspects of poisoningpoisoning

1.1. A case of poisoning is a medicolgal case.A case of poisoning is a medicolgal case.2.2. There are three categories of poisoning: There are three categories of poisoning: ( Homicidal- suicidal and accidental).( Homicidal- suicidal and accidental).3. Medicolegal duties of a doctor in suspected 3. Medicolegal duties of a doctor in suspected

poisoning:poisoning:• First ;treat the patientFirst ;treat the patient• Suicidal cases or accidental do not Suicidal cases or accidental do not

necessarily require notification except if necessarily require notification except if death occurs, but all cases of suspected death occurs, but all cases of suspected homicide. homicide.

Medicolegal aspects of Medicolegal aspects of poisoningpoisoning

1.1. No scope for professional secrecy.No scope for professional secrecy.2.2. Collect and preserve evidence of poisoning e.g. Collect and preserve evidence of poisoning e.g.

sealed samples biological fluids.sealed samples biological fluids.3.3. If a case dies If a case dies Do not issue death certificateDo not issue death certificate , ,

notify the police who may require autopsy.notify the police who may require autopsy.4.4. Detailed written reports of he case and keep in Detailed written reports of he case and keep in

a safe custody.a safe custody.5.5. Facing a case of food poisoning from a public Facing a case of food poisoning from a public

eatery, notify the public health authority eatery, notify the public health authority concerned. concerned.

ToxidromesToxidromes

•Prof. Dr. Enas El TaftazaniProf. Dr. Enas El Taftazani

ToxidromesToxidromes• ILOsILOs;;By the end of this lecture you By the end of this lecture you

must be able to : must be able to : • Define the meaning of a toxidrome.Define the meaning of a toxidrome.• Explain how they could be helpful.Explain how they could be helpful.• Name the types of toxidromes.Name the types of toxidromes.• Describe each type of toxidrome,Describe each type of toxidrome,• Compare between anticholinergic Compare between anticholinergic

and sympathetic toxidrome.and sympathetic toxidrome.• List toxicological causes of each List toxicological causes of each

toxidrometoxidrome

What is the meaning of What is the meaning of toxidrometoxidrome??

• It Is the syndrome caused by a It Is the syndrome caused by a specific type of poison.specific type of poison.

•How they can be helpful?How they can be helpful?• May suggest the drug involved if the May suggest the drug involved if the

history is not reliablehistory is not reliable

What the common toxidromeWhat the common toxidrome??

1.1.AnticholinergicAnticholinergic

2.2.SympathomimeticSympathomimetic

3.3.CholinergicCholinergic

4.4.OpioidOpioid

5.5.BenzodiazepineBenzodiazepine

Anticholinergic syndromeAnticholinergic syndrome

• Symptoms:Symptoms:--Dry m.m. , flushed skin, Dry m.m. , flushed skin, urinary retention, urinary retention,

decreased bowel sounds, dilated pupil decreased bowel sounds, dilated pupil irreactive ,cycloplegia, altered mental irreactive ,cycloplegia, altered mental status{ blind as a bat, hot as hades ,red as status{ blind as a bat, hot as hades ,red as beet ,dry as bone, mad as hatter}.beet ,dry as bone, mad as hatter}.

• Toxic causesToxic causes::Atropine- Antihistaminic-TCA, antipsycotic-Atropine- Antihistaminic-TCA, antipsycotic-

Antiparkinsons- Amanita muscaria Antiparkinsons- Amanita muscaria ( mushroom) ( mushroom)

Sympathomimetic Sympathomimetic toxidrometoxidrome• Symptoms:Symptoms:1.1. Dilated pupil, Hypertension, tachcardia, Dilated pupil, Hypertension, tachcardia,

hyperpyrexia, agitation , hyperpyrexia, agitation , diaphoresis( sweating) dilated pupils-diaphoresis( sweating) dilated pupils-tremors, arrhythmias convulsion and tremors, arrhythmias convulsion and hypotension in severe cases.hypotension in severe cases.

Question : When does bradycardia occur Question : When does bradycardia occur Answer : In pure alpha agonists as a reflex Answer : In pure alpha agonists as a reflex

to the hypertension that is not opposed to the hypertension that is not opposed by vasodilator B- effect.by vasodilator B- effect.

Sympathomimetic Sympathomimetic toxidrometoxidrome

• Toxic causes :Toxic causes :

1.1. Cocaine- Theophylline – Cocaine- Theophylline – amphetamines , caffeine- amphetamines , caffeine- ephedrine.ephedrine.

How to differentiate How to differentiate sympathomimetic from sympathomimetic from

anticholinergicanticholinergic SymptomSymptomAnticholinergiAnticholinergi

ccSympathomimeticSympathomimetic

SkinSkinDryDryDiaphoresisDiaphoresis

Bowel sounds Bowel sounds InhibitedInhibitedHyperactiveHyperactive

Urine Urine retentionretention

PresentPresentAbsentAbsent

Pupil Pupil Dilated Dilated irreactiveirreactive

Dilated reactiveDilated reactive

Cholinergic toxidromeCholinergic toxidrome• SymptomsSymptoms: {: {SLUDGESLUDGE}}

1.1. SSalivation Miosis.alivation Miosis.

2.2. llacrimationacrimation

3.3. UUrinationrination

4.4. DDiaphoresis Bradycardiaiaphoresis Bradycardia

5.5. GEGE gastro-intestinal emptying gastro-intestinal emptying (Vomiting –Diarrhea)(Vomiting –Diarrhea)

6.6. Bronchorhea-bronchospasm-Bronchorhea-bronchospasm-bradycardia bradycardia

Cholinergic syndromeCholinergic syndrome

•Toxic causes:Toxic causes:

•Organophosphates- Organophosphates- carbamates- physeostigmine carbamates- physeostigmine and neostigmineand neostigmine

Opioid syndromeOpioid syndrome

• Symptoms:Symptoms:

1.1. CNS depressionCNS depression

2.2. Pinpoint pupilPinpoint pupil

3.3. Respiratory depressionRespiratory depression

4.4. Bradycardia, hypotension and Bradycardia, hypotension and decreased intestinal motility.decreased intestinal motility.

5.5. Reversed by naloxone. Reversed by naloxone.

Opioid syndromeOpioid syndrome

• Toxic causesToxic causes::

1.1.Morphine and its derivatives.Morphine and its derivatives.

2.2.Meperidine , clonidine.Meperidine , clonidine.

Benzodiazepine toxidromeBenzodiazepine toxidrome

•CNS depression ( altered CNS depression ( altered consciousness)consciousness)

•Rarely serious disturbed vital Rarely serious disturbed vital signs signs