Clinical Toxicology is concerned with diseases and illnesses associated with short term or long term exposure to toxic chemicals. The described approaches have the following benefits in clinical toxicology:
· Diagnosis and treatment of toxicosis
· Treatment of toxicosis
History taking:
Taking through general history aids in the effective treatment of an intoxicated patient. Due of lack of consciousness & altered mental state can’t communicate with the patient. Historical information can include information obtained from family, friends, law enforcement and medical personnel, and any observers.
Treatment of Toxicosis
The basic concepts to approach a toxicosis patient
- Ensure airway so that breathing and circulation are adequate
- Remove unabsorbed material
- Limit the further absorption of toxicant
External/Skin Decontamination : This entails the complete removal of clothing and gentle washing of the victim with copious amounts of lukewarm water. Mild soaps are often useful and may increase effectiveness of the removal of the offending substance.
Internal Decontamination: The most recommended methods of internal decontamination Include gastric lavage, whole bowel irrigation and administration of activated charcoal.
Lavage: This is utilized if a patient has ingested a life-threatening toxicant. A large bore tube is inserted into the stomach and the contents removed with sequential administration and aspiration of small quantities of warm water or saline.
Whole-Bowel Irrigation: This involves the infusion by nasogastric or orogastric tube of a lavage solution consisting of an isosmotic electrolyte (polyethylene glycol electrolyte solution is currently recommended). The goal is to completely irrigate the gastrointestinal tract to prevent or decrease toxicant absorption. The use of an isosmotic compound such as polyethylene glycol results in minimal electrolyte loss and fluid changes.
Activated Charcoal : This is considered the most useful agent for the prevention of absorption of toxicants. Repeated administration (multiple dose activated charcoal) can impair the enteroenteric-enterohepatic circulation of drugs by binding to drugs that undergo significant enterohepatic or enteroenteric recycling, including carbamazepine, digoxin, phenobarbitone, theophylline, and verapamil.
A number of antidotes are effective by altering the distribution or metabolism of a toxicant. Reducing the distribution of toxic substances to their sites of action can be achieved by a variety of methods including blocking access of specific poisons to their receptors with compounds that can compete with these receptors and by using chelating agents to bind the toxicants (e.g., dimercaprol for arsenic). Biotransformation of a toxic compound into a less toxic form can be achieved by certain agents.