INTOKSIKASI

Fajar Yuwanto
SMF Penyakit Dalam
RS Abdul Moeloek
 Intoksikasi Opiat

• Intoksikasi akibat penggunaan opiat : morfin,

petidin, heroin, opium, pentazokain, kodein,
loperamid, dekstrometorfan
• Anamnesis : informasi dari obat-obatan yang
dikonsumsi, dan sisa obat yang ada

• Pemeriksaan fisik : pupil miosis pin point pupil,

depresi nafas, penurunan kesadaran, nadi lemah,
hipotensi, tanda edem paru, needle track sign,
sianosis, spasme saluran cerna dan biler, kejang
• Laboratorium : opiat urin positif atau kadar dalam
darah tinggi

• Pemeriksaan penunjang : opiat urin/darah, analisa

gas darah, elektrolit, glukosa daraah, thorak foto

• Diagnosis banding : intoksikasi obat sedatif :

barbiturat, benzodiazepin, etanol
Penatalaksanaan
 Pemberian antidot nalokson

• Tanpa hipoventilasi : dosis awal 0,4 mg pelan

atau diencerkan
• Dengan hipoventilasi : dosis awal 1-2 mg iv
pelan/diencerkan
 Bila tidak respon berikan nalokson 1-2 mg iv
tiap 5 sampai 10 menit hingga timbul respon
(perbaikan kesadaran, depresi nafas hilang,
dilatasi pupil) atau telah capai dosis maksimal
10 mg,  tidak respon, kaji ulang Dx
• Activated charcoal dapat diberikan pada intoksikasi
oral  30 gram dicampur 240 ml cairan, dosis
maksimal 100 gram
• Jika kejang berikan diazepam 5-10 mg dan dapat
diulang
• Komplikasi : aspirasi, gagal nafas, edem paru akut
 Intoksikasi Organofosfat

• Intoksikasi akibat zat mengandung organofosfat

• Anamnesis : riwayat kontak/ minum zat organofosfat,
muntah paska paparan
• Insektisida golongan fosfat organic (IFO) : Malathoin,
Parathion, Paraoxan , diazinon, dan TEP
• Insektisida golongan karbamat : carboryl dan baygon
• Insektisida golongan hidrokarbon yang diklorkan :
DDT endrin, chlordane, dieldrin dan lindane
• Pemeriksaan fisik : Mual, muntah, hipersalivasi, kram
perut/ diare, kejang, bradikardia, pupil miosis,
penurunan kesadaran, tanda-tanda aspirasi
• Laboratorium : bahan muntah atau darah yg
mengandung organofosfat
• Pemeriksaan penunjang : darah rutin, elektrolit,
fungsi ginjal , foto toraks , EKG, pemeriksaan
organofosfat
 Penatalaksanaan
• Suportif dan simtomatis
• Bilas lambung melalui NGT, carbon aktif 1-2
gram/kgBB
• Atropinisasi, 1- 2 mg atropin sulfat diulang tiap 10
menit hingga atropinisasi, maksimal 50 mg/hari
• Target atropinisasi : nadi >80/min; dilatasi pupil; dry
axillae; TDS >80 mmHg;clear lung (tidak ada whezing
atau rales
 Chlorine Ingestion

Hydrochloric acid has many uses

It is used in the production of chlorides,
fertilizers, and dyes, in electroplating, and
in the photographic, textile, and rubber
industries
Hydrochloric acid (HCl) 17%
 Chlorine Ingestion
• Acute (short-term) inhalation exposure : eye, nose, and
respiratory tract irritation and inflammation and pulmonary edema
in humans.
• Acute oral exposure may cause corrosion of the mucous
membranes, esophagus, and stomach and dermal contact may
produce severe burns, ulceration, and scarring in humans.
• Chronic (long-term) occupational exposure : gastritis, chronic
bronchitis, dermatitis, and photosensitization in workers.
– Prolonged exposure to low concentrations may also cause dental
discoloration and erosion.
• EPA has not classified hydrochloric acid for carcinogenicity
 Chlorine Ingestion
• Ingestion is unlikely to occur because chlorine is a gas
at room temperature.
• Solutions that are able to generate chlorine (eg,
sodium hypochloride bleach) may cause corrosive
injury if ingested
• Severe caustic injuries of the stomach may result in
perforation of its wall and development of acute
abdomen, which requires emergency surgery
– These injuries may appear in the first 48 hours or they may
be delayed until the 14th day after corrosive ingestion
 Sign & Symptom

• Mouth and throat burn, causing severe pain

• Drooling
• Breathing difficulty due to swelling of throat
• Severe abdominal pain
• Bloody vomiting
• Severe chest pain
• Fever
• Rapid drop in blood pressure (shock)
 Prehospital Management
• Victims exposed only to hydrogen chloride gas and
whose skin and clothing appear dry do not pose risks
of secondary contamination to rescuers.
• However, victims exposed to hydrochloric acid or
hydrogen chloride whose clothing or skin is moist or
wet can secondarily contaminate response personnel
by direct contact or through off-gassing vapor.
• There is no antidote for hydrogen chloride poisoning.
Treatment consists of support of respiratory and
cardiovascular functions
 Decontamination
• US ATSDR : In cases of ingestion, do not induce
emesis. Do not administer activated charcoal or
attempt to neutralize stomach contents
• Victims who are conscious and able to swallow
should be given 4 to 8 ounces of water or milk
(Children's dose is 2 to 4 ounces)
• Milk and water are suggested to be useful in the acute
phase (the first 1-3 hours) but their eff ectiveness has
not been proven in controlled studies.