Heavy Metal Poisons
Lead, Mercury, Arsenic, (Cadmium, Chromium)
Widely used for medical purposes, very low potential for abuse, contains limited quantities of narcotics
Ex. Tylenol with codeine, Robitussin (cough syrup)
Schedule V
Dilated pupils, loss of appetite, sleeplessness, increase in body temperature, sweating, confusion
Affect perception, thinking, self-awareness, and emotions
LSD
A patient is found acting paranoid, complaining about snakes biting him, and experiencing hallucinations. What type of substance might they have used?
hallucinogens: LDS, Psllocybins, peyote, etc
A 61 year old man was seen in the Good Luck Neurology Clinic for evaluation of peripheral neuropathy. Upon examination he was found to have dermal hyperpigmentation/depigmentation (salt/pepper) of his skin, scaly palms, and noticeable white transverse ridges on this fingernails that were attributed to chemical intoxication. The chemical agent that is most likely responsible for causing his symptoms is:
Arsenic
Heavy metal typically found in gas additives and older paints, weights, and bullets
Poisoning consistent with nausea, abdominal pain, weight loss, vomiting, seizure, coma, death. Blue discoloration appears along the gum line in the mouth.
Lead Poisoning!
No medical use, high potential for abuse
ex. heroine, LSD, peyote, MDMA, bath salts
Schedule I
MDMA or ecstasy
A worker at a pool cleaning service develops an uncontrollable cough and complains that their airway is burning. What is the suspected poison?
Chlorine Gas
A 13-year-old female presents to your emergency department with her parents. She returned home after a party and has been complaining of dizziness, headache, palpitations and a feeling of chest tightness. She claims to have taken no drugs, but says that she ate at the party. She vomited twice at home and now feels very hungry. What is it likely she was exposed to?
Marijuana
Heavy metal often found in fish and coal-fired power plant pollutants
"Mad Hatter's Disease", acute poisoning causes flu-like symptoms, where as chronic poisoning causes irritability, personality changes, headaches, memory and balance problems, nausea and vomiting, damage to gums, mouth and teeth.
Mercury! Silvery liquid at room temperature
Medical use, low potential for abuse and risk of dependency
Primarily tranquilizers, sleeping medications, etc.
Schedule IV
Symptoms: cardiovascular emergency, acute behavioral changes (extreme aggression or violence), psychosis with or without hallucinations, depression, seizures/shaking, rapid weight gain with severe swelling in the face, hands or feet, intense abdominal pain, jaundice of skin or eyes or vomiting of blood due to liver/kidney disfunction
Anabolic steroid use
You are working in an emergency department when a 35-year-old male is brought in by coworkers. He was spraying pesticides at a local farm and suddenly became dizzy, nauseous, and complained of cramping. Upon assessment, you notice he is sweating profusely, has severe vomiting, and his pupils are very constricted (miosis).
What type of poisoning do you suspect or what do you think caused the poisoning?
Organophosphates/Pesticides
An 18 year old woman is rushed to the Emergency Department by her mother. Upon examination she is showing signs of delirium, comabativeness, hallucinations, rotary nystagmus, miosis, hyperreflexia & sensory anesthesia. She is also exhibiting muscle rigidity & occasional catatonic posturing. Intoxication by which agent can best explain these symptoms?
PCP/angel dust
Naturally occurring element in groundwater
Acute exposure: quick severe gastrointestinal symptoms, difficulty speaking, muscle cramps, convulsions, kidney failure, delirium, and death.
Lesser, chronic exposure: skin lesions w/changes in pigment, headache, personality changes, and eventual coma.
Arsenic!
Accepted medical use, moderate potential for abuse, moderate to low risk of dependence
Ex. steroids, ketamine, barbiturates
Schedule III
Central nervous system depressant: pinpoint pupils, unconsciousness, respiratory depression, awake but unable to talk, slow or erratic pulse, bluish-purple or grey-ashy skin
Opioid overdose-- including that of heroin, morphine, fentanyl, codeine, oxycodone, tramadol, methadone, hydrocodone
It is a cold November morning. You are called to a rural cabin where three individuals are complaining of a sudden onset of severe headache, dizziness, nausea, cheery-red skin, and confusion. They have been running a propane heater all night with the windows sealed.
What do you suspect is causing these symptoms?
A drug whose toxic effects include boastfulness, talkativeness, impaired motor coordination, ataxia, slowed reaction time, retinal damage, emesis, and dehydration.
Methanol poisoning
A victim of suspected heavy metal poisoning has severe gastrointestinal damage ("red velvet like"), petechial hemorrhages of the heart, hyperpigmentation of the skin, and delayed rigor mortis. What poison most likely caused this death?
Arsenic! Gastrointestinal damage along with hyperpigmentation are the biggest clues!
Severely restricted medical use, high potential for abuse
Ex. cocaine, methamphetamine, methadone, oxycodone (stimulants and pain relievers)
Schedule II
Symptoms include slurred speech, unconsciousness or unresponsiveness, slow or irregular breathing, cold/clammy skin, vomiting while semi-conscious, confusion or seizures
Alcohol poisoning
A 50-year-old man was arrested for public intoxication. He has been in a holding cell for 48 hours without alcohol. He is now shaking, sweating, experiencing hallucinations (seeing things that are not there), and his blood pressure is elevated. What is the patient experiencing and why is this a medical emergency?
Alcohol withdrawals
Can lead to seizures, cardiac issues, and death.
A 17-year-old male presents to your emergency department with his parents. Mom is concerned because the child has been very aggressive, anxious and paranoid over the last week. Mom says that he is an “intense” athlete and that the coach has convinced him he can become a professional athlete. What is a possible cause of these symptoms?
Anabolic steroid usage