poison

poison

[poi-zuhn]
poison, any agent that may produce chemically an injurious or deadly effect when introduced into the body in sufficient quantity. Some poisons can be deadly in minute quantities, others only if relatively large amounts are involved. Factors of importance in determining the severity of a poison include the nature of the poison itself, the concentration and amount, the route of administration, the length of exposure, and the age, size, and physical health of the individual. If poisoning is suspected a physician or poison control center should be called immediately. The remainder of the poison and its container should be saved; the label may list ingredients, first aid measures, or antidotes. For most ingested poisons emptying the stomach is the most important treatment; vomiting is best accomplished in the conscious individual by administering syrup of ipecac with large quantities of water. The major exceptions to this treatment are in cases of ingestion of corrosives, such as lye, and certain hydrocarbons, such as kerosene. In corrosive ingestions a small amount of milk may be given, but vomiting should not be induced since the damage that may have already been sustained by the mucous membranes of the esophagus and stomach may advance to perforation; the patient should be seen by a physician as soon as possible. Hydrocarbons are extremely volatile, and the dangers of their being aspirated into the lungs when vomiting is induced are greater than their toxicity if absorbed into the body. In gas or vapor poisoning the patient should be carried to a nonpolluted atmosphere; artificial respiration should be employed if necessary. If any poison has been absorbed through the skin, all contaminated garments should be removed immediately and the skin washed with soap and water. Poisoning is a significant cause of accidental death in children and is best treated by prevention; potential poisons in the home should be stored in locked cabinets. In chemistry, poison refers to a substance that inhibits or slows a chemical reaction. See separate articles on botulism; carbon monoxide; food poisoning; lead poisoning; mercury poisoning; poison gas; poison ivy; snakebite; toxin.

Poison ivy (Toxicodendron radicans)

Either of two North American species of white-fruited woody vines or shrubs of the sumac, or cashew, family. The species found in eastern North America (Toxicodendron radicans) is abundant; a western species, known as poison oak, is less common. Both species are sometimes classified as genus Rhus. A key identifier is leaves with three mitten-shaped leaflets. Contact with urushiol, an oil produced by the plant, can cause severe inflammation and blistering of human skin. Urushiol may be carried from the plant on clothing, shoes, tools, or soil; by animals; or by smoke from burning plants. Because urushiol is nonvolatile, a reaction may result from wearing clothing a year or more after its contact with the plant.

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Any of several poisonous herbaceous plants of the parsley family, especially Conium maculatum, believed to be the plant that killed Socrates. It is now common in the U.S. as well as in Europe. A tall biennial, this plant has green stems spotted with red or purple, large compound leaves, and white flowers. Though the poison is concentrated in the seeds, the entire plant is dangerous to livestock when fresh. Despite their common name, poison hemlocks are not conifers (see hemlock). Water hemlocks (Cicuta species) are similar and also dangerous.

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Any substance (natural or synthetic) that, at a certain dosage, damages living tissues and injures or kills. Poisons spontaneously produced by living organisms are often called toxins, venoms if produced by animals. Poisons may be ingested, inhaled, injected, or absorbed through the skin. They do not always have an all-or-none effect; degrees of poisoning may occur, and at a given dose some substances are far more toxic than others (e.g., a pinch of potassium cyanide can kill, whereas a single dose of ordinary table salt must be massive to kill). Poisoning may be acute (a single dose does significant damage) or chronic (repeated or continuous doses produce an eventual effect, as with chemical carcinogens). The effects produced by poisons may be local (hives, blisters, inflammation) or systemic (hemorrhage, convulsions, vomiting, diarrhea, clouding of the senses, paralysis, respiratory or cardiac arrest). Agricultural pesticides are often poisonous to humans. Some industrial chemicals can be very toxic or carcinogenic. Most therapeutic drugs and health-care products can be poisons if taken inappropriately or in excess. Most forms of radiation can be toxic (see radiation injury). Seealso antidote; arsenic poisoning; fish poisoning; food poisoning; lead poisoning; medicinal poisoning; mercury poisoning; mushroom poisoning.

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In the context of biology, poisons are substances that can cause damage, illness, or death to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism. Legally and in hazardous chemical labelling, poisons are especially toxic substances; less toxic substances are labelled "harmful", "irritant", or not labelled at all.

In medicine (particularly veterinary) and in zoology, a poison is often distinguished from a toxin and a venom. Toxins are poisons produced via some biological function in nature, and venoms are usually defined as biologic toxins that are injected by a bite or sting to cause their effect, while other poisons are generally defined as substances which are absorbed through epithelial linings such as the skin or gut.

Terminology

Some poisons are also toxins, usually referring to naturally produced substances, such as the bacterial proteins that cause tetanus and botulism. A distinction between the two terms is not always observed, even among scientists.

Animal toxins that are delivered subcutaneously (e.g. by sting or bite) are also called venom. In normal usage, a poisonous organism is one that is harmful to consume, but a venomous organism uses poison to defend itself while still alive. A single organism can be both venomous and poisonous.

The derivative forms "toxic" and "poisonous" are synonymous.

Within chemistry and physics, a poison is a substance that obstructs or inhibits a reaction, for example by binding to a catalyst. For example, see nuclear poison.

Paracelsus, the father of toxicology, once wrote: "Everything is poison, there is poison in everything. Only the dose makes a thing not a poison." The phrase "poison" is often used colloquially to describe any harmful substance, particularly corrosive substances, carcinogens, mutagens, teratogens and harmful pollutants, and to exaggerate the dangers of chemicals. The legal definition of "poison" is stricter. A medical condition of poisoning can also be caused by substances that are not legally required to carry the label "poison".

Uses of poison

Throughout human history, intentional application of poison has been used as a method of assassination, murder, suicide and execution. As a method of execution, poison has been ingested, as the ancient Athenians did (see Socrates), inhaled, as with carbon monoxide or hydrogen cyanide (see gas chamber), or injected (see lethal injection). Many languages describe lethal injection with their corresponding words for "poison shot". Poison's lethal effect can be combined with its allegedly magical powers; an example is the Chinese gu poison. Poison was also employed in gunpowder warfare. For example, the 14th century Chinese text of the Huo Long Jing written by Jiao Yu outlined the use of a poisonous gunpowder mixture to fill cast iron grenade bombs.

On the whole, however, poisons are usually not used for their toxicity, but may be used for their other properties. The property of toxicity itself has limited applications: mainly for controlling pests and weeds, cleaning and maintenance, and for preserving building materials and food stuffs. Where possible, specific agents which are less poisonous to humans have come to be preferred, but exceptions such as phosphine and many household chemicals continue in use.

Most poisonous materials still in use are used for their chemical or physical properties other than being poisonous. Many over-the-counter medications, such as aspirin and Tylenol, are quite toxic if ingested in sufficiently large quantities. Even alcohol can become toxic if too much is ingested in a short enough time. In laboratory environments, where specific chemical properties are often required, the most effective, easiest, safest, or cheapest option for use in a chemical synthesis may be a poisonous material. If a toxic substance possesses these properties more exactly than a non-toxic one, the toxic substance is superior. Chromic acid is an example of such a "simple to use" reagent, but reactivity, in particular, is important. Hydrogen fluoride (HF), for example, is both poisonous and extremely corrosive. However, it has a high affinity (free energy) for silicon, which is exploited by using HF to etch glass or to manufacture silicon semiconductor chips.

On the other hand, certain medical treatments actually make deliberate use of the toxicity of certain substances. Antibiotics (originally harvested from organisms but now artificially produced in laboratories) are highly disruptive to the biochemistry of micro-organisms while having almost no direct effect upon humans. Similarly, the drugs used in chemotherapy are quite toxic; the reason chemotheraputic drugs have far more severe side effects than antibiotics is that their toxicity is not as narrowly tailored. Their benefit arises from the fact that they are—hopefully—more toxic to cancerous cells than normal ones. Such substances could be classified as poisons under the categories defined above, as they are generally artificial in nature, but are not generally discussed as such.

Biological poisoning

Acute poisoning is exposure to a poison on one occasion or during a short period of time. Symptoms develop in close relation to the exposure. Absorption of a poison is necessary for systemic poisoning. In contrast, substances that destroy tissue but do not absorb, such as lye, are classified as corrosives rather than poisons.

Chronic poisoning is long-term repeated or continuous exposure to a poison where symptoms do not occur immediately or after each exposure. The patient gradually becomes ill, or becomes ill after a long latent period. Chronic poisoning most commonly occurs following exposure to poisons that bioaccumulate such as mercury and lead.

Contact or absorption of poisons can cause rapid death or impairment. Agents that act on the nervous system can paralyze in seconds or less, and include both biologically derived neurotoxins and so-called nerve gases, which may be synthesized for warfare or industry.

Inhaled or ingested cyanide as used as method of execution on US gas chambers almost instantly starves the body of energy by inhibiting the enzymes in mitochondria that make ATP. Intravenous injection of an unnaturally high concentration of potassium chloride, such as in the execution of prisoners in parts of the United States, quickly stops the heart by eliminating the cell potential necessary for muscle contraction.

Most (but not all) biocides, including pesticides, are created to act as poisons to target organisms, although acute or less observable chronic poisoning can also occur in non-target organism, including the humans who apply the biocides and other beneficial organisms. For example, the herbicide 2,4-D imitates the action of a plant hormone, to the effect that the lethal toxicity is specific to plants. Indeed, 2,4-D is not a poison, but classified as "harmful" (EU).

Many substances regarded as poisons are toxic only indirectly, by toxication. An example is "wood alcohol" or methanol, which is not poisonous itself, but is chemically converted to toxic formaldehyde and formic acid in the liver. Many drug molecules are made toxic in the liver, and the genetic variability of certain liver enzymes makes the toxicity of many compounds differ between individuals.

The study of the symptoms, mechanisms, treatment and diagnosis of biological poisoning is known as toxicology.

Exposure to radioactive substances can produce radiation poisoning, an unrelated phenomenon.

Poisoning management

  • Poison Control Centers (In the US reachable at 1-800-222-1222 at all hours) provide immediate, free, and expert treatment advice and assistance over the telephone in case of suspected exposure to poisons or toxic substances.

Initial management

Decontamination

  • If the toxin was recently ingested, absorption of the substance may be able to be decreased through gastric decontamination. This may be achieved using activated charcoal, gastric lavage, whole bowel irrigation, or nasogastric aspiration. Routine use of emetics (syrup of Ipecac) and cathartics are no longer recommended.
    • Activated charcoal is the treatment of choice to prevent absorption of the poison. It is usually administered when the patient is in the emergency room. However, charcoal is ineffective against metals, Na, K, alcohols, glycols, acids, and alkalis.
    • Whole bowel irrigation cleanses the bowel, this is achieved by giving the patient large amounts of a polyethylene glycol solution. The osmotically balanced polyethylene glycol solution is not absorbed into the body, having the effect of flushing out the entire gastrointestinal tract. Its major uses are following ingestion of sustained release drugs, toxins that are not absorbed by activated charcoal (i.e. lithium, iron), and for the removal of ingested packets of drugs (body packing/smuggling).
    • Gastric lavage, commonly known as a stomach pump, is the insertion of a tube into the stomach, followed by administration of water or saline down the tube. The liquid is then removed along with the contents of the stomach. Lavage has been used for many years as a common treatment for poisoned patients. However, a recent review of the procedure in poisonings suggests no benefit. It is still sometimes used if it can be performed within 1 h of ingestion and the exposure is potentially life threatening.
    • Nasogastric aspiration involves the placement of a tube via the nose down into the stomach, the stomach contents are then removed via suction. This procedure is mainly used for liquid ingestions where activated charcoal is ineffective, e.g. ethylene glycol.
    • Emesis (i.e. induced by ipecac) is no longer recommended in poisoning situations.
    • Cathartics were postulated to decrease absorption by increasing the expulsion of the poison from the gastrointestinal tract. There are two types of cathartics used in poisoned patients; saline cathartics (sodium sulfate, magnesium citrate, magnesium sulfate) and saccharide cathartics (sorbitol). They do not appear to improve patient outcome and are no longer recommended.

Antidotes

Some poisons have specific antidotes:

Poison/Drug Antidote
paracetamol (acetaminophen) N-acetylcysteine
vitamin K anticoagulants, e.g. warfarin vitamin K
opioids naloxone
iron (and other heavy metals) desferrioxamine, Deferasirox or Deferiprone
benzodiazepines flumazenil
ethylene glycol ethanol, fomepizole or Thiamine
methanol ethanol or fomepizole
cyanide amyl nitrite, sodium nitrite & sodium thiosulfate
Organophosphates Atropine & Pralidoxime
Magnesium Calcium Gluconate
Calcium Channel Blockers (Verapamil, Diltiazem) Calcium Gluconate
Beta-Blockers (Propranolol, Sotalol) Calcium Gluconate and/or Glucagon
Isoniazid Pyridoxine
Atropine Physostigmine

Enhanced excretion

Further treatment

  • In the majority of poisonings the mainstay of management is providing supportive care for the patient, i.e. treating the symptoms rather than the poison.

See also

References

External links

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