A comprehensive textbook of adult emergency medicine for trainee doctors - covers all the problems likely to present to a trainee in the emergency department. [books.google.com]

Overview Chronic toxic encephalopathy Etiology : chronic or repeated high-dose exposure (e.g,, inhalation) to organic solvents or heavy metals → cerebral, cerebellar, and brain stem atrophy Presentation Mental conditions (e.g., personality changes) Multifocal [amboss.com]

Arsenic poisoning’ is distinguished from ‘Cholera’ by: A Voice change B Pain in throat after vomiting C Tenesmus & anal irritation present D Burning sensation preceding vomiting 16. C) Tenesmus & anal irritation present 17. 6. [slideshare.net]

He has presented 61 scientific papers and has published 33 peer-reviewed journal articles and 15 book chapters on poisoning-related topics. [pharmacy.ucsf.edu]

• Anemia

  Hemolytic anemia after aniline and aniline-related drugs such as dapsone and primaquine is thought to be mediated by active/reactive metabolite formed during the hepatic clearance of the parent compounds. [flipper.diff.org]

  Dapsone-induced methemoglobinemia and hemolytic anemia. Clin Pharm 1992; 11: 800-5. Dawson AH, Whyte IM. Management of dapsone poisoning complicated by methaemoglobinemia. Med Toxicol Adverse Drug Exp 1989; 4: 387-92. [drugs.com]

  After a serious exposure or repeated exposures to aniline, anemia can occur. There is no evidence that aniline causes cancer. [wwwn.cdc.gov]

  For chronic poisoning aniline characterized by headaches, deterioration of sleep, lethargy, fatigue, palpitations, sievetest skin, often with yellowish shade, toxic hepatitis, anemia. Carcinogenic effect aniline is not. First aid and treatment. [medicalency.com]

  Google Scholar Lee MJ, Park KN: A case of acute dapsone poisoning complicated with methyelene blue-induced hemolytic anemia. J Korean Soc Clin Toxicol 2006, 4 (2):170–174. [aoemj.biomedcentral.com]

• Fatigue

  In case of poisoning A. in the lungs cases, there are complaints of weakness, fatigue, dizziness, headache; blueness of the lips, ears, nail phalanxes; in the blood metgemoglobin killed Ganza. [medicalency.com]

  References: [2] [4] Pyrethroid Sources of exposure : skin contact with, ingestion of, or inhalation of insecticides (e.g., malaria control); permethrin treatment of scabies, head and pubic lice Effects Headaches, dizziness, fatigue, coma Nausea Irritation [amboss.com]

  Symptoms of hypoxia such as dyspnea, fatigue and headache appear when the concentration reaches 20 to 45%. "Administration of methylene blue is indicated in symptomatic patients with methemoglobin levels greater than 30%." [haz-map.com]

  However it is very dangerous to avoid drinking, despite the possible vomiting.At any sign of dehydration (fatigue, dizziness) you should seek medical care. [medical-dictionary.thefreedictionary.com]

  Methemoglobin Level: Signs and Symptoms: 30-50% Headache, fatigue, dizziness, rapid heart rate, mild shortness of breath 50-70% Stupor, slow heart rate, respiratory depression, irregular heart rhythm, acid-base imbalance 60-70% Cardiac arrest, loss of [wwwn.cdc.gov]

• Gastric Lavage

  These include, gastric lavage, the administration of methylene blue and exchange transfusion. The possibility of a late haemolytic reaction being a complication of methylene blue treatment is mentioned. [unboundmedicine.com]

  PHENOL -Only corrosive where gastric lavage can be done. -Metabolites : Pyrocatechol Hydroquinone -Ochronosis : Hydroquinone deposits in cartilages. [slideshare.net]

  This technique, which is known as gastric lavage, involves introducing 20-30 mL of tap water or 9% saline solution into the patient's digestive tract and removing the stomach contents with a siphon or syringe. [medical-dictionary.thefreedictionary.com]

  Gastric lavage is useful in certain circumstances to remove caustic material and prepare for endoscopic examination. [wwwn.cdc.gov]

  This can be done by removing contaminated clothing and rinsing the skin with water, inducing emesis, instituting gastric lavage, administering activated charcoal and cathartic, {04} {05} {06} {10} {20} or instituting hemodialysis. {04} {06} {11} In most [drugs.com]

• Unconsciousness

  Drug overdoses cause a range of symptoms, including excitability, sleepiness, confusion, unconsciousness, rapid heartbeat, convulsions, nausea, and changes in blood pressure. [medical-dictionary.thefreedictionary.com]

  Continued exposure may lead to difficult breathing, dizziness, stupor, unconsciousness, convulsions may occur but appear to be uncommon. Cardiac effects: heart blocks, arrhythmias, and shock. [flipper.diff.org]

• Sepsis

  Significant updating of following topics - acute coronary syndrome management, trauma, sepsis management, imaging, arrhythmias. Expansion of administration section - especially patient safety. Changes to drug overdose sections in toxicology section. [books.google.com]

• Abdominal Pain

  Blurry vision Brownish discoloration of the conjunctiva and the cornea Nausea, vomiting, abdominal pain Irritation of skin, mucous membranes, and respiratory tract Diagnosis : clinical Treatment : supportive Dimethylformamide (DMF) Sources of exposure [amboss.com]

  Manifestations of acute poisoning include abdominal pain, nausea, vomiting, and collapse. [medical-dictionary.thefreedictionary.com]

  Clinical effects of overdose The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive: Abdominal pain {05} {07} [drugs.com]

• Epigastric Pain

  Manifestations of acute poisoning include abdominal pain, nausea, vomiting, and collapse. [medical-dictionary.thefreedictionary.com]

• Hypotension

  Acute exposure to skin, airways or gastrointestinal tract may cause cyanosis, methaemoglobinaemia, headache, shallow respiration, dizziness, confusion, stupor, hypotension, lethargy, convulsions and coma, jaundice, pain on urination, haemolysis and anaemia [ihcworld.com]

  Patients who are comatose, hypotensive, or have seizures or cardiac arrhythmias should be treated in the conventional manner. [wwwn.cdc.gov]

  […] on auscultation - Herald the onset of pulmonary edema Cyanosis - Late finding Thin, frothy white/yellow secretions Wheezing Tachypnea Stridor Accessory muscle use for respiratory effort Cardiovascular findings may include the following: Tachycardia Hypotension [emedicine.medscape.com]

• Tachycardia

  […] following: Crackles on auscultation - Herald the onset of pulmonary edema Cyanosis - Late finding Thin, frothy white/yellow secretions Wheezing Tachypnea Stridor Accessory muscle use for respiratory effort Cardiovascular findings may include the following: Tachycardia [emedicine.medscape.com]

• Pruritus

  […] eat cigarettes, marked by stimulation and then depression of the central and autonomic nervous systems, and sometimes death from respiratory paralysis. scombroid poisoning epigastric pain, nausea, vomiting, headache, dysphagia, thirst, urticaria, and pruritus [medical-dictionary.thefreedictionary.com]

• Psychiatric Symptoms

  Hallucinations or other psychiatric symptoms may indicate poisoning by a hallucinogenic plant. Evidence of an empty container or information from the victim are helpful in determining exactly what substance has caused the poisoning. [medical-dictionary.thefreedictionary.com]

• Kidney Failure

  Both hepatic and renal failures can be caused by which of the following: A Paracetamol toxicity B Carbon tetrachloride C Arsenic D Copper sulphate E Silver nitrate 36. Ans. D Copper sulphate PCM, CCl4, AgNO3 - liver failure. As - kidney failure. [slideshare.net]

  Renal Acute aniline exposure can cause painful urination; blood, hemoglobin or methemoglobin in the urine; decreased urinary output; and acute kidney failure. Bladder-wall irritation, kidney ulceration, and tissue death can also occur. [wwwn.cdc.gov]

• Headache

  […] coal-tar benzol cold curing compounding room containing crimson antimony cyanosis described dipping room disease dizziness employed exhaust exposed exposure floor footwear gastric juice German girls gloves golden antimony golden sulphide grain handle headache [books.google.com]

  References: [2] [4] Pyrethroid Sources of exposure : skin contact with, ingestion of, or inhalation of insecticides (e.g., malaria control); permethrin treatment of scabies, head and pubic lice Effects Headaches, dizziness, fatigue, coma Nausea Irritation [amboss.com]

  This enzyme is responsible for the biosynthesis of prostoglandins, which are involved in the dilation of blood vessels that causes the pain experienced in a headache. [ch.ic.ac.uk]

  In acute poisoning aniline in mild cases, victims complain of weakness, dizziness, headache pain ; marked blueness of the lips, ears, nail phalanxes; in the blood metgemoglobin killed Ganza. [medicalency.com]

  These cases have been characterized by marked cyanosis, sometimes accompanied by vertigo and weakness, digestive disorders, headache and somnolence. [jamanetwork.com]

• Dizziness

  […] acute Akron aniline fumes aniline oil aniline poisoning benzine poisoning buffing carbon disulphide carbon tetrachloride chloroform chronic coal-tar benzol cold curing compounding room containing crimson antimony cyanosis described dipping room disease dizziness [books.google.com]

  References: [2] [4] Pyrethroid Sources of exposure : skin contact with, ingestion of, or inhalation of insecticides (e.g., malaria control); permethrin treatment of scabies, head and pubic lice Effects Headaches, dizziness, fatigue, coma Nausea Irritation [amboss.com]

  In acute poisoning aniline in mild cases, victims complain of weakness, dizziness, headache pain ; marked blueness of the lips, ears, nail phalanxes; in the blood metgemoglobin killed Ganza. [medicalency.com]

  Acute exposure to skin, airways or gastrointestinal tract may cause cyanosis, methaemoglobinaemia, headache, shallow respiration, dizziness, confusion, stupor, hypotension, lethargy, convulsions and coma, jaundice, pain on urination, haemolysis and anaemia [ihcworld.com]

  Patients with evidence of significant exposure (e.g., cyanosis, dizziness, headache or severe skin irritation) should be transported to a medical facility for evaluation. [wwwn.cdc.gov]

• Confusion

  Acute exposure to skin, airways or gastrointestinal tract may cause cyanosis, methaemoglobinaemia, headache, shallow respiration, dizziness, confusion, stupor, hypotension, lethargy, convulsions and coma, jaundice, pain on urination, haemolysis and anaemia [ihcworld.com]

  Drug overdoses cause a range of symptoms, including excitability, sleepiness, confusion, unconsciousness, rapid heartbeat, convulsions, nausea, and changes in blood pressure. [medical-dictionary.thefreedictionary.com]

  […] amounts of aniline for short periods of time decreases the ability of blood to carry oxygen .Lack of oxygen causes effects ranging from severe headache, nausea, sometimes vomiting, to dryness of throat and loss of appetite Central nervous symptoms: confusion [flipper.diff.org]

  […] basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive: Abdominal pain {05} {07} {08} {18} {29} anxiety {05} {06} {10} {20} chest pain {03} {05} {06} {07} {08} {18} {20} confusion [drugs.com]

  Arsenic also was odorless and tasteless and easily confused with flour or sugar and other cooking essentials. By the 1830s, morbid descriptions of murders with arsenic terrified the public and became a staple of the British popular press. [crosscut.com]

• Vertigo

  These cases have been characterized by marked cyanosis, sometimes accompanied by vertigo and weakness, digestive disorders, headache and somnolence. [jamanetwork.com]

  […] eye contact, and ingestion of disinfectants, tobacco smoke, or embalming fluid (an aqueous solution stabilized with methanol ; formalin ) Effects Irritation of the skin ( contact dermatitis ), mucous membranes, eyes, and respiratory tract Headache, vertigo [amboss.com]

  […] for short periods of time decreases the ability of blood to carry oxygen .Lack of oxygen causes effects ranging from severe headache, nausea, sometimes vomiting, to dryness of throat and loss of appetite Central nervous symptoms: confusion, ataxia, vertigo [flipper.diff.org]

  The symptoms of methemoglobinemia differ depending on the concentration level of MetHb in the blood, with 0–20% potentially producing cyanoderma; 20–40% potentially producing headache, anxiety, vertigo, and a frequent pulse; 40–60% potentially producing [aoemj.biomedcentral.com]

• Stupor

  Acute exposure to skin, airways or gastrointestinal tract may cause cyanosis, methaemoglobinaemia, headache, shallow respiration, dizziness, confusion, stupor, hypotension, lethargy, convulsions and coma, jaundice, pain on urination, haemolysis and anaemia [ihcworld.com]

  Continued exposure may lead to difficult breathing, dizziness, stupor, unconsciousness, convulsions may occur but appear to be uncommon. Cardiac effects: heart blocks, arrhythmias, and shock. [flipper.diff.org]

  Methemoglobin Level: Signs and Symptoms: 30-50% Headache, fatigue, dizziness, rapid heart rate, mild shortness of breath 50-70% Stupor, slow heart rate, respiratory depression, irregular heart rhythm, acid-base imbalance 60-70% Cardiac arrest, loss of [wwwn.cdc.gov]

If cardiogenic pulmonary edema is strongly suspected Findings on chest radiography are as follows: Initial films may be normal Early changes include hyperinflation and hilar enlargement Later changes are typical for noncardiogenic pulmonary edema See Workup [emedicine.medscape.com]

• Heinz Bodies

  It is known that ascorbic acid promotes the rate of hydroxylation of aniline to p -aminophenol 2, which is a potent agent in the production of Heinz bodies not only in vivo but also in vitro 3, and ascorbic acid is able to produce Heinz bodies in vitro [nature.com]

  Aniline induces the formation of Heinz bodies. Persons with glucose-6-phosphate dehydrogenase (G6PD) deficiency or alcoholism are at increased risk of aniline-induced hemolysis. [wwwn.cdc.gov]

Important factors in treatment are discussed. These include, gastric lavage, the administration of methylene blue and exchange transfusion. The possibility of a late haemolytic reaction being a complication of methylene blue treatment is mentioned. [unboundmedicine.com]

Most organic solvents do not have an antidote; therefore, treatment is generally supportive. For an overview of other types of substance toxicity (e.g., with organophosphates ), see the learning card on poisoning. [amboss.com]

Treatment Treatment for poisoning depends on the poison swallowed or inhaled. Contacting the poison control center or hospital emergency room is the first step in getting proper treatment. [medical-dictionary.thefreedictionary.com]

Phosphoric acid is used predominantly in the manufacture of fertilizers and agricultural feeds, in water treatment, and as a component of detergents and cleansers. [accessmedicine.mhmedical.com]

In the second case, methylene blue treatment was required because the patient’s MetHb level was 46.8%, and his symptoms improved after the treatment. The final clinical progress of both workers was positive. [aoemj.biomedcentral.com]

inhalation) to organic solvents or heavy metals → cerebral, cerebellar, and brain stem atrophy Presentation Mental conditions (e.g., personality changes) Multifocal neurologic deficits (e.g., memory impairment) Grading Clinical features Diagnosis Prognosis [amboss.com]

Prognosis One of the hallmarks of phosgene toxicity is an unpredictable asymptomatic latent phase before the development of noncardiogenic pulmonary edema. [emedicine.medscape.com]

Prognosis The outcome of poisoning varies from complete recovery to death, and depends on the type and amount of the poison, the health of the victim, and the speed with which medical care is obtained. [medical-dictionary.thefreedictionary.com]

Overview Chronic toxic encephalopathy Etiology : chronic or repeated high-dose exposure (e.g,, inhalation) to organic solvents or heavy metals → cerebral, cerebellar, and brain stem atrophy Presentation Mental conditions (e.g., personality changes) Multifocal [amboss.com]

Alveoli may collapse, resulting in significant ventilation/perfusion (V/Q) mismatch, unless the patient receives ventilatory support with positive end-expiratory pressure (PEEP) Etiology Phosgene exposure may result from any of the following [11] : Small-scale [emedicine.medscape.com]

What, then, of the epidemiology that the WHO in 1992 was boldly to describe as "comprehensive and exacting epidemiological studies, subjected to critical independent assessment"? Muro's work was first-hand. [theguardian.com]

Epidemiology According to OSHA, millions of kilograms of phosgene are produced annually, with 10,000 workers at risk of exposure. [emedicine.medscape.com]

Because phosgene is poorly soluble in water, it reacts minimally with oropharyngeal and conducting airway tissues and as a result can penetrate deeply into the lung, where it exerts its effects at the alveolar-capillary membrane (see Pathophysiology). [emedicine.medscape.com]

Prevention Most accidental poisonings are preventable. The number of deaths of children from poisoning has declined from about 450 per year in the 1960s to about 50 each year in the 1990s. [medical-dictionary.thefreedictionary.com]

(ERG, 2016) Protective Clothing Skin: Wear appropriate personal protective clothing to prevent skin contact. Eyes: Wear appropriate eye protection to prevent eye contact. [cameochemicals.noaa.gov]

Reduction of the amount of prostoglandin, therefore, helps prevent headaches and other pain. How it's made Paracetamol is one of the most common drugs used in the world, and is manufactured in huge quantities. [ch.ic.ac.uk]

Resources are available through the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (ATSDR). [emedicine.medscape.com]

Prevention of poisoning: go on contact method of obtaining aniline; transportation of aniline in railway tanks and send it to the consuming shops for pipelines; sealing and mechanization of processes associated with the use of aniline, effective ventilation [medicalency.com]