Rd18

REVIEW TOPIC - POISONING - CHEMICAL, DRUGS & BITES
Interventions for the Treatment of
Organophosphorus Pesticide Poisoning
Self-poisoning withOrgano- and later due to peripheral respira- would have required several hours aspiration and long term ventilation.
RESUSCITATION
for a significant number of patients.
PATHOPHYSIOLOGY
ATROPINE
OXYGEN AND IV FLUIDS
respiratory function - to 'atropinise' ('ageing') in patients taking dimethyl PRALIDOXIME
the pralidoxime has just reactivated.
OTHER DRUGS
FUTURE TREATMENTS
DECONTAMINATION
Down To Earth
1 South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, References for this information can be found
Nuffield Department of Clinical Medicine, University of Oxford, England online at http://ccforum.com/content/8/6/ 2 Department of Clinical Medicine, University of Colombo, Sri Lanka.
3 Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, ACT,Australia.
Michael Eddleston,1,2 Nick A
4 Department of Clinical Medicine, University of Peradeniya, Sri Lanka.
Buckley, 3 and Andrew Dawson.4,5
5 Department of Clinical Pharmacology and Toxicology, Mater Hospital, Newcastle, Australia.
Correspondence: M Eddleston, Dept. of Clinical Medicine, Faculty of Medicine, PO Box 271, 25
Kynsey Road, Colombo-08, Sri Lanka. eddlestonm@eureka.lk Drug Poisoning
INTRODUCTION
MANAGEMENT OF THE POISONED
Initial Management
follow later but as soon as possible.
HOW DOES A POISONED PATIENT
prevent Wernickes' encephalopathy.
naloxone, an opioid antagonist, can The Central Nervous System:
sion due to all varieties of opioids. Cellular Hypoxia: Drugs that
Toxicological Diagnosis
Other Organ System Damage may
in an overdose of narcotics, barbitu- rates, alcohol and other sedative- examples are that of paraquat affect- antipsychotic, anti depressants, diphen- necrosis due to poisoning by para- hydramine, theophylline; isoniazid etc.
cetamol, which may result in hepatic Certain Behavioural Effects of
Drugs may be a cause of death in an
indirect manner. For example, alcohol or sedative-hypnotic drugs can cause The Cardiovascular System: Over-
like phencyclidine or LSD may die in tricyclic antidepressants, digitalis and phenytoin, carbamazepine, alcohol and history, should be substantiated
other sedative intoxication. Twitching anticholinergics), by the formation of other sympathomimetic agents. Mus- tablet bezoars (e.g. salicylates), order to quantify the drug ingestion.
Clinical Examination
haloperidol and other anti psychotics. preparations (e.g. theophylline).
Certain clues from the physical
Laboratory Tests
Specific Antidotes
examination of the patient can help
Selective antidotes are available only for a Antidote
1) Vital signs:
a) Blood pressure - Hypertension
Drugs that may induce an elevated
anion gap acidosis are:
Type of elevation Agents
of the Anion gap
with calcium channel blockers, ß - METHODS OF ENHANCING
ELIMINATION OF DRUGS
cardia is common with tricyclic anti- 1) Dialysis procedures:
b) Respiration - Rapid respiration
is typical of salicylates, carbon monox- Drugs that cause alteration in serum
ide and others producing metabolic potassium levels are:
c) Temperature - Hyperthermia
is associated with sympathomimetics, anticholinergics, salicylates and drugs 2) Eyes: Miosis - constriction of
pupils, is typical of opioids, clonidine, phenothiazines, cholinesterase inhibitors salicylate, phenytoin, phenobarbital, Mydriasis- dilatation of pupils is
2) Forced Diuresis and urinary pH
atropine and other anticholinergic agents. manipulation:
a) Alkalinisation of urine - (pH >7.5) teristic of intoxication with alcohol, sedatives. Presence of both vertical Decontamination
tive of poisoning with phencyclidine. 3) Skin: It may appear flushed, hot
References:
and dry in poisoning with atropine with Ipecac syrup or gastric lavage 1) Kent R Olson: Basic and Clinical Pharma- and other antimuscarinics. Excessive with normal saline is generally used if cology, 9th ed. the McGraw-Hill companies mimetics, nicotine and anti cholineste- hour of ingestion of the drug. Acti-
2) Curtis D. Klaasen: Goodman & Gilman's:The Pharmacological Basis of therapeutics, rase agents. Cyanosis may be due to vated charcoal is useful in binding
Dr Atiya R Faruqui and
Dr Sujith J. Chandy
4) Nervous system: Nystagmus,
Dept. of Pharmacology & Clinical
Pharmacology, CMC Vellore
DOG BITES AND RABIES
SNAKE BITES
into the glutal region. (b) Active Immunisation: Currently the follow- Treatment: Once symptoms of rabies Post exposure prophylaxis: Post expo- Pre-exposure prophylaxis: Individuals INSECT BITES AND STINGS
Hospital Management: Vital signs of SCORPION STINGS
Post-exposure vaccination: (a) Passive Immunisation: In severe (high risk) simple analgesics and antihistamines.
Dr S Banerjee, Clinician
dose, or if it is not available, Equinine in a charitable clinic, Delhi
REGULATORY MATTERS
'I just saw the July - September 2004 Banned Drug
The Central Government of India has notified on December 13, 2004 the ban on Rofecoxib formulations for human use. It is in the context of certain risk to human beings. It prohibits manufacture, sale and distribu- tion Rofecoxib with immediate effect. The notification implies immediate withdrawal of the stock that is still in the retail outlets and supply chain.
Dr Krisantha Weerasuriya
This follows the recommendation of the National Pharmacovigilance Essential Drugs and Medicines Policy Advisory Committee meeting held on October 11, 2004 for banning the (EDM), WHO South-East Asia Regional drug, in the context of Merck withdrawing the drug in September 2004.
Kerala Drugs Controller has banned the follow-
ing batches of drugs for substandard quality
Sample tests conducted during the month of November 2004 at the Thiruvananthapuram drug control laboratory revealed a few batches of drugs, marketed by about a dozencompanies in Kerala, were of substandard quality. They are: welcome readers tocontribute for 'Readers Medicine
Batch Number
Modern Pharmaceuticals, Kandli MT 053, MT 054 and A Health Education Publication
from the Policy Advocacy &
Research Group of CMAI.
Christian
Association of
Editorial Advisory Group
Aluminium Hydroxide tablets IP Bharath Parentarals Ltd., The concerned manufacturers have been asked to withdraw the substandard batches from the market by the drug control department.
Compiled from Chronicle Pharmabiz
Cox2 Inhibitors
Design & Production
Susamma Mathew
The National Pharmacovigilance Advisory Committee (NPAC) has asked Published by
drug companies which licensed to manufacture and sell generics of Cox-2 inhibitor category drugs to submit additional data on the product safety with immediate effect. The move is a fall out of the reported ADRs and the subsequent withdrawal of rofecoxib, a cox-2 inhibitor drug, from the international markets including India.
Plot No 2, A-3 Local Shopping CentreJanakpuri, New Delhi 110 058 The manufacturers of COX-2 drugs like, celecoxib, valdecoxib parecoxib generics are expected to initiate additional studies such as safety profile during use for more than 18 months, potential reactions of the drug in various dosage forms and designs etc. immediately and submit the data to Printed at: Creative Lab

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