Chiong - Toxicology Lab Final

John Miguel P.
Chiong
BS Pharmacy - 3
TOXICOLOGY CASE STUDY #3
History: A 30-year-old white male presents to your emergency department after

ingesting “white powder” from a bag that was given to him by his friend. He has
developed weakness, vomiting and diarrhea.
PMH:
None.
Physical
Examination:
T: 100.4 ° F HR: 120 bpm RR: 20 breaths per minute BP: 90/60
mm Hg General: He is awake and alert, but actively vomiting
and having diarrhea.
Pulmonary: Clear to auscultation.
CV: Tachycardic without murmur, normal perfusion.
Neurologic: GCS 15. Cranial nerves II-XII intact. Remaining neurologic
exam is nonfocal.
QUESTIONS CASE STUDY #3
1. From what type of poisoning is this patient suffering and what are the typical signs
and symptoms?
- Arsenic poisoning, Arsenic is a periodic table element that is toxic to most kinds
of life. Many food products contain trace levels of arsenic, which is usually
harmless to humans in such small concentrations. However, bigger doses can be
dangerous. The symptoms of arsenic poisoning may differ based on the amount
and length of exposure. Acute arsenic poisoning can induce symptoms such as
stomach discomfort, vomiting, diarrhea, dehydration, and shock. Chronic arsenic
exposure can cause skin lesions, diabetes, cardiovascular disease, and cancer.
2. What initial therapy, if any, should be instituted?

- The patient needs chelation therapy, medications that bind to heavy metals and
remove them from the body. Heavy metals cannot be detected by blood testing.
These should not be used as a testing technique. Because heavy metals are
extremely dangerous, allowing them to remain in the human body's circulation
would kill them. As a result, heavy metals are stored in fatty tissue by the body.
Unfortunately, this might sometimes imply inside the brain. Furthermore, the body
accumulates heavy metals within cell walls because the chemical structure of the
molecules used to create cell walls is comparable to that of heavy metals. The
human body constructs its cell walls using "healthy metals" such as calcium,
magnesium, manganese, and potassium. When it is poisoned with heavy metals,
it may unintentionally transfer the dangerous heavy metals into the cell walls
rather than the beneficial metals.
History: A 12-month-old male presents to your emergency department after ingesting a

watch battery, which was left out on the counter. He has been drooling since the
incident and refusing his bottle.
PMH:
None.
Physical
Examination:
mm Hg General: He is awake, alert and calm in appearance.
HEENT: Drooling from
mouth. Pulmonary: Clear to
auscultation.
CV: Regular rate and rhythm without murmur, normal
perfusion. Extremities: Normal.
1. What is the initial approach to this patient?

- When possible, the initial assessment should include the patient's age, battery
size, time of ingestion, and current position of the battery. These are the most
essential risk variables for predicting serious injury. Expert opinion from similar
medical backgrounds is used to provide therapy recommendations. More
research is needed to better define the role of acid blockade, endoscopy, and
Magnetic Resonance Imaging in the postremoval treatment of these individuals,
as well as to establish the best time to begin enteral feeding. Advocacy efforts
are ongoing and critical in reducing the frequency of these potentially
catastrophic injuries.
2. What complications may be associated with these types of batteries?

- Electrical discharge, pressure necrosis, blockage, and leaking of battery contents
are all possible causes of complications. Within a few hours of consumption,
full-thickness burns, oesophageal perforation, trachea-oesophageal, and even
oesophago-aortic fistulation are possible.
3. On x-ray, the battery is located in the esophagus at the level of the aortic arch. What
therapy is indicated?
- It needs to be taken out right away where the battery is located. Endoscopy is the
removal method of choice. Foley catheters have been recommended for the
removal of esophageal foreign bodies, however their use carries an added risk of
aspiration. Magnetized probes are a possibility in the hands of an expert.
History: A 19-month-old male presents to your emergency department with his parents
after ingesting 35 mL of phenytoin suspension. Parents relate that he appears to be
“wobbly” and “sleepy”. He has had no vomiting and no seizure activity.
PMH: Brain aneurysm, seizure disorder, feeding

disorder. Physical Examination:
mm Hg General: He appears
very sleepy but is arousable and has an intact gag reflex.
HEENT: Examination reveals horizontal and vertical nystagmus.
Mouth examination reveals gingival hyperplasia.
Pulmonary: Clear to auscultation.

CV: Regular rate and rhythm without murmur, capillary refill
normal. Neurologic: GCS = 15, cranial nerves II-XII intact.
Truncal ataxia is present.
Hyperreflexia present, all DTR’s.
1. What are the usual signs of acute phenytoin toxicity?

- Coma
- Confusion
- Seizures
- Dizziness
- Fever
- Low blood pressure
- Muscle rigidity or spasms
- Sleepiness
2 What initial therapy should be instituted?

- Phenytoin consistently binds to activated charcoal, obstructing absorption. One
dosage of activated charcoal may be helpful for acute ingestions, especially for
large acute overdoses when phenytoin reduces GI motility and delays
absorption.
3. What are the signs and symptoms of chronic phenytoin toxicity?

- The neurotoxic effects range with concentration and can range from moderate
nystagmus to ataxia, slurred speech, vomiting, lethargy, coma, and death.
Interestingly, in very high quantities, phenytoin can cause seizures. The
neurological and cardiovascular systems are where phenytoin mostly shows its
harmful effects. Only very rarely can oral phenytoin overdose result in
cardiovascular damage. instead, neurotoxicity is the major side effect.

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John Miguel P.

TOXICOLOGY CASE STUDY #3

History: A 30-year-old white male presents to your emergency department after

QUESTIONS CASE STUDY #3

2. What initial therapy, if any, should be instituted?

TOXICOLOGY CASE STUDY #4

History: A 12-month-old male presents to your emergency department after ingesting a

QUESTIONS CASE STUDY #1

1. What is the initial approach to this patient?

2. What complications may be associated with these types of batteries?

PMH: Brain aneurysm, seizure disorder, feeding

Pulmonary: Clear to auscultation.

Hyperreflexia present, all DTR’s.

QUESTIONS CASE STUDY #5

1. What are the usual signs of acute phenytoin toxicity?

2 What initial therapy should be instituted?

3. What are the signs and symptoms of chronic phenytoin toxicity?

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