Rodenticides And Other Large Animal Toxins Strychnine/Brucine Effects/MOA Glycine receptor antagonist on spinal cord PNS Clinical Manifestations Conscious seizures, until metabolic demands lead to AMS, multiorgan failure (renal, heart, brain, lung) MGMT/Notes Benzos, cooling, hydration, nondepolarizing NMB, urine alkalinization AC binds 1:1 so 1g/kg x 1 Effective management within first 6 hours is essential Rapid onset vs tetanus (which inhibits glycine release, not competitive antagonism) Professor Touery survived strychnine by also ingesting AC Mole/gopher poison [...]

Carbamates Organophosphates and Riot Agents Organophosphates Agents Dimethyl: azinphos-methyl, demeton-s-methyl, dichlorvos, dimethoate, fenitrothion, malathion, oxydemeton-methyl, parathion-methyl Diethy: Chlorpyrifos, diazinon, disulfoton, ethion, parathion, quinalphos diMethyl More important to give 2-paM Exposure Dermal exposure with the concentrated product or for prolonged periods of time. Volatility contributes to exposure: Dichlorvos > malathion Distributed in fat, liver, kidney, salivary gland => redistribute out, can have prolonged effects. Phosphorothioates (diethyl) may have delayed onset due to activation Clinical Manifestations PNS [...]

Metal Toxicity and Chelators Aluminum (Al) Source/Events Aluminum= Anticholinergic + seizures Foil (chasing dragon) Many medical sources (meds/HD fluids) Dialysis dementia Metalworking/refining “Potroom palsy” (pulm fibrosis similar to pneumoconiosis)  Organ/Toxicity Microcytic hypochromic resistant to iron (before CNS manifestations) Inhibits delta-aminolevulinic acid dehydrogenase leading to accumulation of erythrocyte protoporphyrins Central anticholinergic effect Neuro (acute/chronic) (interacts w ACh pathway in brain, anticholinergic effect) Encephalopathy, myoclonus and seizures - CAN BE DELAYED onset of days to weeks Transported [...]

Laws Acts and Agencies Hazardous Materials Incident Response International hazard classification system (IHCS) = Each hazard is assigned a 4 digit number know as the United Nations, North American or Product ID numbers - Displayed on vehicle placards Class 1 - Explosives Class 2 - Gases Class 3 - Flammable or combustible liquids Class 4 - Flammable solids Class 5 - Oxidizers and organic peroxides Class 6 - Poisonous materials and infectious substances Class 7 [...]

Hazards classification pictograms International hazard classification system (IHCS) Class 1: Explosives Class 2: Gases Class 3: Flammable or combustible liquids Class 4: Flammable solids Class 5: Oxidizers and organic peroxides Class 6: Poisonous materials and infectious substances Class 7: Radioactive substances Class 8: Corrosive materials Class 9: Miscellaneous Each hazard is assigned a 4 digit number known as the United Nations, North American or Product ID numbers - Displayed on vehicle placards NFPA 704- National Fire Protection Association - Fixed placarding Left to [...]

Carbon Monoxide Small increase in CO partial pressure leads to large increase in COHb.  When this occurs hemoglobin and O2 partial pressure may be normal = false normal readings of SpO2 CO also interacts with other small gaseous ligands (free radical nitric oxide). Accumulation of free radical NO leads to: Activation of NMDA Release of NE and AA Endothelial injury Neutrophil activation Lipid peroxidation CO binds to Cytochrome C oxidase => inhibiting ATP synthesis, generation [...]

Botulism and Clostridia Species Review Clostridia species and toxins C. botulinum produces serotypes A through H C. baratti → toxin F C. batyricum → toxin E C. argentinense → toxin G Clostridia species review Types Type A = West of Mississippi (0-7 day incubation) Typer B = East of Mississippi (0-5 day incubation) A/B process meat/vegetables - smells putrified E - ALASKA -> Raw fermented fish/animals (food looks and tastes NORMAL) (incubation 0-2 days) Most [...]

Pesticides, Herbicides, Fungicides and Insecticides Barium Sources Rodenticide/insecticide and depilatories Barium sulfate (contrast) Effects/MOA Causes hypokalemia due to redistribution - inh Ca-activated K rectifier channels → QT prolong Clinical Manifestations Paralysis Severe hypoK within 2 hours Parkinsonism findings on MRI MGMT/Notes White powder that resembles FLOUR Pulmonary  ORAL sodium sulfate or Mg sulfate (not IV- converts to barium sulfate=bad) HD Methyl bromide Effects/MOA Oral and dermal routes  Direct cytotoxic (intact methyl bromide) and alkylating agent [...]

Agonists, Antagonists And Various Key Points GABA antagonists Colchicine (Mandrake, Mayapple) Clozapine (chlorpromazine?) Cicutoxin (water hemlock aka cowbane) Bicuculline B-lactams (piperacillin/tazobactam) Lindane (aldrin) Pyrethroids/pyrethrins (AND Na channel opener) Picrotoxin Thujone (absinthe) Tetramine (cage convulsant) TCAs GABA-B agonists GHB GBL, GHV, GVL 1,4-BD Phenibut (adrafinil) Glycine antagonists Similar to GABA but glycine receptor is a Cl- inhibitory receptor in the spinal cord. Strychnine Normal mental status until late phases when metabolic complications from convulsions cause AMS. [...]

Toxic Events Epping jaundice Methylene dianiline Essing bakery Arsenic Minamata bay Methylmercury Ouch-ouch Cadmium Phossy jaw Phosphorus Rice oil disease / Chloracne Dioxin, polychlorinated biphenyls Seveso italy TCP Ginger jake TOCP Parkinsons MPTP/MPP+ Silo gas/welding gas Nitrogen dioxide (sulfur dioxide?) Dry cleaners Methylene chloride (carbon monoxide) Popcorn workers lung Acrolein/fromaldehyde Roncovite/Dow Beer Cobalt Manchester, Staffordshire beer Arsenic Exit signs Tritium Bhopal Methylisocyanate DBCP Male infertility Goiana institute of radiotherapy Cesium 137 For more chapters, visit [...]