Toxicology Lecture 10 (Chapter 7 Volatiles)

VOLATILES
 Definition: volatiles are substances that

easily vaporized.
 Volatiles of study include:
ethyl alcohol (Ethanol), methanol, iodine,
kerosene, and hydrocarbons.
1) Ethanol
1) Ethanol is a clear, colorless liquid having a slight pleasant odor.
• Source: from fermentation of sugar using living yeast.
• Uses: used as antiseptic, organic solvent, in cosmetic lotions and in
beverages.
 Conditions of Poisoning:
• Accidental:
- Children (drink cosmetic preparations containing ethanol).
- Addicts (acute on top of chronic).
• Homicidal: To facilitate rape and robbery.
 Pharmacokinetics:
• Absorption:
 Major part (80%) from small intestine.
 Minor part (20%) from stomach & large intestine.
Ethanol…..
Distribution:
 To all tissues and body fluids, parallels the water content of each.
 Crosses the alveolar membrane, the blood brain barrier as well
as the placenta.
Metabolism:
 90-98% is metabolized in liver.
• Ethanol + Alcohol dehydrogenase > Aldehyde + Acetaldehyd
> Acetic acid CO2 + H2O.
Ethanol…
Excretion: Ethanol is excreted as unchanged through:
 Urine.
 Breath.
 Small amounts can be detected in sweat, tears, bile, gastric
juice and other secretions.
Fatal dose: 300-400 ml of pure alcohol.
• Fatal period: Within 10 hours.
Mechanism of Action of Ethanol
Central
 Ethyl alcohol depress central nerve system in descending order
from cortex to medulla , depending on the ingested amount.
 Ethanol effects are potentiated with barbiturates.
Peripheral
 Vasodilatation and false sensation of heat due defect of heat
centre
 Ethanol metabolism: decrease in nicotinamide adenine
dinucleotide (NAD/NADH) ratio. NAD is co enzyme that
facilitate metabolicpathway.
Clinical Picture
According to blood alcohol concentration
 Mild intoxication 150 mg/100 ml (normal: 50 mg/100 ml)
 Alcoholic euphoria (CNS depression). –
 Abnormal behavior and sexual crimes
 Moderate intoxication (150-300 mg/100 ml)
 Staggering gait (drunkard gait)
 Slurred speech with tremor of hands and lips due to acetaldehyde.
 Vomiting (local gastric irritation a
 Sever intoxication (more than 300 mg/100 ml)
 weak and rapid pulse, low B.P.
 Subnormal temperature, slow and shallow respiration with alcoholic
smell & pale moist skin
 Fatal intoxication (more than 500 mg/100 ml)
 Death occurs due to Respiratory center inhibition leading to central
asphyxia.
INVESTIGATIONS
Routine laboratory investigations
 ABG
Decreases serum glucose
Toxicological screening
 Rapid tests: finger to the nose and heel to shin of tibia
 Chemical analysis: Blood, urine, and expired air
Treatment
 Supportive measures :ABC
 GIT decontamination: Gastric lavage with NaHCO3 then leave
strong coffee or tea in the stomach
 Elimination of absorbed poison: Forced alkaline diuresis using
NaHCO3.
 Hemodialysis is very effective , it is indicated if : blood alcohol>
350 mg %, and acid-base and or electrolyte disturbance
 Antidotes: no specific antidote
 Symptomatic:
 Metabolic acidosis: NaHCO3.
 Hyporglycemia 10% -50% dextrose solution IV.
 Hypothermia: warm the patient.
 Shock: Fluids and inotropic agents
Methyl alcohol (Methanol, Wood alcohol )
 Source: From distillation of wood.
 Uses:
 Antifreeze solvent, fuel, remover and household cleaners.
 It is used to adulterate ethyl alcohol(cheap).
 Conditions of poisoning
• Accidental:
- Ingestions of adulterated beverages.
- Less commonly by inhalation of fumes, or through percutaneous absorption.
 Pharmacokinetics:
 Absorption: inhalation, ingestion and skin contact.
 Distribution: to all of the body but mainly distributed to optic nerve.
 Metabolism: (90% in liver) slower than that of ethanol
 N.B. Formaldehyde & Formic acid are more toxic
metabolites than methanol itself.
 Excretion: through kidneys and lungs.
 Fatal dose:
- 60 - 100 mL of pure methanol.
- 15 mL produce blindness
 Fatal period: Few hours.
 Mechanism of Action:
 CNS depression (more than Ethanol).
 G.l.T. irritation.
Mechanism of Action:
 CNS depression (more than Ethanol).
 G.l.T. irritation.
 Metabolic acidosis due to:

1- Accumulation of formic acid.
2- Accumulation lactic acid, which is generated by lowering of hepatic
NAD/NADH ratios.
 -Ocular toxicity as formic acid inhibits cytochrome oxidase enzyme
in the optic nerve resulting in cellular ischemia, optic degeneration
and optic atrophy.
Clinical Picture
• 1. GIT: nausea, vomiting, colic, and back pain (pancreatitis).
• 2. CNS depression: convulsions then coma, with weak rapid
pulse, o pressure, subnormal temperature and slow shallow
respiration.
• 3. Eyes: pain in the eyes, photophobia, blurring of vision and
dilated fixed pupils.
4. Metabolic acidosis: tachypnea (air hunger) and confusion.
 Cause of death: Central asphyxia
Investigations
1- Routine laboratory investigation.
 ABG: metabolic acidosis.
 Serum glucose: usually increased
2- Toxicological screening.
3- Fundus Examination: Initial and serial examinations are
essential to assess optic nerve affection.
Treatment:
1. Supportive measures: ABC
2. GIT decontamination: Gastric lavage with NaHC03 then leave strong
coffee or tea in the stomach.
3. 3. Elimination of the absorbed poison:
- Forced alkaline diuresis.
 Hemodialysis is indicated if:
 methanol blood level >50 mg/dl.
 Visual symptoms
 Severe metabolic acidosis.
 Renal failure.
 Failure of treatment
Treatment (cont..)
 Antidotes:
a) Ethanol: Competes with methanol for alcohol dehydrogenase enzyme.
Therefore, it reduces the metabolism of methanol to its toxic
metabolites.
b) 4-methyl pyrazole (fomepizole): Inhabits alcohol dehydrogenase
enzyme.
 Advantage: It does not cause CNS depression like ethanol.
c) Folinic acid (leucovorin calcium): Converts formic acid to C0 2 +
H2O.
 Symptomatic treatment:
 Metabolic acidosis: NaHCo3
 Hypoglycemia: 10-50% dextrose solution IV.
 Hypothermia: warming the patient.
 Shock: fluid expansion and dobutamine.
 Care of eyes
Iodine
 It is a topical disinfectant. It is a household poison, and

poisoning occurs due to accidental\suicidal ingestion.
Action: corrosive effect on mucous membranes
Clinical picture of toxicity: burning taste, abdominal pain ,
vomiting of brown stained vomitus, may be blue if stomach
contains starch
Treatment of Iodine Poisoning
 Gastric lavage with soluble starch or activated charcoal to adsorb
iodine
 Milk, as demulcent
 1-2% sodium thiosulfate is then given to convert iodine to iodide
 Atropine 1mg, to reduce the secretions.
 IV Fluid as well as symptomatic treatment.
 Corticosteroids may be given to reduce the chance of esophageal
stricture
Hydrocarbons
 Hydrocarbons are the simplest organic compounds contain only carbon

and hydrogen.
 Source: Petroleum distillation.
 Uses: Hydrocarbons are one of the most important
energy resources.
 Main types of hydrocarbons:
1- Aliphatic: gasoline, naphtha, kerosene and turpentine.
2- Aromatic: benzene, toluene and xylene.
3- Halogenated: methylene chloride, carbon tetrachloride trichloroethylene
and tetrachloroethylene
Kerosene Poisoning
 Source: it is a petroleum product.
 Uses: It is used as fuel, solvent, paint remover and lubricant
 Condition of poisoning:
 • Accidental: in children. r
 • Suicidal: in young females.
 Fatal dose:
- 20 ml.
 Fatal period:
- 24 hours (central asphyxia).
- Few days (pneumonia).
Mechanism of Action of Kerosene
1. Local:
- Skin irritation.
- Mucus membranes irritation.
2. Remote:
CNS depression due to:
-Direct effect (large amount).
-Hypoxia due to chemical pneumonitis.
-Acidosis
Clinical picture:
1. Acute: (Ingestion or inhalation)

- G.l.T irritation: nausea, vomiting, colic and diarrhea.
- C.N.S. depression: coma with cyanosis death in 24 hours.
- Lung: aspiration pneumonitis due to its aspiration
during vomiting or ingestion.
2. Chronic (Inhalation)
 Anemia, weight loss, weakness, numbness and paresthesia.
Treatment:
 Supportive measures: ABC
 GIT decontamination:
 Emesis is Contraindicated (aspiration pneumonitis).
 Gastric lavage (with cuffed endotracheal tube) is indicated in:
Ingestion of large amounts.
0ther toxic additives.
 Decontamination:
1. Remove contaminated clothes.
2. Wash skin with soap and water.
irrigate exposed eyes with copious water.
 Symptomatic (aspiration pneumonitis)
1. Antipyretics for fever
2. Antibiotics for bronchopneumonia.
3. Bronchodilators for bronchospasm.
Corticosteroids for preventing pneumonitis, but some authors
claimed to be ineffective

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VOLATILES

 Definition: volatiles are substances that

 Metabolic acidosis due to:

 It is a topical disinfectant. It is a household poison, and

 Hydrocarbons are the simplest organic compounds contain only carbon

1. Acute: (Ingestion or inhalation)

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