Therapy and management of toxicosis

THERAPY AND MANAGEMENT
OF TOXICOSIS
AMIR SOHAIL

THERAPY OF TOXICOSIS
A logical and planned approach is the most effective
way to treat acute Poisoning.
If no specific toxicant can be identified or no
exposure determined.
Then!!!!
“Treat the Patient, Not the Poison”

THERAPY OF TOXICOSIS
Once a determination is made that the patient is
exposed to a potentially toxicant then follow the
following principals.
1. Stabilize vital signs.
2. Obtain a history to evaluate the patient.
3. Decontaminate to prevent continued systemic
absorption of the toxicant.
4. Administer an antidote if indicated and available.
5. Enhance elimination of absorbed toxicant.
6. Provide symptomatic and supportive care.

1. STABILIZE VITAL SIGNS
• Briefly, attention should be paid to maintaining
adequate ventilation, maintaining cardiovascular
function with attention to appropriate fluid and
electrolyte administration.
• Also maintaining acid-base balance, controlling central
nervous system signs such as seizures, and maintaining
body temperature.

2. EVALUATION OF THE PATIENT
Once vital signs are stable, history should be
Obtained.
A minimum database in suspected toxicological
cases includes
Complete blood count, blood urea nitrogen,
creatinine, serum electrolytes, glucose, liver
enzymes, electrocardiogram, blood gases, pulse
oximetry, urinalysis, and body temperature.
• Abdominal radiographs should be considered to
detect ingested metal objects.

3. DECONTAMINATION
• The goal of decontamination is to prevent continued
absorption of the toxicant.
• It is done on the base of
– TOXICITY OF SUBSTANCE
– TYPE OF SUBSTANCE
– TIME SINCE EXPOSURE
– SPECIES AFFECTED

TOXICITY OF SUBSTANCE
• If a substance is nontoxic or has relatively low
toxicity, then extensive decontamination is generally
not necessary.
• If the dose approaches a toxic dose, then more
vigorous decontamination procedures are needed.

TYPE OF SUBSTANCE
The nature of the substance should be considered.
• If volatile organic hydrocarbon has been ingested, the
high risk of aspiration of material into the lungs
following the administration of an emetic.
• Strong acids or alkalis can enhance the damage to
mucosa when emesis occurs.

TIME SINCE EXPOSURE
• Studies have shown that the amount of material
retrieved from the stomach following induction of
emesis or performance of gastric lavage (GL)
declines dramatically with time.
• If emesis was successfully induced at home before
presentation, there is little to be gained from
further attempts to remove material from the
stomach.

SPECIES AFFECTED
• Some species do not vomit, and if such animals
are exposed to toxicants, the administration of
emetics is contraindicated.
• The performance of GL is less likely to be worth
the time and effort in a ruminant because of the
large volume of contents in the rumen.

TOPICAL DECONTAMINATION
• Exposure to toxicants other than oral route may
necessitate specific decontamination such as
• Ocular irrigation or bathing.
• Washing hair and Skin.
!!!!!Severely depressed or comatose patients require
close monitoring to avoid hypothermia or aspiration of
water and detergent. Whatever decontamination
procedure is undertaken.

GIT DECONTAMINATION
 Removing poison from the stomach is most
effective in the first 2 hours after ingestion, is of
limited benefit more than 4 hours after ingestion.
Done by
 Emesis.
 Gastric Lavage.
 Adsorption therapy with activated charcoal.
 Gastrotomy.

EMESIS
It is most effective way of emptying the stomach in
those patients who can vomit but contraindicated in
those,
Who cannot vomit.
Or when the patient is unconscious or depressed.
patient is in seizure, or ingested corrosive or caustic
material.
Emesis induced at home is not effective by table salt or
copper sulphate.

• Following approaches are acceptable for emesis
IPECAC SYRUP
• 1-2ml/Kg B.W
• If vomiting has not occurred in 15 minutes one repeat
dose may be given.
• May cause excessive vomiting and CNS depression
• If overdose can be inactivated by administration of
Activated Charcoal.
HYDROGEN PEROXIDE
• 3% orally 2-5ml/Kg B.W is most effective if it is
followed a moisten meal or if stomach contains
ingesta.

• Dosage should not exceed 40 to 50 ml total.
LIQUID DISHWASHING DETERGENT
• Should be given at 10ml/Kg b.w produce vomiting in
20 minutes.
• Phosphate containing detergents are most effective.
• Laundry detergents are highly irritant and should not
be used.
EMETICS RECOMMENDED FOR VETERINARY USE
• In Dogs, Apomorphine (0.04mg/Kg I.V, 0.08mg/Kg
Subcut.), Naloxone (0.04mg/Kg I.V).
• Cats, Xylazine (1.1mg/Kg I.M) but it cause
respiratory depression which is recovered with
Yohambine

GASTRIC LAVAGE
• Alternative mean of GIT decontamination.
Can be used when emesis is not effective.
Performed on unconscious animal.
• Enterogastric Lavage is the combination of
gastric lavage and retrograde enema given
with gastric tube.

Measuring tube size for lavage Lubricating the tube
Entering the tube into stomach Palpation the gastric tube

Passing the tube Giving anesthesia to animal Lavage Procedure

ADSORPTION THERAPY
• It is physical binding of a toxicant with an unabsorable
carrier, which is eliminated through feces.
• Effective for large non polar molecules.
• Drugs and treatment administered in the presence of
Activated Charcoal are likely to be adsorbed and
reduced in efficiency.
• Dosage is 2-5 Mg/Kg b.w in water slurry.

• It is usually administered with cathartic such as
sodium sulfate or sorbitol.
• This combination enhance the removal of toxicant
charcoal complex and prevent the constipation occur
from the charcoal.
ADSORPTION THERAPY

GASTROTOMY OR RUMENOTOMY
• May be necessary in situations that are refractory to
emesis, lavage or adsorption therapy.
• Foreign bodies that containing toxic metals such as
lead, zinc are indicated for surgical intervention.
• An abdominal radiograph may be useful in detecting
the metals.
• Oils, Tars and other agent reduce motility and need
surgical removal

4. ADMINISTER AN ANTIDOTE
• Antidotes are therapeutic agents that have a specific
action against the activity or effect of a toxicant.

5. ENHANCED ELIMINATION
• FORCED DIURESIS.
• PERITONEAL DIALYSIS

6. SYMPTOMATIC AND SUPPORTIVE CARE
• Treat the Patient according to the symptoms
produced.
• Respiratory stimulants
• Seizure Control
• Histamine Blocking
• Metabolic acidosis
• Diuresis

RESPIRATORY STIMULANTS
Doxapram 1-10mg/Kg.
Over dosage must be cared.
SEIZURE CONTROL
Diazepam 0.5mg/Kg I.V may be repeated if needed
every 20 minutes up to 3 times.
Phenobarbital, if diazepam fails then use it @6mg/Kg
I.V.
Pentobarbital, if Phenobarbital fails then use it.

HISTAMINE BLOCKING
Cimetidine is given for gastric irritation and vomiting.
Dogs 5-10 mg/Kg orally.
METABOLIC ACIDOSIS
Sodium Bicarbonate 0.5-2 mg/Kg every 4 hours I.V.
Blood pH Bicarbonate and other indicators of acid base
status should be monitored.
Sodium Lactate 0.17 molar concentration is given @16-
32 mg/Kg I.V.

DIURESIS
Maintaining the Urine flow MANNITOL 1gm/kg I.V.
Reducing the cerebral edema MANNITOL 2 gm/kg I.V.
Relieving the heart failure FRUOSAMIDE 2-4 gm/kg I.V
or I.M twice daily
Reducing ascites from liver failure FRUOSAMIDE 1-2
gm/kg Orally or SQ twice daily.
Correcting Pulmonary edema FRUOSAMIDE 2-4 gm/kg
I.V or I.M twice daily.
Combating the Acute Renal Failure FRUOSAMIDE 5-20
gm/kg I.V as needed

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