Pharmacology for Dentistry

402 Section 11/ Chelating Agents & Treatment of Poisoning

• Nausea and vomiting.


• Blurring of vision, hyperemia of optic
  disc and blindness.


• Pancreatitis.


• Albuminuria.


• Coma followed by death.

Treatment of Methanol Poisoning

• Gastric lavage, activated charcoal.


• Hospitalization: Correction of
  acidosis.


• IV/oral ethyl alcohol.


• Maintenance of nutrition.


• Administration of folinic acid (1 mg/
  kg, IV) together with folic acid (1 mg/
  kg IV) to accelerate the metabolic
  degradation of formate.


• Administration of 4-methylpyrazole
  (inhibitor of alcohol dehydrogenase).


• In severe case: Haemodialysis.

TREATMENT OF SNAKE BITE

Vipers, Cobras and Kraits are the common
poisonous snakes and in India 40,000 to
50,000 deaths recorded per year due to
snake bite.

Local Signs & Symptoms in the Bitten
Part

• Fang marks.


• Local pain & bleeding.


• Bruising.


• Lymphangitis.


• Inflammation (swelling, redness,
  heat).


• Blistering.


• Lymph node enlargement.


• Local infection, abscess formation &
  necrosis.

Generalised (Systemic) Symptoms &

Signs

• Nausea, vomiting, malaise, abdominal
  pain weakness.


• Visual disturbances, faintness, collapse,
  shock, hypotension, pulmonary edema
  & conjunctival edema.


• Bleeding & clotting disorders.


• Skeletal muscle breakdown.


• Acute pituitary/adrenal insufficiency.
  First-aid Treatment


• First aid treatment is carried out
  immediately before hospitalisation.


• Immobilise the bitten limb with a splint
  or sling.


• Consider pressure-immobilisation for
  some elapid bites.


• Avoid any interference with the bite
  wound as this may introduce infec-
  tion, increase absorption of the venom
  and increase local bleeding.


• Tight (arterial) tourniquets are not
  recommended.

Treatment in hospital

• Rapid clinical assessment and
  resuscitation.


• History (especially the snake identifi-
  cation).


• Physical examination.


• Investigation/laboratory tests:
  
  
  • 20 minute whole blood clotting test
    (20 WBCT).
  
  
  • Haemoglobin concentration/
    haematocrit.
  
  
  • Platelet count.
  
  
  • WBC count.
  
  
  • Biochemical abnormalities.
  
  
  • Urine examination etc.