IRRITANT POISONS FOR THE GASTROINTESTINAL TRACT.pptx

This presentation is about poisons that make pathological effects on the gastrointestinal tract

1. Irritant Poisons

2. Irritant Poisons metallic poisons arsenic lead iron

3. Irritant Poisons Non metallic poisons Pesticides Organophosphorus compounds

4. Common characters of Metallic poisons Have double action: local and systemic

5. Common characters of Metallic poisons For each metal there is a most sensitive area e.g mercury –kidney

6. Common characters of Metallic poisons Toxic action appears after a latent period

7. Common characters of Metallic poisons They are cumulative. The excretion of a single dose of an irritant poison may continue for few weeks.

8. Common characters of Metallic poisons Many of them are re-excreted in GIT, as mercury is re-excreted in caecum, arsenic is re-excreted in the descending colon.

9. Common characters of Metallic poisons They are not affected by putrefaction.

10. Common characters of Metallic poisons Their antidote chelators Have acute and chronic picture of poisoning.

11. Common characters of Metallic poisons Stomach tube can be used in the treatment of acute poisoning.

12. Common characters of Metallic poisons All have metallic taste except arsenic They can be detected by atomic absorption & Reinch’s test

13. Arsenic Poisoning

14. Sources Environmental sources Seafood and shellfish Meats, grains, and drinking water

15. Arsenic compounds White arsenic soluble and toxic Yellow arsenic insoluble and non toxic. Inorganic

16. Arsenic compounds Inorganic Arsenates Arsenites Paris green (Cu aceto- arsenite ), present in Fowler's solutions sodium arsenate is used as a red dye Lead arsenate is used as an insecticides.

17. Arsenic compounds Arsine gas Very toxic gas, a colorless gas with garlic odor.

18. Uses of Arsenic compounds In farming and forestry to kill weeds, ants, termites, insects, rats, and mice.

19. Uses of Arsenic compounds To protect wood from decay

20. Uses of Arsenic compounds In the microelectronics industry For worming animals

21. Uses of Arsenic compounds In some herbal medicines

22. Mode of poisoning Homicidal It's tasteless and odorless.

23. Homicidal Mode of poisoning It has compounds of different colors

24. Homicidal Mode of poisoning A long Latent period

25. Homicidal Mode of poisoning Symptoms are similar to those of food poisoning or gastro enteritis.

26. Mode of poisoning Accidental Industrial: during manufacturing of insecticides

27. Accidental Mode of poisoning When children eat insecticides containing arsenic.

28. Mechanism of toxicity Direct gastrointestinal irritant that causes necrosis and ulceration before it is completely absorbed.

29. Mechanism of toxicity Binding to SH group of pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase enzymes inhibition and reduction of energy production

30. Toxicokinetics Absorption Inhalation Ingestion Dermal

31. Toxicokinetics Distribution Bounds to protein of Hb Distribute to liver , spleen , lung , intestine and skin .

32. Toxicokinetics Excretion Renal mainly Concentrated in nail hair and skin

33. Types of toxicity Acute Chronic

34. Acute arsenic poisoning Clinical pictures Nausea and vomiting. Abdominal colic Diarrhea with a rice water stool resembling cholera

35. Clinical pictures Acute arsenic poisoning The breath may smell of garlic Hematuria ,proteinuria ,tubular necrosis

36. Differential diagnosis between acute arsenic toxicity and cholera infection

37. Fatal period; 24 hours. Fatal dose: 120 mg Arsenic

38. Treatment of acute poisoning The immediate life-threat in early acute arsenic poisoning is hypovolaemia and shock secondary to profound gastrointestinal fluid losses

39. Treatment of acute poisoning Stomach wash using Ferric hydroxide solution (freshly prepared) to precipitate arsenic in the form of ferric arsenite .

40. Treatment of acute poisoning Antidote B.A.L (British anti-lewisite) DMSA; dimercaptosuccinic acid DMPS ( dimercaptopropane -sulfonate Pencillamine +BAL

41. Treatment of acute poisoning Symptomatic treatment i.V fluids Morphine for colic pain Glucose and vitamins to support liver

42. Skin lesions Chronic arsenic poisoning Eczema , keratosis (thickening of palms and soles).

43. Chronic arsenic poisoning Skin lesions Melanosis

44. Chronic arsenic poisoning Skin lesions Degeneration , and falling of hair (alopecia)

45. Chronic arsenic poisoning Skin lesions Brittle nails with Mees lines .

46. Chronic arsenic poisoning Peripheral neuritis (mixed motor and sensory).

47. Chronic arsenic poisoning Myocardial degeneration. Toxic hepatitis. An aplastic anemia associated with basophilic stippling.

48. Chronic arsenic poisoning Carcinogenic lung, skin and bladder (transitional cell) carcinoma has been observed in populations with multiple exposures.

49. Treatment Chronic arsenic poisoning Begins with escaping the source of poisoning

50. Treatment Chronic arsenic poisoning Antidote B.A.L, penicillamine DMSA ( diamercaptosuccinic acid) is used orally and preferred than penicillamine.

51. Treatment Chronic arsenic poisoning Supportive treatment for liver by dextrose infusion, vit K and Ca. Symptomatic treatment