Common Household Poisoning Nur Afni Amir Drug & Poison - - PowerPoint PPT Presentation
Common Household Poisoning Nur Afni Amir Drug & Poison Information Pharmacist National Poison Centre, USM TOPIC OUTLINE At the end of this lecture, you should be able to answer these question What are common household poisoning?
Nur Afni Amir Drug & Poison Information Pharmacist National Poison Centre, USM
*swimming pool disinfectants &industrial bleach : up to 20% hypochlorite
while those with a concentration of less than 10% are irritants (Kiristioglu et al, 1999). 3.Household bleach is a mild to moderate irritant which does not cause tissue damage unless ingested in large amounts. Systemic toxicity may occur after a large ingestion. 4.Ingestion of more than 100 mL in a child or 300 mL in an adult of a household bleach (<10% sodium hypochlorite) may cause significant toxicity.
SEVERE *concentrated solution significant esophageal & gastric burns dysphagia, drooling, severe throat, chest & abdominal pain. hematemesis & GI perforation systemic toxicity:electrolyte disturbances, metabolic acidosis, mental status changes, cardiovascular effects and pulmonary edema
Hypochlorite + Acid (Toilet bowl /tile cleaner) = Chlorine gas
Hypochlorite + Ammonia = chloramine gas
INHALATION OF CHLORAMINE /CHLORINE GAS
is NOT a respiratory hazard
when mixing bleach with other household cleaning products
membrane (eyes,nose,throat)
respiratory symptoms
with household products, upper airway edema may cause obstruction and chemical pneumonitis may also
ingested
basic substances for neutralization is contraindicated due to the possibility of exothermic reaction and subsequent burning.
mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).
INHALATION EXPOSURE
support(eg, intubation) as necessary EYE EXPOSURE
DERMAL EXPOSURE
with water.
injuries.
INHALATION & OCULAR
Hydrogen peroxide's toxicity is mainly due to the release of oxygen gas causing venous or arterial gas embolism. Each mL of 3% hydrogen peroxide releases 10 mL of oxygen gas
INGESTION: Ingestion of higher (greater than 10%) concentration products. caustic injuries to the gastrointestinal tract, leading to hemorrhagic gastritis, burns in the mouth, throat, esophagus, and stomach, ulcerating colitis, intestinal gangrene, and gas embolization. Systemic gas embolization can involve any organ, resulting in seizure, cerebral infarction, cerebral edema, spinal cord infarction, acute myocardial infarction, hypotension, cardiac arrest, and death. INHALATION: Inhalation of vapors from concentrated (greater than 10%) solutions may result in severe pulmonary irritation. Acute lung injury and respiratory arrest OCULAR: Eye exposure to high concentrations can cause corneal ulceration and perforation. DERMAL: Dermal exposure to concentrated solutions has resulted in burns and gangrene
SEVERE TOXICITY
ANIONIC, NONIONIC CATIONIC Mildly irritating Hazardous
Most common surfactant in bath soap,shampoo, general laundry detergents Common in heavy duty laundry detergent
Disinfectants,industrial products, fabric
softener,swimming pool algicides
Anionic Surfactant
sulfate
Irritants effect Nonionic Surfactant
gluconate
Produce less local irritation than anionic Cationic Surfactant
burns are possible with ingestion of just a few mL of concentrated solution.
and shock (rare)
chlorides
THESE ARE CHEMICALS THAT IRRITATE, BURN OR DAMAGE SKIN AND OTHER LIVING CELLS. Consists of:
WEAK IRRITANTS Acetic acid 5-10% Aluminium sulfate 5-20% Hydrochloric acid <5% Phosporic acid 15-35% CORROSIVE (DANGER) Acetic acid>/=50% Glycolic acid >10% Hydrochloric acid >10% Oxalic acid >10% Phosphoric acid >60% Sulfuric acid >10% Zinc sulfate >50% STRONG IRRITANTS Acetic acid 10-50% Boric acid Hydrochloric acid 5-10% Oxalic acid <10% Phosphoric acid 35-60% Sulfuric acid <10 % Zinc sulfate 5-50%
Automobile battery
Toilet Bowl Cleaner (liquid)
Toilet Bowl Cleaner (granular)
Metal cleaners and antirust
Drain cleaners
esophagus may be severely affected even when there are no burns in the mouth & throat.
MILD TO MODERATE ORAL TOXICITY
Mild : irritation or grade I burns (superficial hyperemia and edema) burns of the oropharynx, esophagus or stomach Moderate toxicity: grade II burns (superficial blisters, erosions and ulcerations) are at risk for subsequent stricture formation, particularly esophageal. Some patients (particularly young children) may develop upper airway edema SEVERE ORAL TOXICITY deep burns and necrosis of the gastrointestinal mucosa. complications often include perforation (esophageal, gastric, rarely duodenal), gastrointestinal bleeding. Hypotension, tachycardia, tachypnea and, rarely, fever Stricture formation (esophageal, less often
Upper airway edema is common and often life threatening.
Composition Examples Volatility Viscosity / Surface Tension Risk of Aspiration Risk of CNS Toxicity Heavier fractions motor oil, petroleum jelly Lower Higher Lower Lower Lighter fractions Kerosene, gasoline white spirit Higher Lower Higher Higher The toxicity that results from exposure to a petroleum distillate will depend both on its composition and the route of exposure.
Poorly absorbed from the GI tract Mainly aspiration hazards Do not cause any appreciable systemic toxicity unless aspiration has occurred
Maintain a clear airway and ensure adequate ventilation. Give oxygen if indicated Gastric lavage and Activated charcoal should NOT be given due to the increased risk of aspiration. Observe patients for at least 6 hours after exposure. Monitor pulse, respiratory rate, oxygen saturation, conscious level and temperature. The need for x-ray is dependant on likelihood of aspiration. Patients may be considered for discharge 6 hours after ingestion if asymptomatic, if there are no signs in the chest and a chest x-ray is normal, with advice to return if symptoms develop.
NAPHTHALENE
TTest to differentiate mothball ingredientst to differentiate mothball ingredients N P C Place the mothball in the glass
C N P Place the mothball in the saturated salt solution by adding 3 tablespoonfuls of table salt into half a glass of water and stirring it vigorously until the salt does not dissolve any more P N Plain water Salt solution
MILD TO MODERATE : nausea, vomiting, diarrhea, headache, restlessness SEVERE: lethargy, hemolysis, hemolytic anemia, methemoglobinemia, hyperkalemia, dysuria, hematuria,seizures, coma, metabolic acidosis, renal failure, and acute lung injury *high risk to G6PD deficiency patient
MILD TO MODERATE: Most inadvertent ingestions are asymptomatic. Inhalation can cause nausea, headache and vomiting. It can also cause irritation to the eyes and nose. SEVERE : Hepatotoxicity, hemolytic anemia, and methemoglobinemia (rare)
MILD TO MODERATE : nausea and vomiting. Seizures SEVERE : delirium, visual hallucinations, cerebral edema, and status epilepticus, hypotension, tachycardia, respiratory failure and death.
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