Toxicology

INTRODUCTION TO TOXICOLOGY
PRESENTED BY
DR P.NAVEEN
ASST.PROFESSOR
DEPARTMENT OF PHARMACOLOGY
ANURAG UNIVERSITY
Anything in excess is poison-Theodore Levrtt
Never take the antidote before the poison.
Caution is advised while decontaminating a victim of poisoning,
Over enthusiasm may results in eliminating the patient not the
poison. – John Morrison
There is poison in the fang of the serpent, in the mouth
of the fly and sting of a scorpion but wicked man is
saturated with it. – Chanakya
According to Swiss alchemist Paracelsus (Father of Toxicology )
“There is no substance as a non poison.”
Every substance is a poison it all depends on dose and mode of

administration.
Toxicology
It is the science deals with the properties, action, toxicity, lethal
dose estimation and treatment of poison (or) poisonings.
Poison classification
CINCAM:
C: Caustics - (acids, bases)

I : Irritants - (inorganic, organic)
N: Neurotoxic - (cerebral, spinal, peripheral)
C: Cardiovascular
A: Asphyxiates
M: Miscellaneous
Toxicity Rating
S.NO Fatal dose Rating

1 ≤ 5 mg / kg 6 = Super toxic
2 5.1 mg / kg to 50 mg / kg 5 = Extreme toxic
3 51 to 500 mg / kg 4 = Very toxic
4 501 mg / kg to 5 gm / kg 3 = Moderately toxic
5 5.1 gm /kg to 15 gm /kg 2 = Slightly toxic
6 ≥ 15 gm / kg 1 = Non toxic
General Management of Poisoning
1. Stabilization.
2. Evaluation.
3. Decontamination.
4. Poison elimination.
5. Antidote administration.
6. Nursing and Psychiatric care.

Stabilization.
❖The initial survey should always be directed at the assessment and

correction of life threatening problems. If present attention must be
paid to ABCD of resuscitation.
A = Airway
B = Breathing
C = Circulation
D = Depression of the CNS
❖ Retention of carbon dioxide and hypoxia conditions indicates for

assistance of ventilation.
Evaluation
If the patient is not in crisis, i.e. he is alert with normal speech and
pulse proceed to a complete systemic examination. As far as treatment
is concerned , the emphasis should be on basic supportive measures.
Decontamination
The removal of contaminants / poisons.

Methods of Decontamination
1. Emesis.
2. Gastric lavage.
3. Catharsis.
4. Activated charcoal.
5. Whole bowel irrigation.
1. Emesis.
Inducing vomiting by administration of Ipecac syrup.
30 ml + 250 to 500 ml water for adults.
15 ml + 250 to 500 ml water for children's
If vomiting not occur with in 30 mins administer same dose.
Still no effect do stomach wash to remove not only poison but also the
ipecac consumed.
2. Gastric lavage ( Stomach wash)
It recommended mainly for patients who have ingested a life threatening
dose (or) who exhibit significant morbidity and present within 1 to 2 hrs
of ingestion.
Solutions for gastric lavage:
✓Water or saline Sodium thiosulphate
✓Desferrioxamine KMnO4 ( 1: 5000)
✓Calcium gluonate
Precaution:
Never undertake gastric lavage in a patient who has ingested a non toxic
agent / non toxic amount.
3. Catharsis.
Purging the body by the use of a cathartic to stimulate evacuation of the
bowels.
Two groups of cathartics used in toxicology
Ionic or Saline: These are alter physico chemical properties with in the
intestinal lumen leads to osmotic retention of fluid which activates
motility reflexes and enhance expulsions.
Ex:
Magnesium citrate – 4 ml / kg, Magnesium Sulphate – 30 gm
Sodium sulphate – 30 gm
Saccharides:
Better choice for adults not for children's because in children’s it can
cause electrolyte imbalance.
Ex: D – Sorbitol 50 ml of 70 % solution in adults.
❖ No real evidence for cathartics to reduce mortality – morbidity.

Activated charcoal
Decreases the absorption of various poisons by adsorbing them on
to its surface.
Ex: 1 gm / kg body weight dose
50 – 100 gm for adults
10 – 30 gm for child
Disadvantages:
Unpleasant taste, Irritation, vomiting, constipation / Diarrhea
Whole bowel irrigation
This method is recommended for late presenting overdoses when
several hours elapsed since ingestion.
It involves the installation of large volumes of a suitable solution
into a stomach in a naso gastric tube over a period of 2 to 6 hrs
producing voluminous diarrhea.
Ex: Poly ethylene glycol and electrolyte lavage solution
Poly ethylene glycol - 3350
Poison Elimination
Absorbed poison elimination from the body by following

techniques…
1. Forced diuresis.
2. Haemodialysis.
3. Haemoperfusion.
4. Haemofilteration.
Antidote Administration
Antidote works in following ways
1. Inert complex formation Ex: Chelating agent for heavy metals.
2. Accelerated detoxification Ex: Thio sulphate antidote accelerate the
conversion of cyanide to non toxic cyanate
3. Reduces toxic conversions Ex: Ethanol inhibit metabolism of
methanol
4. Receptor site competitions Ex: Nalaxone antagonize the effects of
opiods
5. Toxic effect bypasses Ex: 100% oxygen bypasses the cyanide
poisoning .
UNIVERSAL ANTIDOTE
Mixture of two parts activated charcoal, one part tannic acid,

and one part magnesium oxide intended to be administered to
patients who consumed poison.
TYPES OF TOXICOLOGY
• Mechanistic Toxicology (Basic Biology and chemistry)

• Regulatory Toxicology (Rule making and compliance)
• Descriptive Toxicology (Testing)
Mechanistic Toxicology
THANK YOU

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INTRODUCTION TO TOXICOLOGY

Every substance is a poison it all depends on dose and mode of

C: Caustics - (acids, bases)

S.NO Fatal dose Rating

6. Nursing and Psychiatric care.

❖The initial survey should always be directed at the assessment and

❖ Retention of carbon dioxide and hypoxia conditions indicates for

The removal of contaminants / poisons.

❖ No real evidence for cathartics to reduce mortality – morbidity.

Absorbed poison elimination from the body by following

Mixture of two parts activated charcoal, one part tannic acid,

• Mechanistic Toxicology (Basic Biology and chemistry)

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