REVIEW TOPIC — POISONING – CHEMICAL, DRUGS & BITES
Interventions for the Treatment of
Organophosphorus Pesticide Poisoning
Self-poisoning withOrgano- and later due to peripheral respira- would have required several hours
aspiration and long term ventilation.
for a significant number of patients.
OXYGEN AND IV FLUIDS
respiratory function – to ‘atropinise’
(‘ageing’) in patients taking dimethyl
the pralidoxime has just reactivated.
Down To Earth
1 South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine,
for this information can be found
Nuffield Department of Clinical Medicine, University of Oxford, England
online at http://ccforum.com/content/8/6/
2 Department of Clinical Medicine, University of Colombo, Sri Lanka.
3 Department of Clinical Pharmacology & Toxicology, Canberra Clinical School, ACT,Australia.
Michael Eddleston,1,2 Nick A
4 Department of Clinical Medicine, University of Peradeniya, Sri Lanka.
Buckley, 3 and Andrew Dawson.4,5
5 Department of Clinical Pharmacology and Toxicology, Mater Hospital, Newcastle, Australia.
M Eddleston, Dept. of Clinical Medicine, Faculty of Medicine, PO Box 271, 25
Kynsey Road, Colombo-08, Sri Lanka. [email protected]
MANAGEMENT OF THE POISONED
follow later but as soon as possible.
HOW DOES A POISONED PATIENT
prevent Wernickes’ encephalopathy.
, an opioid antagonist, can
The Central Nervous System:
sion due to all varieties of opioids.
: Drugs that
Other Organ System Damage
in an overdose of narcotics, barbitu-
and other sedative-
examples are that of paraquat
antipsychotic, anti depressants, diphen-
necrosis due to poisoning by para-
hydramine, theophylline; isoniazid
, which may result in hepatic
Certain Behavioural Effects of
may be a cause of death in an
indirect manner. For example, alcohol
drugs can cause
The Cardiovascular System
like phencyclidine or LSD
may die in
tricyclic antidepressants, digitalis and
phenytoin, carbamazepine, alcohol and
, should be substantiated
), by the formation of
tablet bezoars (e.g. salicylates
order to quantify the drug ingestion.
and other anti psychotics.
preparations (e.g. theophylline
Certain clues from the physical
of the patient can help
Selective antidotes are available only for a
1) Vital signs
a) Blood pressure
Drugs that may induce an elevated
anion gap acidosis are
Type of elevation Agents
of the Anion gap
with calcium channel blockers, ß -
METHODS OF ENHANCING
ELIMINATION OF DRUGS
cardia is common with tricyclic anti-
1) Dialysis procedures
– Rapid respiration
is typical of salicylates, carbon monox-
Drugs that cause alteration in serum
and others producing metabolic
potassium levels are
is associated with sympathomimetics,
2) Eyes: Miosis
– constriction of
pupils, is typical of opioids, clonidine,
phenothiazines, cholinesterase inhibitors
salicylate, phenytoin, phenobarbital,
- dilatation of pupils is
2) Forced Diuresis and urinary pH
atropine and other anticholinergic agents.
a) Alkalinisation of urine – (pH >7.5)
teristic of intoxication with alcohol,
. Presence of both vertical
tive of poisoning with phencyclidine.
: It may appear flushed, hot
and dry in poisoning with atropine
syrup or gastric lavage
1) Kent R Olson: Basic and Clinical Pharma-
and other antimuscarinics.
with normal saline
is generally used if
cology, 9th ed. the McGraw-Hill companies
mimetics, nicotine and anti cholineste-
hour of ingestion of the drug. Acti-
2) Curtis D. Klaasen: Goodman & Gilman’s:The Pharmacological Basis of therapeutics,
Cyanosis may be due to
is useful in binding
Dr Atiya R Faruqui and
Dr Sujith J. Chandy
4) Nervous system
Dept. of Pharmacology & Clinical
Pharmacology, CMC Vellore
DOG BITES AND RABIES
into the glutal region. (b) Active
Currently the follow-
Once symptoms of rabies
Post exposure prophylaxis:
INSECT BITES AND STINGS
Vital signs of
Post-exposure vaccination: (a) Passive
In severe (high risk)
simple analgesics and antihistamines.
Dr S Banerjee, Clinician
dose, or if it is not available, Equinine
in a charitable clinic, Delhi
‘I just saw the July – September 2004
The Central Government of India has notified on December 13, 2004 the
ban on Rofecoxib formulations for human use. It is in the context of
certain risk to human beings. It prohibits manufacture, sale and distribu-
tion Rofecoxib with immediate effect. The notification implies immediate
withdrawal of the stock that is still in the retail outlets and supply chain.
Dr Krisantha Weerasuriya
This follows the recommendation of the National Pharmacovigilance
Essential Drugs and Medicines Policy
Advisory Committee meeting held on October 11, 2004 for banning the
(EDM), WHO South-East Asia Regional
drug, in the context of Merck withdrawing the drug in September 2004.
Kerala Drugs Controller has banned the follow-
ing batches of drugs for substandard quality
Sample tests conducted during the month of November 2004 at the Thiruvananthapuram
drug control laboratory revealed a few batches of drugs, marketed by about a dozencompanies in Kerala, were of substandard quality. They are:
welcome readers tocontribute for ‘Readers
Modern Pharmaceuticals, Kandli MT 053, MT 054 and
A Health Education Publication
from the Policy Advocacy &
Research Group of CMAI.
Editorial Advisory Group
Aluminium Hydroxide tablets IP Bharath Parentarals Ltd.,
The concerned manufacturers have been asked to withdraw the substandard batches from
the market by the drug control department.
Compiled from Chronicle Pharmabiz
Design & Production
The National Pharmacovigilance Advisory Committee (NPAC) has asked
drug companies which licensed to manufacture and sell generics of Cox-2
inhibitor category drugs to submit additional data on the product safety
with immediate effect. The move is a fall out of the reported ADRs and the
subsequent withdrawal of rofecoxib, a cox-2 inhibitor drug, from the
international markets including India.
Plot No 2, A-3 Local Shopping CentreJanakpuri, New Delhi 110 058
The manufacturers of COX-2 drugs like, celecoxib, valdecoxib parecoxib
generics are expected to initiate additional studies such as safety profile
during use for more than 18 months, potential reactions of the drug in
various dosage forms and designs etc. immediately and submit the data to
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