Toxicology

Toxicology is “the study of the adverse effects of chemicals or physical agents on living organisms “ It deals with poisons, snake bites, scorpion stings and insect stings.

According to WHO, about 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of envenomings (poisoning from snake bites). There are between 81,410 and 1,37,880 deaths and around three times as many amputations and other permanent disabilities each year.

The act of deliberate self-harm or accidental or homicidal ingestion of harmful substances that causes ill-health, injury or death into the body by different means may cause acute poisoning. Many preferred to die by poisoning for a peaceful death instead of passing by hanging or burning.

According to National Poisons Information Centre, New Delhi, analysis of poisoning calls showed that the highest incidence of poisoning was due to household agents(44.1%), followed by drugs(18.8%), agricultural pesticides (12.8%), industrial chemicals (8.9%), animal bites and stings (4.7%), plants (1.7%), unknown (2.9%) and miscellaneous (5.6%)

Effects of toxic substances (including toxins, venoms, and toxicants) can be lethal when not treated at the earliest.

The introduction of Emergency Medicine has been a game-changer for treating such cases. It has dogmatically laid down guidelines for the management of patients with poisoning, snake bites and insect bites and stings

Guidelines:

Assessment of clinical condition Resuscitation/critical actions

• Targeted History
• A-B-C-D-E’s: Using the Classic emergency approach Airway, breathing, circulation, disability and exposure.
• Critical actions to intubate, resuscitate with fluids, initiate life-saving measures

Decontamination is the reduction or removal of chemical agents.

• It’s is the most effective and crucial step which can make the difference between survival (or minimal injury) and death (or severe injury).
• It may be accomplished by the removal of these agents by physical means by orogastric lavage, whole bowel irrigation or single-dose activated charcoal.

Enhanced elimination by multidose charcoal therapy, urinary alkalisation or extracorporeal removal techniques like hemodialysis, hemoperfusion and continuous renal replacement therapy.

Quick detection of a “TOXIDROME”

• Toxidrome describes a group of signs and symptoms and/or characteristic effects associated with exposure to a particular substance or class of substances.

Careful monitoring of poisoned patient.

• Vitals
• Careful cardiac monitoring
• Determine blood glucose and blood parameters

Antidote and Antivenom is the definitive management of toxins, venoms

• Figuring out the poison could be time consuming which can be detrimental to outcome, so toxidromic approach and stabilisation are the key to save the life of a poisoned patient.