HEAVY METAL POISONING
ARSENIC
Symptoms :
Acute Poisoning : It includes a burning sensation in mouth and on lips, thirst, difficulty in swallowing, inflammation of gums and mouth, abdominal pain, vomiting and diarrhoea. In severe poisoning, there is cyanosis and weakness. The body temperature falls, the pulse is weak and rapid, loss of consciousness follows and death is due to circulatory failure.
 |
| uploaded by carepharma24.com |
Clinical Manifestation :
Removal of patient from source of poison to prevent further exposure
Removal of unabsorbed poison
Emesis : It should be done by mechanical means.
Gastric lavage : Stomach wash with potassium permanganate should be done.
Magnesium sulphate or castor oil purges the unabsorbed poison.
Antidote :
Dimercaprol injection is given intramuscularly 6 hourly.
Eggs and albumin should be used for the demulcent action. It prevents further absorption of arsenic by forming a smooth casting on gastric mucosa.
Symptomatic treatment :
Replacement of fluids by IV drips.
Peripheral vasco- constructor should be injected in cases of peripheral circulatory failure.
Morphine is used for severe pain.
Chronic poisoning symptoms : The main signs of chronic poisoning are skin rashes, loss of hair and fingernails, weakness, loss of weight, sore and inflamed gums and mouth, vomiting, abdominal pain and diarrhoea or constipation. Nervous changes also occur and the breath has characteristics of the odour of garlic.
Clinical Manifestation :
It includes :
Removal of patient from further exposure to poison
Dimercaprol injection helps to improve peripheral neuritis
General nutrition improvisation in general nutrition
LEAD
Acute poisoning symptoms : The symptoms of lead poisoning include loss of appetite and sleep, severe abdominal pain, a feeling of pain in the joints and muscles. The central nervous system and blood forming mechanism are affected in cases of severe poisoning. Lead encephalopathy is characterised by headache, confusion, excitement, hallucinations and convulsions, Haematological changes include anaemia, haemolysis and impaired synthesis of haem. The gums frequently exhibit the blue ‘lead line’.
Clinical Manifestation :
Emetics may be used to expel the unabsorbed poisons
Gastric lavage : Stomach wash is done by sodium or magnesium sulphate followed by plane water
Albumin should be given to prevent further absorption of poison
Chelating agents, e.g - EDTA should be used in injection form. Penicillamine can also be used orally or in the I/V drip form
Symptoms :
Chronic Lead Poisoning : It includes vomiting, abdominal pain. Metallic taste and blue line on the gums, chronic constipation. There may be lead palsies (wrist drop, foot drops) and encephalopathy, haematological changes include anaemia, basophilia, decrease in platelets, hypertension and nephritis. In females, it also causes menstrual disturbances and abortion.
Clinical Manifestation :
It is done in following steps -
The patients is removed from further exposure of lead poison
Sodium or potassium iodide is given orally to facilitate the elimination of lead through kidneys
Calcium gluconate is given intravenously if abdominal pain persists
Chelating agent, i.e - EDTA or dimercaprol, should be used parenterally
In chronic constipation, magnesium sulphate should be used
MERCURY
Symptoms :
Acute poisoning : It includes feeling of metallic taste, choking of throat, burning sensation in abdomen associated with diarrhoea. Thrombocytopenia and bone marrow depression may occur. There is whiteness of mucus membrane of the mouth with change in voice. Appearance of blood vomiting and urine may occur. In severe cases, there is complete renal failure due to necrosis of the tubules.
Clinical Manifestation :
It is done in the following order -
A mixture of white albumin of eggs, glucose and sodium bicarbonate in milk is introduced into the stomach to convert the mercury into insoluble mercury albuminate. It is followed by a mixture of magnesium carbonate and charcoal in warm water
Dimercaprol injection should be given to form non- toxic complex with absorbed mercury
Penicillamine is also effective antidote against mercury
Symptomatic treatment : It includes the use of morphine (in severe pain), demulcents (in burning sensation), I/V glucose (in peripheral circulatory collapse), cardiac stimulant (in heart collapse)
Symptoms :
Chronic poisoning : Symptoms include nausea, loss of appetite, abdominal pain, swollen inflamed gums, skin eruption and paralysis of speech muscles.
Clinical Manifestation :
Avoid further exposure to poison
Regular antiseptic, e.g - borax powder is used
A course of dimercaprol or penicillamine should be given
Organo - phosphorus Compounds : These include Malathion. OMPA and TEPP (tetraethyl pyrophosphate). They are absorbed from all routes.
Symptoms :
These depend on the route of entry. Primarily there is headache, nausea, vomiting, tightness of chest, diminution of vision etc. These symptoms are followed by sweating pallor, incoordination, confusion, diarrhoea, delirium, paralysis of respiration muscles, bronchospasm, pulmonary edema, coma and death.
Clinical Manifestation :
Stomach wash with potassium permanganate is done
Atropine sulphate injection should be given intramuscularly to control the muscarinic and CNS action of the poison
Cholinesterase reactivators like pralidoxime chloride and pyridine 2-aldox methiodide should be used if atropine sulphate is ineffective
Phenobarbitone injection may be given to control convulsion
Symptomatic treatment like artificial respiration or tracheostomy may be used, if required
Organo - chlorine Compounds : Commonly used as insecticides are DDT, BHC and dieldrin.
