Toxicology | 1367

ศูนย์พิษวิทยารามาธิบดี PoisonCenter.mahidol.ac.th | โทร. 1367

Opioid

  1. Morphine
  2. Heroine
  3. Dextromethorphan

Symptom

  • ↓ Temp. (Cold)

  • ↓ PR (Bradycardia)

  • ↓ BP (Hypotension)

  • ⇊ RR (Hypopnea)

  • ↓ Pupils (Miosis)

  • ↑ Skin Diaphoresis

  • ↓ Bowel sound Hypoactive

Treatment

  • Naloxone 2 mg IV stat
    if Respiaratory depression

  • Naloxone 0.2 mg IV stat
    if Minimal respiaratory depression


Cholinergic
(โค - ขี้ - เขียว)

  1. Organophosphate
    • Azinophos-methyl (Gluthion)
    • Carbophenothion (Tri-thion)
    • Chlorthion
    • Diazinon (Basudin)
    • Dicrotophos (Bidrin)
    • Dicapthion (Di-Captan)
    • Ethion (Nialate)
    • Fenthion (Baytex)
    • Malathion (Cythion)
    • Parathion
    • Phosphamidon (Dimecron)
    • TEPP (Bladan, Tetron)
    • Tichlorfon (Dipterex, Tugon)
  2. Carbamate
    • Aldicarb (Temik)
    • Aminocarb (Metacil)
    • Bendiocarb (Ficam)
    • Propoxur (Baygon)
    • Carbaryl (Sevin)
    • Carbofuran (Furaxdan)
    • Methomyl (Lannate, Nudrin)
    • Mexacarbate (Zectron)

Toxidrome

  • ↓ Temp. (cold)

  • ↓ PR (Bradycardia)

  • ⥊ BP (Normal)

  • ⥊ RR (Normal)

  • ↓ Pupils (Miosis)

  • ↑ Skin Diaphoresis

  • ↑ Bowel sound Hyperrrrrractive (ขี้)

Treatment

  • NG lavage 1000 ml (if < 1 hr)
  • Activated charchoal
    1 gm/kg (if < 4 hr)
  • Atropine 0.02-0.05 mg/Kg
    IV q 5 min until
    control mucous membrane hepersecretion or airway clear

Cause of death

  1. Bronchorrhea
  2. Bronchospasm
  3. Bradycardia
  4. Salivation
  5. Lacrimation
  6. Urination
  7. Diaphoresis
  8. GI (Diarrhea)
  9. Emesis

Anti - Cholinergic
(แห้ง - แดง - ร้อน)

  1. Atropine
  2. Antihistamine
  3. TCAs (Tricyclic antidepressants)

Toxidrome

  • ↑ Temp. (Hot)

  • ↑ PR (Tachycardia)

  • ↑ BP (Hypertension)

  • ⥊ RR (Normal)

  • ↑ Pupils (Mydriasis)

  • ⇈ Skin (Dry) รักแร้แห้งงมาก

  • ↓ Bowel sound (Hypoactive)

Treatment



Sympathomimetic

  1. Cocaine
  2. Amphetamine
  3. Ephedrine
  4. Pseudoephedrine

Toxidrome

  • ↑ Temp. (Hot)

  • ↑ PR (Tachycardia)

  • ↑ BP (Hypertension)

  • ↑ RR (Techypnea)

  • ↑ Pupils (Mydriasis)

  • ↑ Skin (Diaphoresis

  • ↓ Bowel sound (Hypoactive)

Treatment


Corrosive agents
(Acid-Base)

  1. Acid → Coagulation necrosis
  2. Alkali → Liquefaction necrosis

Toxidrome

  • Drooling = oropharyngeal injury
  • Dysphonia, stridor, respiratory distress = laryngotracheal injury
  • Odynophagia, dysphagia = esophageal injury
  • Abdominal pail, GI bleeding = stomach injury
  • Retrosternal chest pain (mediastinitis)

Treatment



Sympathomimetic

  1. Cocaine
  2. Amphetamine
  3. Ephedrine
  4. Pseudoephedrine

Toxidrome

  • ↑ Temp. (Hot)

  • ↑ PR (Tachycardia)

  • ↑ BP (Hypertension)

  • ↑ RR (Techypnea)

  • ↑ Pupils (Mydriasis)

  • ↑ Skin (Diaphoresis

  • ↓ Bowel sound (Hypoactive)

Treatment


Lab