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Poison

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For other uses, see Poison (disambiguation).
EU standard toxic symbol, as defined by Directive 67/548/EEC.

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.

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Uses of poison

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, 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 continue in use.

Throughout human history, intentional application of poison has been used as a method of assassination, murder, suicide and execution. [1][2] 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 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.[3]

"Poisoning of Queen Bona" by Jan Matejko

Poisonous materials are often used for their chemical or physical properties other than being poisonous. The most effective, easiest, safest, or cheapest option for use in a chemical synthesis may be a poisonous material. Particularly in experimental laboratory syntheses a specific reactivity is used, despite the toxicity of the reagent. Chromic acid is an example of such a "simple to use" reagent. Many technical applications call for some specific physical properties; a toxic substance may possess these properties and therefore be superior. Reactivity, in particular, is important. Hydrogen fluoride (HF), for example, is 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.

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 medical 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).[4]
    • 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.[5] 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, i.e. ethylene glycol.
    • Emesis (i.e. induced by ipecac) is no longer recommended in poisoning situations.[6]
    • 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.[7]

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 Phisostigmin

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.

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References

  1. ^ Kautilya suggests employing means such as seduction, secret use of weapons, poison etc. - Kautilya Arthshastra and the Science of Management: Relevance for the Contemporary Society By S.D.Chamola. ISBN 8178711265. Page 40.
  2. ^ Kautilya urged detailed precautions against assassination - tasters for food, elaborate ways to detect poison. - Moderate Machiavelli? Contrasting The Prince with the Arthashastra of Kautilya. Journal. Critical Horizons. Publisher: Brill Academic Publishers. ISSN 1440-9917 (Print) 1568-5160 (Online). Subject: Humanities, Social Sciences and Law. Issue: Volume 3, Number 2 / September, 2002. DOI: 10.1163/156851602760586671
  3. ^ Needham, Joseph (1986). Science and Civilization in China: Volume 5, Part 7. Taipei: Caves Books, Ltd. Page 180.
  4. ^ "Position paper: whole bowel irrigation". J Toxicol Clin Toxicol. 42 (6): 843–54. 2004. PMID 15533024.
  5. ^ Vale JA, Kulig K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. (2004). "Position paper: gastric lavage". J Toxicol Clin Toxicol. 42 (7): 933–43. PMID 15641639.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ "Position paper: Ipecac syrup". J Toxicol Clin Toxicol. 42 (2): 133–43. 2004. PMID 15214617.
  7. ^ "Position paper: cathartics". J Toxicol Clin Toxicol. 42 (3): 243–53. 2004. PMID 15362590.

See also

External links

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