Poisoning or intoxication

Toxins present a variety of both incapacitating and lethal effect. Most toxins of military significance can be broadly classified in one of two ways. Neurotoxins disrupt the nervous system and interfere with nerve impulse transmission similar to nerve agents (Chapter 1). However, all neurotoxins do not operate through the same mechanism of action or do they produce the same symptoms. Cytotoxins are poisons that destroy cells or impair cellular activities. Symptoms may resemble those of vesicants (Chapter 3) or they may resemble food poisoning or other diseases. Toxins may also produce effects that are a combination of these general categories. The consequences of intoxication from any individual toxin can vary widely with route of exposure and dose. In addition, some toxins act as biomediators and cause the body to release excessive, and therefore harmful, amounts of chemicals that are normally produced by the body. 

The neurotoxins may be transmitted to man through bioaccumulation in an intermediate marine host. Toxic bivalves result from the filter-feeding of jP. brevis cells during red tides, and if consumed result in neurotoxic shellfish poisoning, or NSP. Human oral intoxication is rarely fatal. 

Intoxication The state of being under the influence of a poison or drug, with effects ranging from stimulation and exhilaration to stupefaction and loss of consciousness. 

Antidotes e. g. silibinin against Amanita poisoning or N-acetylcysteine in paracetamol intoxication, haemarginate in acute porphyria Primary iiver therapeutics e. g. penicillamine, glucocorticoids, azathioprine, interferon-a, aimed at primary intervention in the aetiology or pathomechanism of liver disease. 

With an excessive, single exposure, the result will be either a systemic pesticide poisoning or a topical lesion frequently observed on the skin or in the eyes. Since most acute intoxications are from the carbamate and organoposphate insecticides, the systemic manifestations are cholinergic and are due to the inhibition of acetyl cholinesterase and the resultant accumulation of the neurotransmitter acetylcholine, at the synapse. Topical effects, in contrast, either are the result of the irritant properties of the chemicals in the formulation or have an allergenic basis for their occurrence (3). However, topical effects are not necessarily exclusively the result of exposure to the active ingredient in the formulation but may result from a reaction to one or more inerts as well. 

Salicylate poisoning or serious intoxication often occurs in children and sometimes is fatal. Salicylate intoxication should be seriously considered in any young child with coma, convulsions, or cardiovascular collapse. The fatal dose varies with the preparation. Death has followed use of 10-30 g of sodium salicylate or aspirin in adults, but larger amounts have been ingested without a fatal outcome. The lethal dose of methyl salicylate (oil of wintergreen, sweet birch oil, gaulthe-ria oil, betula oil) is considerably less than that of sodium salicylate. As little as 4 mL (4.7 g) of methyl salicylate may be fatal in children. 

IV. Diagnosis of ethanol intoxication is usually simple, based on the history of ingestion, the characteristic smell of fresh alcohol or the fetid odor of acetaldehyde and other metabolic products, and the presence of nystagmus, ataxia, and altered mental status. However, other disorders may accompany or mimic intoxication, such as hypoglycemia, head trauma, hypothermia, meningitis, or intoxication with other dmgs or poisons. 

All organic solvents are toxic to a greater or lesser degree the prolonged inhalation of almost any vapour will produce some harmful effect on a human being. Some solvents are acute poisons, some have a cumulative poisoning effect, and others produce narcosis or intoxication on inhalation, or dermatitis on contact with the skin. Information on these aspects and on the maximum vapour concentrations permitted in working areas can be obtained from specialized reference books. The handbooks by Sax (1992) and Bretherick (1999) deal comprehensively with solvent properties and hazards. Health risks in the use of common solvents are dealt with in RSC/CEC (1986, 1988). 

Because alcohol intoxication may be simulated by many pathologic conditions, including diabetic acidosis, the postconvulsive depression of epilepsy, uremia, head injuries, and poisonings by any other central nervous depressant and some stimulants (280), a diagnosis of acute alcoholism should not be made casually chemical testing of blood, urine, or expired air is always desirable. 

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