Table of Toxins and their Treatments: Categorized

Table of Toxins and their Treatments

Categorized

Toxin	Source	Symptoms / Mechanism	Treatment
Nitrogen Dioxide (NO₂)	Air Pollutant	Can cause pneumonitis by direct effects on lungs upon inhalation.
Ozone (O₃)	Air Pollutant	Causes shallow, rapid breathing, decreased pulmonary compliance, cough, tightness of chest, dry throat. Due to free-radical intermediates generated by ozone.
Particulate Matter	Air Pollutant	Pneumoconiosis: Caused by inhalation of dusts. Silicosis is the most common form of pneumoconiosis. Silica dusts are engulfed by macrophages ------> fibrotic nodules through the lung Asbestosis: Pulmonary fibrosis. Risk for bronchial cancer, especially in smokers. Risk for malignant mesothelioma.
Carbon Monoxide (CO)	Air Pollutant Automobile exhaust, inadequately ventilated stoves.	Cherry Red Tissues, resulting from carboxyhemoglobin. Hypoxia. Headache, from cerebral edema.	Ventilate room and remove gas. Supportive measures: respiration, hydration, acid-base balance. Hyperbaric O₂: O₂ at greater than 100% will decrease the half-life of CO from 320 minutes to 25 minutes.
Sulfur Dioxide (SO₂)	Air Pollutant Fossil fuel combustion	Forms sulfurous acid on contact with mucous membranes, irritating membranes. Membrane irritation, bronchial constriction, especially in asthmatics.
beta-Blockers	Drug overdose	Hypoglycemia, heart blocks, arrhythmias, cardiac failure.	Glucagon can reverse the effects of hypoglycemia.
Acetaminophen	Drug overdose	Central hepatocellular necrosis, hepatotoxicity. Alcohol and starvation can cause acetaminophen metabolism to divert to microsomal metabolism, which has N-aceto-p-benzoquinoneimine (BZQ) as a hepatotoxic intermediate.	N-Acetylcysteine provides reduced sulfhydryl groups and restores glutathione to its reduced form.
Amphetamines (Cocaine)	Drug overdose	Moderate OD: Confusion, delirium, arrhythmias, HTN, panic. Severe OD: Convulsions, circulatory collapse, hyperpyrexia, coma, death. Severe intoxication is rare in adults.	Supportive.
Anticholinergics (Atropine)	Drug overdose		Physostigmine, carbamate cholinesterase inhibitor that does not enter the CNS. It increases amounts of ACh to combat the toxin.
Aspirin (Salicylates)	Drug overdose	Compensated metabolic acidosis, compensated by hyperventilation. Sx: tinnitus is often first sign of toxicity, dizziness, confusion. At higher doses: Fever, dehydration, convulsion, coma. Children are more prone to it than adults.	NaHCO₃ to alkalinize urine and increase excretion of salicylate. Hemodialysis and respiratory support are needed in severe cases.
Barbiturates (Phenobarbitol)	Drug overdose	Severe respiratory depression, perhaps some CV depression. Death by central respiratory arrest.	NaHCO₃ to alkalinize the urine and increase excretion, as phenobarbitol is an organic acid.
Benzodiazepines (Diazepam)	Drug overdose	Rarely fatal by itself, but effects similar to barbiturates.	Flumazenil
Calcium-Channel Blockers (Verapamil)	Drug overdose	Bradyarrhythmias, heart block, cardiac arrest	Calcium
Digitalis (Digoxin)	Drug overdose	GI: Anorexia, nausea, vomiting are usually the earliest signs of toxicity. CV: Toxicity results from severe hypokalemia, causing arrhythmias: Bradycardia, ectopic beats, AV block, sinus arrest. CNS: Centrally stimulated vomiting, disorientation, color and visual disturbances.	Digoxin-specific antibody fragments.
Fibrinolytic agents: Streptokinase, Urokinase	Drug overdose	Hemorrhage	Aminocaproic Acid or Tranexamic Acid is given to counteract the effects of the fibrinolytic agents.
Gold Salts	Drug overdose	Nephrosis, aplastic anemia.	Penicillamine binds up gold salts and promotes their excretion. Dimercaprol can also be used.
Heparin	Drug overdose	Hemorrhage	Protamine Sulfate, which must be dosed carefully, as protamine sulfate is itself an anti-coagulant. 1 mg of protamine sulfate for every 100U of heparin overdose.
Iron	Drug overdose	As few as 10 tablets can kill a child. Necrotizing Gastroenteritis: vomiting, abdominal pain, blood diarrhea, then metabolic acidosis, coma, death.	Supportive therapy, gastric lavage. Deferoxamine (Desferal) IM or IV to chelate iron in blood.
Isoniazid	Drug overdose	Hepatotoxicity in the elderly. Peripheral Neuritis in slow acetylators, occurs because Isoniazid is a competitive inhibitor of pyridoxine. Optic Neuritis. Seizures in some people.	Pyridoxine (Vit-B₆) can reverse convulsions and peripheral neuritis.
Opioids (Heroin)	Drug overdose	Coma, pinpoint pupils, respiratory depression. Histamine degranulation. Complete respiratory collapse in severe poisoning, death by central respiratory arrest.	Respiratory support. Careful with O₂ therapy as it may suppress stimulation of breathing in the carotid chemoreceptors. Administer it with CO₂. Naloxone is opioid antagonist. Nalorphine is alternative antagonist.
Tri-Cyclic Antidepressants (TCA's)	Drug overdose	The leading cause of drug-overdose death in the U.S. is from Tri-Cyclics. Wide variety of symptoms can be seen: Arrhythmias, CNS confusion and hallucinations, GI disturbance, coma, stupor, death.	Symptomatic and supportive therapy. Physostigmine may be indicated if anti-cholinergic symptoms are prominent. NaHCO₃ increases urinary excretion.
Warfarin	Drug overdose Rodenticide	Hemorrhage	Fresh frozen plasma, Factor IX are used when immediate coagulation is needed. Phytonadione (Vitamin-K) is given to reverse the effects of warfarin, but it takes 24 hours to take effect.
Ethanol	Drug overdose Solvent; Alcohol	Severe respiratory depression, cardiorespiratory arrest.	Respiratory support.
Nitrites p-Aminophenol Aniline Nitrobenzene p-Aminopropiophenone Atrazine	Fertilizer	Methemoglobinemia: Especially in babies. Iron is kept in the ferric (Fe⁺³) state, which cannot bind O₂ ------> baby dies of anoxia in extreme cases. The baby will appear extremely cyanotic, hence methemoglobinemia is nick-named Blue Baby Syndrome. Methemoglobin is chocolate brown in color.	Methylene Blue can be given as antidote, as it helps to convert methemoglobin back to hemoglobin.
Methylbromide	Fumigant
Phosphine	Fumigant From aluminum or zinc phosphide, in the presence of moisture.	Severe pulmonary irritation, pulmonary edema.
Cyanide	Fumigant Silver polish, Fumigant, metallurgy, electroplating. Burnt plastics.	CN^- inhibits cytochrome oxidase by forming a stable complex with ferric iron (Fe⁺³), preventing it from going back down the Ferrous (Fe⁺²) state. This prevent cytochrome oxidase from utilizing oxygen, resulting in tissue hypoxia. Venous blood is bright red because it is not being deoxygenated by the tissues. Hyperventilation, followed by flushing, headache, dizziness, tachypnea. Hypoxic convulsions, death by respiratory arrest.	Nitrite: It causes methemoglobinemia which can then bind up all of the extra cyanide, driving it away from the cytochrome oxidase. Co₂ EDTA + Hydroxocobalamin: Takes up cyanide, forming cyanocobalamin (Vit B12). Thiosulfate: Give to promote the formation of thiocyanate and its subsequent excretion.
Dibromochloro-propane	Fumigant Soil fumigant for controlling nematodes	Pulmonary edema, gastric carcinoma in rats. Occupational exposure can cause oligospermia.
Ethylene Dibromide	Fumigant Soil fumigant for controlling nematodes	Pulmonary edema, gastric carcinoma in rats.
Dithiocarbamate	Fungicide
Hexachlorobenzene	Fungicide	Caused 300 deaths in Turkey in the 1950's. Caused cutaneous porphyria with skin lesions, porphyrinuria, photosensitization.
Pentachlorophenol	Fungicide Wood preservative	Thermogenic. Uncouples oxidative phosphorylation from ATP production. Fatal fever. Similar to dinitrophenols.	Ice baths, correct fluid and electrolytes, O₂.
Dinitrophenols (Dinitro-Orthocresol)	Herbicide	They are thermogenic. They uncouple oxidative phosphorylation with ATP production, release heat. High fever which can be fatal.	Ice baths, correct fluid and electrolytes, O₂.
Paraquat	Herbicide Bipyridyl	Forms a superoxide radical ------> singlet O₂ radical, which attacks lipids in cell membranes ------> lipid hydroperoxides which form lipid free radicals and do damage in lungs. Paraquat affects the lung, regardless of route of exposure. Pneumonitis.	Gastric lavage, cathartics, to prevent further GI absorption of paraquat. Hemodialysis and hemoperfusion may be helpful to detoxify.
2,4,-Dichlorophenoxy-acetic Acid (2,4-D)	Herbicide Chlorophenoxy	Does not contain dioxin. Rapidly excreted with short half-life. Relatively safe. High doses have shown stiffness, neuromuscular paralysis in lab animals.
2,4,5-Trichlorophen-oxyacetic Acid (2,4,5-T)	Herbicide Chlorophenoxy	Does contain dioxin. Rapidly excreted with short half-life. Relatively safe. High doses have shown stiffness, neuromuscular paralysis in lab animals.
Dioxin (TCDD) 2,3,7,8-Tetrachloro-p-dioxin	Herbicide Chlorophenoxy Contaminant of some chlorophenoxy herbicides, Agent Orange	Long half life of about 7 years. Potent inducer of Cyt-P450 enzymes. Deadly to guinea pigs, hamsters. Much less toxic to humans. May be carcinogenic in large quantities. Chloracne = Severe dermatitis caused by dioxin.
Benzene Hexachlorides	Insecticide
Chlorinated Cyclodienes (Aldrin, Dieldrin Heptachlor, Chlordane)	Insecticide	Similar to DDT, except they caused fatalities and can be absorbed through the skin. No longer used.
DDT Chlorophenothane (DDT)	Insecticide	Very high dose in lab animals, produces seizures. Convulsant: Mechanism of CNS stimulation appears to be delayed closing of Na⁺ channels and prevention of opening K⁺ channels. Biomagnification: Increase in presence through food chain ------> egg-shell thinning, decreased population of fish-eating birds.
Lindane, Toxaphene	Insecticide	Less persistent than DDT and used as a pesticide.
Mirex, Kepone	Insecticide	Similar to DDT. Convulsions at high doses, oligospermia, liver injury. Enterohepatic circulation and biliary excretion.	Cholestyramine can promote their fecal excretion.
Nicotine	Insecticide Botanical Insecticide Tobacco, environmental	Ganglionic stimulation causes salivation, vomiting. Neuromuscular stimulation leads to depolarizing blockade, muscular weakness. Ultimately, convulsions and central respiratory arrest.
Pyrethrum	Insecticide Botanical Insecticide From chrysanthemums	Very safe. Some people may be allergic. At very high dose, they show the same convulsant action as DDT.
Rotenone	Insecticide Botanical Insecticide Plant roots	Rotenone blocks mitochondrial respiration. Oral ingestion produces GI irritation, nausea, vomiting. Conjunctivitis, dermatitis, pulmonary irritation.
Aldicarb Aminocarb Carbaryl Carbofuran Dimetan Dimetilan Isolan Methomyl Propoxur Pyramat Pyrolan Zectran	Insecticide Carbamate	They carbamylate the cholinesterase enzyme, which is a more labile bond and thus is considered reversible. They are not transformed by Cyt-P450 enzymes, but rather are active ingested form. Symptoms: Similar but less severe than those seen for organophosphates.	Atropine. 2-PAM (Pralidoxime) does not work and in fact may make the symptoms worse, by further potentiating ACh.
Azinophos-methyl Chlorfenvinphos Diazinon Dichlorvos Dimethoate Fenitrothion Malathion Parathion-methyl Trichlorfon	Insecticide Organophosphate	Organophosphates are cholinesterase inhibitors that irreversibly bind to and inhibit cholinesterase, increasing levels of ACh and cholinergic activity. Thus they are cholinomimetic. SLUD: Salivation, Lacrimation, Urination, Defecation. Sweating, bradycardia, hypotension. Peripheral depolarizing blockade and paralysis. Confusion, ataxia, convulsions. Death by central respiratory arrest.	2-PAM (Pralidoxime): Only effective within the first few minutes of exposure. It is a strong nucleophile that can bind with the organophosphate, releasing it from cholinesterase, before the bond has aged. Atropine is treatment of choice after the bond has aged and become irreversible.
Parathion	Insecticide Organophosphate	Biotransformed to Paraxon before it has its toxic effect.	2-PAM, Atropine (see above)
Triothocresylphos-phate (TOCP) Mipafox Leptophos	Insecticide Organophosphate	They may cause delayed neurotoxicity sequelae. Residual paralysis and axonal degeneration, occurring weeks after an episode of organophosphate poisoning.
Antinomy	Metal	Toxicity is similar to arsenic.
Barium	Metal	Soluble barium salts (BaCl2) produce CV and CNS effects.
Beryllium	Metal	Skin lesions, dermatitis, granulomas. Causes cancer in lab animals. Causes pneumonitis by direct irritation to the lungs.
Chromium	Metal	Cr⁺³ is essential as a glucose tolerance factor and is used therapeutically in treatment of NIDDM. Cr⁺⁶ is a carcinogen of the respiratory tract.
Cobalt	Metal	Essential metal in vitamin B-12. Excess causes polycythemia, or when combined with alcohol, it causes cardiomyopathy.
Copper	Metal	Wilson's Disease: Autosomal-recessive deficiency of ceruloplasmin: retardation, biliary cirrhosis.	Penicillamine as the primary chelating agent, to get rid of excess copper.
Manganese	Metal	Chronic exposure produces Parkinson-like syndrome.	Treated similar to Parkinson's Disease
Nickel	Metal	Nickel Carbonyl (Ni(CO)₄) is the most toxic form of nickel and can cause pneumonia. Nickel Subsulfate: Carcinogen that is inhaled Nickel Itch: Dermatitis caused by elemental nickel jewelry.
Silver	Metal	Causes discoloration of skin known as argyria.
Tin	Metal	Lead Line along gingiva
Zinc	Metal		CaNa₂ EDTA
Fluoride	Metal Added to drinking water	High concentrations: discoloration of teeth. Extreme concentrations: Brittle bones.
Cadmium	Metal Alloys, dye, batteries, plastics. In environment, concentrates in tobacco and rice.	The metal accumulates in the pancreas, thyroid, and testis. Kidneys: Major site of damage. Cadmium metallothionein complexes from the liver go to the kidney, where the cadmium is released and damages the parenchyma. Resp: Emphysema and pulmonary fibrosis. Itai-Itai Disease: "Yuck-Yuck," from cadmium exposure in Japanese rice. Cadmium caused osteomalacia. Cancer: In lab animals, lung and prostate cancers. To a lesser extent, kidney and stomach cancers.	Metal chelators don't work. Supportive therapy only.
Arsenic (As⁺³, As⁺⁵)	Metal Heavy Metal Pesticides, water. Occupational (sheep dip, vineyard sprays)	Signs: Mees' Lines in fingernails. CV: Vasodilation, increased capillary permeability. Blackfoot Disease = Gangrene of extremities. 3 D's: diarrhea, dermatitis, dementia. Diarrhea: Rice-water stools, abdominal distress. Dermatitis: Hyperkeratosis of palms and soles, boils, hyper-pigmentation with long-term exposure. Dementia: Polyneuropathy, encephalopathy. Cancer: Squamous cell carcinoma, Basal-cell carcinoma. Lung cancer.	Supportive. Metal Chelators: Dimercaprol is treatment of choice. Also penicillamine, succimer.
Arsine Vapor (AsH₃)	Metal Heavy Metal	Acute Poisoning: Hemolysis, anemia, hemoglobinuria, jaundice and kidney injury. GI symptoms less prominent.	Supportive. Metal Chelators: Dimercaprol, Penicillamine, Succimer
Lead	Metal Heavy Metal Paint-chips in older homes, leaded gasoline, water laced with lead from lead pipes, improperly glazed pottery, occupational.	Lead Line along gingiva. Lead palsy, lead colic. Lead encephalopathy: Mental retardation, convulsions in children. Peripheral neuropathy is seen in adults. Hem: Basophilic stippling, microcytic hypochromic anemia, ALA + coproporphyrin found in the urine.	CaNa₂ EDTA is first-choice chelator. Add Dimercaprol (BAL) in more severe cases. Add Succimer in cases of severe lead poisoning in kids. Calcium Gluconate can be given for the relief of lead colic.
Mercury Inorganic Salts (HgCl, HgCl₂)	Metal Heavy Metal Industrial discharge into rivers. In the past, medicinal sources: acne skin creams, diuretic, cathartic, antiseptic.	Intestinal pain, colic, vomiting. Concentrates in kidney and can have effects in kidney. Acute poisoning: tubular nephritis, shock, diarrhea, superficial corrosion. Mercury Line along gingiva may be seen chronically, ashen-gray appearance in the mouth.	Gastric lavage. Dimercaprol IV for symptomatic patients. Don't give it orally. Succimer is a new orally effective chelator that seems to be effective.
Mercury, Organic (Methylmercury) (CH₃Hg)	Metal Heavy Metal Fungicide They are accumulated in algae and concentrate in fish through the food chain.	Paresthesias, ataxia. Visual-field Constriction. Mental retardation if developing fetus is damaged, even at levels that are not symptomatic to the mother.	Don't use dimercaprol: It increases mercury levels in the brain! Non-absorbable polythiol resin will help excrete organic mercury that is in enterohepatic circulation.
Mercury, Elemental Vapor	Metal Heavy Metal Usually occupational, dental amalgams.	Lead Line along gingiva. Neuropsychologic. Tremors, depression, insomnia, shyness, reduced self-esteem.	Dimercaprol, Succimer. Same as mercury salts, except gastric lavage is not helpful.
Aluminum	Metal Used in antacids	Shaver's Disease: Pulmonary fibrosis resulting from aluminum inhalation.
Alpha-Nephthyl Thiourea	Rodenticide
Phosphorous Zinc Phosphide	Rodenticide	GI irritation, vomiting. Vomitus is luminescent and has a garlic odor. GI hemorrhage may ensue, with death within 24 hours. Or, severe liver injury may ensue. Chronic Complications: Anemia, bronchitis. Phossy Jaw = Necrosis of the mandible.
Sodium Fluoroacetate	Rodenticide	Metabolized to fluorocitrate, which then inhibits aconitase in the citric acid cycle. CNS and CV toxicities.
Strychnine	Rodenticide	It inhibits glycine receptors in the CNS, producing severe CNS excitation. Glycine is primarily in the spinal cord. Stiffness of face and neck muscles, convulsions. Opisthotonos: Body hyperextended, arched backward, with head and heals on ground.	Prevent convulsions, respiratory support. Minimize sensory stimuli. Diazepam for convulsions. May need to use general anesthetics or neuromuscular blocking agents (tubocurarine).
Red Squill	Rodenticide From plant bulbs containing scillaren glycosides	Scillaren glycosides act similar to Digitalis. Cardiotoxicity, arrhythmias, convulsions.
Thallium	Rodenticide Metal	Hazardous because it is not selectively toxic for rodents. GI toxicity, brain, liver, kidney. Reddening of the skin, neuropathy, alopecia are characteristic signs. May also see psychoses, delirium.	Prussian Blue (ferric ferrocyanide) interrupts the enterohepatic circulation of Thallium, enhancing its excretion.
Isopropanol	Solvent Alcohol Rubbing Alcohol	Produces CNS depression and severe gastritis. Can also cause kidney injury.
Methanol	Solvent Alcohol Canned fuels, paints, paint-removers, anti-freeze.	Formaldehyde and formic acid are products of metabolism. Metabolic acidosis, blindness, both due to the accumulation of formic acid. Formaldehyde effects: (1) It irritates mucous membranes, (2) Occupational exposure can cause asthma, (3) It can provoke skin reactions in sensitive subjects.	Correct the acidosis. Ethanol: Ethanol has a 100-fold better affinity for alcohol dehydrogenase than methanol, thus it will displace methanol as a substrate. 4-methylpyrazole is a specific inhibitor of alcohol dehydrogenase that may be used instead of ethanol. Dialysis may be necessary.
Aliphatic Hydrocarbons	Solvent Aliphatic Hydrocarbon	Methane, ethane, propane, butane are harmless unless they're in such high concentration that they displace O₂. Higher molecular-weight hydrocarbons are CNS depressants. N-hexane is also a neurotoxin.
Gasoline and Kerosine	Solvent Aliphatic Hydrocarbon	CNS Depression. Ingestion is dangerous because it can lead to aspiration into lungs ------> hemorrhagic pulmonary edema and death within 24 hrs.	Gastric lavage is usually contraindicated, because of danger of aspiration.
Benzene	Solvent Aromatic Hydrocarbon Gasoline, pumping gas.	CNS Depression with acute exposure. Chronic: aplastic Anemia, leukemia, due to a number of different active metabolites.
Toluene	Solvent Aromatic Hydrocarbon Glue Sniffing	CNS Depression, but no hematologic abnormalities or cancer.
Diethylene Glycol	Solvent Glycol	Renal toxicity same as with Ethylene Glycol. No longer used.
Ethylene Glycol	Solvent Glycol Antifreeze, automobile radiators	Biotransformed by Alcohol Dehydrogenase and Aldehyde Dehydrogenase into Oxalic Acid, which chelates Ca⁺² and damages the kidney. Also, metabolic acidosis from the oxalic acid.	(1) Ethanol, to displace ethylene glycol from its substrate. (2) NaHCO₃ for the metabolic acidosis. (3) Parenteral Ca⁺², to replace chelated Ca⁺² and prevent tetany.
Propylene Glycol	Solvent Glycol Drug solvent	It does not produce kidney injury.
Glycol Ethers (Ethylene Glycol Monomethyl Ether, Ethylene Glycol Monoethyl Ether)	Solvent Glycol Ether Films, wire insulation, paint, fingernail polish.	Teratogenic, testicular atrophy.
Propylene Glycol Monomethyl Ether	Solvent Glycol Ether	It is not teratogenic and is a safe compound.
Carbon Tetrachloride (CCl₄)	Solvent Halogenated Hydrocarbon	It is metabolized by Cyt-P450 to the trichloromethyl (Cl3C) free radical. Radical attacks membrane lipids ------> lipid peroxidation ------> increased intracellular Ca+2 and cell death. Symptoms: CNS Depression, cardiotoxicity (sensitizes heart to catecholamines), kidney injury, liver injury, liver cancer.
Chloroform (CHCl₃)	Solvent Halogenated Hydrocarbon	CNS Depression. May produce kidney injury.
Methylene Chloride 1,1,1-Trichloroethane Trichloroethylene Tetrachloroethylene	Solvent Halogenated Hydrocarbon	All are relatively safe halogenated hydrocarbons used in commerce and industry. High levels will cause CNS Depression.
Vinyl Chloride (CH₂=CHCl)	Solvent Halogenated Hydrocarbon	CNS Depression and known carcinogen.
Methyl Bromide	Solvent Halognated Hydrocarbon	Lung toxicity when inhaled.

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