PENYEBAB KERACUNAN
Anak balita
Dewasa
TERAPI KERACUNAN
Untuk kepentingan klinik, semua agen toksik dibagi 2 klas :
1. Agen toksik yang memerlukan terapi spesifik atau ada
antidotnya
2. Agen toksik yang tidak memerlukan terapi spesifik
Tx simtomatik memperbaiki fungsi vital
Tx supportive
Prinsip penting dalam toksikologi klinik :
HISTORY
What was ingested? (obtain samples of substance,
vomitus)
Route of intoxication?
When was the substance ingested?
How much of the substance was ingested?
Use of alcohol or other possibly potentiating
substances?
Was an attempt made to induce vomiting?
Has an antidote or activated charcoal been
administered?
Patterns of drug habituation or abuse?
Does the patient have a psychiatric history
pertinent to suicide attempts or recent episodes of
depression?
Physical Exam
Pay special attention to:
Skin condition (cyanosis, pallor, wasting, needle
marks, staining)
Pupil responses, impaired vision
Signs of caustic ingestion, burning
Amount of salivation, breath odor, presence of
vomitus
Breath sounds for evidence of aspiration,
atelectasis, pulmonary secretions
Cardiac dysrhythmias
Abdominal pain
Gastric Lavage
A method of GI decontamination that may be superior to
ipecac-induces emesis
Advantages:
Immediate recovery of a portion of the gastric contents (if
performed within 1 hour of ingestion)
Control of lavage duration
Direct access for administration of activated charcoal
Activated charcoal:
A medication that works by
binding to certain poisons,
preventing them from being
absorbed into the body.
Used only for ingested
toxins.
InstaChar
Actidose
LiquiChar
SuperChar
Two Types
of
Activated
Contraindications to Charcoal
Inability to swallow
Administration of Activated
Charcoal
Shake container
thoroughly.
Activated Charcoal
continued
Activated Charcoal
continued
CHEMICAL ADSORPTION
Activated charcoal adsorbs drugs and chemicals
on the surfaces of the charcoal particles, thereby
preventing absorption and toxicity
chemicals are adsorbed by charcoal :theophylline,
phenobarbital carbamazepine, dapsone and quinine .
Chemical are not well adsorbed by activated
charcoal : alcohols, hydrocarbons, metals, and
corrosives
should not be used simultaneously with ipecac
because charcoal can adsorb the emetic agent in
ipecac and thus reduce the drug's emetic effect.
CHEMICAL INACTIVATION
need more time than charcoal and gastric lavage
Antidotes can change the chemical nature of a
poison by rendering it less toxic or preventing its
absorption
Exp :
Formaldehyde + ammonia
hexamethylenetetramine
Sodium formaldehyde sulfoxylate can convert
mercuric ion to the less soluble metallic mercury
Sodium bicarbonate converts ferrous iron to ferrous
carbonate, which is poorly absorbed
PURGATION
to minimize absorption by hastening the passage of
the toxicant through the gastrointestinal tract
cathartic
Exp. Sorbitol
sodium sulfate avoided in patients with
congestive heart failure.
magnesium sulfate should be used cautiously in
patients with renal failure
Carbon
monoxide
poisoning...
can be a
serious
possibility with
fire victims.
DIALYSIS
Hemodialysis and peritoneal dialysis
Hemodialysis is much more effective than peritoneal
dialysis and may be essential in a few life-threatening
intoxications, such as with methanol, ethylene glycol,
and salicylates
Organophosphate Poisoning
MUSCARINIC
D-efacation
U-rination
M-iosis
B-bronchorrea
E-xcitation (muscular)
L-acrimation,
salivation
NICOTINIC
M-uscle weakness
T-achycardia
W-weakness
H-hypertension
F-fasiculations
Anticholinergic
Treatment
atropine
what physiologic effects would you expect to see
from atropine?
pralidoxime (2-PAM)
regenerates acetylcholinesterase
what is the function of acetylcholinesterase?
What physiologic response would you expect to
see?
Rattlesnake
Marine Animals
Stingray
Snake bite
snake bite
Injection
Ingestion
Inhalation
Absorption