Prussic acid poisoning Health Dictionary

A colourless, pungent, fuming liquid. Secreted by the parietal cells in the lining of the stomach, it aids in the digestion of the food.... hydrochloric acid

This illness is characterised by vomiting, diarrhoea and abdominal pain, and results from eating food contaminated with metallic or chemical poisons, certain micro-organisms or microbial products. Alternatively, the foods – such as undercooked red kidney beans or ?sh of the scombroid family (mackerel and tuna) – may contain natural posions. Food poisoning caused by chemical or metallic substances usually occurs rapidly, within minutes or a few hours of eating. Among micro-organisms, bacteria are the leading cause of food poisoning, particularly Staphylococcus aureus, Clostridium perfringens (formerly Cl. welchii), Salmonella spp., Campylobacter jejuni, and Escherichia coli O157.

Staphylococcal food poisoning occurs after food such as meat products, cold meats, milk, custard and egg products becomes contaminated before or after cooking, usually through incorrect handling by humans who carry S. aureus. The bacteria produce an ENTEROTOXIN which causes the symptoms of food poisoning 1–8 hours after ingestion. The toxin can withstand heat; thus, subsequent cooking of contaminated food will not prevent illness.

Heat-resistant strains of Cl. perfringens cause food poisoning associated with meat dishes, soups or gravy when dishes cooked in bulk are left unrefrigerated for long periods before consumption. The bacteria are anaerobes (see ANAEROBE) and form spores; the anaerobic conditions in these cooked foods allow the germinated spores to multiply rapidly during cooling, resulting in heavy contamination. Once ingested the bacteria produce enterotoxin in the intestine, causing symptoms within 8–24 hours.

Many di?erent types of Salmonella (about 2,000) cause food poisoning or ENTERITIS, from eight hours to three days after ingestion of food in which they have multiplied. S. brendeny, S. enteritidis, S. heidelberg, S. newport and S. thompson are among those commonly causing enteritis. Salmonella infections are common in domesticated animals such as cows, pigs and poultry whose meat and milk may be infected, although the animals may show no symptoms. Duck eggs may harbour Salmonella (usually S. typhimurium), arising from surface contamination with the bird’s faeces, and foods containing uncooked or lightly cooked hen’s eggs, such as mayonnaise, have been associated with enteritis. The incidence of human S. enteritidis infection has been increasing, by more than 15-fold in England and Wales annually, from around 1,100 a year in the early 1980s to more than 32,000 at the end of the 1990s, but has since fallen to about 10,000. A serious source of infection seems to be poultry meat and hen’s eggs.

Although Salmonella are mostly killed by heating at 60 °C for 15 minutes, contaminated food requires considerably longer cooking and, if frozen, must be completely thawed beforehand, to allow even cooking at a su?cient temperature.

Enteritis caused by Campylobacter jejuni is usually self-limiting, lasting 1–3 days. Since reporting of the disease began in 1977, in England and Wales its incidence has increased from around 1,400 cases initially to nearly 13,000 in 1982 and to over 42,000 in 2004. Outbreaks have been associated with unpasteurised milk: the main source seems to be infected poultry.

ESCHERICHIA COLI O157 was ?rst identi?ed as a cause of food poisoning in the early 1980s, but its incidence has increased sharply since, with more than 1,000 cases annually in the United Kingdom in the late 1990s. The illness can be severe, with bloody diarrhoea and life-threatening renal complications. The reservoir for this pathogen is thought to be cattle, and transmission results from consumption of raw or undercooked meat products and raw dairy products. Cross-infection of cooked meat by raw meat is a common cause of outbreaks of Escherichia coli O157 food poisoning. Water and other foods can be contaminated by manure from cattle, and person-to-person spread can occur, especially in children.

Food poisoning associated with fried or boiled rice is caused by Bacillus cereus, whose heat-resistant spores survive cooking. An enterotoxin is responsible for the symptoms, which occur 2–8 hours after ingestion and resolve after 8–24 hours.

Viruses are emerging as an increasing cause of some outbreaks of food poisoning from shell?sh (cockles, mussels and oysters).

The incidence of food poisoning in the UK rose from under 60,000 cases in 1991 to nearly 79,000 in 2004. Public health measures to control this rise include agricultural aspects of food production, implementing standards of hygiene in abattoirs, and regulating the environment and process of industrial food production, handling, transportation and storage.... food poisoning

The final end product of certain native or dietary proteins, especially the nucleoproteins found in the nucleus of cells. Unlike the much smaller nitrogenous waste product urea, which is mostly recycled to form many amino acids, uric acid is an unrecyclable metabolite. It is a bent nail that won’t restraighten, and it must be excreted: nucleoprotein to purine to uric acid to the outside in the urine or the sweat. (See GOUT, PURINES.)... uric acid

Ascorbic acid, or vitamin C (see APPENDIX 5: VITAMINS), is a simple sugar found in living tissues – its highest concentrations being in the adrenal cortex (see ADRENAL GLANDS) and the eye. Stress and CORTICOTROPIN lead to a loss of ascorbic acid from the adrenal cortex. Fresh fruit and vegetables, particularly blackcurrants, citrus fruits, berries and green vegetables, are the richest dietary sources; it may also be synthetically prepared. Ascorbic acid is easily eliminated from the diet by traditional methods of cooking, being very soluble in water and easily destroyed by heat, alkalis, traces of copper or by an oxidase released by damage to plant tissues. De?ciency may lead to SCURVY, traditionally associated with sailors, among elderly people living alone or in poor communities living at subsistence level. It has been claimed that large doses (1–2 g daily) will prevent the common cold, but few large controlled trials have been carried out and it is inadvisable for people to dose themselves with large quantities of ascorbic acid, which may result in the formation of oxalate stones in the urinary tract. (See also VITAMIN.)... ascorbic acid

See SEPTICAEMIA.... blood-poisoning

See DNA.... deoxyribonucleic acid

One of the constituents of the vitamin B complex, folic acid derives its name from the fact that it is found in many green leaves, including spinach and grass. It has also been obtained from liver, kidney and yeasts. It has proved to be of value in the treatment of macrocytic anaemias (see ANAEMIA), particularly those associated with SPRUE and nutritional de?ciencies.

In order to prevent NEURAL TUBE defects and cleft lip or palate (see CLEFT PALATE), all women planning to become pregnant should be advised to have a diet rich in folic acid in the months before conception until 13 weeks’ gestation, or to take folic acid tablets.

Recent research has suggested that adequate levels of folic acid can prevent the build-up of homocysteine, a compound in the blood closely associated with heart attacks and strokes. It has been suggested that the o?cial recommendation of 200 micrograms a day in the diet should be doubled. (See APPENDIX 5: VITAMINS.)... folic acid

A valuable antistaphylococcal antibiotic used both orally and topically. It is particularly useful in osteomyelitis (see BONE, DISORDERS OF).... fusidic acid

A colourless, syrupy, sour liquid, which is produced by the action of a bacterium upon lactose, the sugar found in milk. The growth of this organism and consequent formation of lactic acid cause the souring of milk, and the same change takes place to a limited extent when food is long retained in the stomach.

Lactic acid (CH3.CHOH.COOH) is produced in the body during muscular activity, the lactic acid being derived from the breakdown of GLYCOGEN. Muscle fatigue is associated with an accumulation of lactic acid in the muscle. Recovery follows when enough oxygen gets to the muscle, part of the lactic acid being oxidised and most of it then being built up once more into glycogen.... lactic acid

Lead and lead compounds are used in a variety of products including petrol additives (in the UK, lead-free petrol is now mandatory), piping (lead water pipes were once a common source of poisoning), weights, professional paints, dyes, ceramics, ammunition, homeopathic remedies, and ethnic cosmetic preparations. Lead compounds are toxic by ingestion, by inhalation and, rarely, by skin exposures. Metallic lead, if ingested, is absorbed if it remains in the gut. The absorption is greater in children, who may ingest lead from the paint on old cots

– although lead-containing paints are no longer used for items that children may be in contact with.

Acute poisonings are rare. Clinical features include metallic taste, abdominal pain, vomiting, diarrhoea, ANOREXIA, fatigue, muscle weakness and SHOCK. Neurological effects may include headache, drowsiness, CONVULSIONS and COMA. Inhalation results in severe respiratory-tract irritation and systemic symptoms as above.

Chronic poisonings cause gastrointestinal disturbances and constipation. Other effects are ANAEMIA, weakness, pallor, anorexia, insomnia, renal HYPERTENSION and mental fatigue. There may be a bluish ‘lead line’ on the gums, although this is rarely seen. Neuromuscular dysfunction may result in motor weakness and paralysis of the extensor muscles of the wrist and ankles. ENCEPHALOPATHY and nephropathy are severe effects. Chronic low-level exposures in children are linked with reduced intelligence and behavioural and learning disorders.

Treatment Management of patients who have been poisoned is supportive, with removal from source, gastric decontamination if required, and X-RAYS to monitor the passage of metallic lead through the gut if ingested. It is essential to ensure adequate hydration and renal function. Concentrations of lead in the blood should be monitored; where these are found to be toxic, chelation therapy should be started. Several CHELATING AGENTS are now available, such as DMSA (Meso-2,3dimercaptosuccinic acid), sodium calcium edetate (see EDTA) and PENICILLAMINE. (See also POISONS.)... lead poisoning

One of the NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) that is an analgesic (see ANALGESICS) for mild to moderate pain in RHEUMATOID ARTHRITIS, OSTEOARTHRITIS and other musculoskeletal disorders. Also used for DYSMENNORRHOEA and MENORRHAGIA. It must be used with care as it has several side-effects, in particular diarrhoea and occasional haemolytic ANAEMIA. It must not be used in patients with INFLAMMATORY BOWEL DISEASE (IBD).... mefenamic acid

See FUNGUS POISONING.... mushroom poisoning

An antibiotic drug, active against gram-negative (see GRAM’S STAIN) micro-organisms, used to treat and prevent infections of the URINARY TRACT.... nalidixic acid

Nicotinic acid is a member of the vitamin B complex. It is essential for human nutrition, the normal daily requirement for an adult being about 15–20 mg. A de?ciency of nicotinic acid is one of the factors in the etiology of PELLAGRA, and either nicotine acid or NICOTINAMIDE is used in the treatment of this condition. Nicotinic acid also reduces the concentration of blood lipids (see HYPERLIPIDAEMIA).... nicotinic acid

Group of chemicals found in cells and which carry biochemical codes for heredity and day-to-dayfunctioning of cells.... nucleic acid

This is an irritant poison that is used domestically for cleaning purposes. It is also found in many plants including rhubarb and sorrel. Oxalic acid, when swallowed, produces burning of the mouth and throat, vomiting of blood, breathlessness and circulatory collapse. Calcium salts, lime water or milk should be given by mouth. An injection of calcium gluconate is an antidote.... oxalic acid

This plays an important part in the transfer of acetyl groups in the body’s METABOLISM and is one of the essential constituents of the diet. The daily requirement is probably around 10 milligrams. It is widely distributed in food stu?s, both animal and vegetable; yeast, liver and egg-yolk are particularly rich sources. (See APPENDIX

5: VITAMINS.)... pantothenic acid

A crystalline substance sparingly soluble in water that is used externally in ointments and pastes. It has antifungal properties and helps to loosen and remove scales. In high concentrations it is useful in treatment of verrucae (WARTS) and corns (see CORNS AND BUNIONS).... salicylic acid

A drug used in the control of bleeding. It inhibits the activation of PLASMINOGEN and FIBRINOLYSIS, and may be useful when bleeding cannot be stopped – for instance, dental extraction in HAEMOPHILIA. The drug is also useful in MENORRHAGIA.... tranexamic acid

A preparation used in the treatment of cholesterol gall-stones when laparoscopic CHOLECYSTECTOMY and endoscopic biliary procedures cannot be used (see GALL-BLADDER, DISEASES OF).... ursodeoxycholic acid

An organic acid produced by the LIVER when it is rapidly oxidising fatty acids – a metabolic process which occurs, for example, during starvation. The acid produced is then converted to ACETONE, which is excreted.... acetoacetic acid

In our context, a substance having a pH below that of neutral water (7.0) when in solution. Most metabolic waste products are acidic. Sour. See pH... acid

The balance between the acid and alkaline elements present in the blood and body ?uids.

The normal hydrogen ion concentration of the PLASMA is a constant pH 7·4, and the lungs and kidneys have a crucial function in maintaining this ?gure. Changes in pH value will cause ACIDOSIS or ALKALOSIS.... acid base balance

Carbolic acid, or phenol, was the precursor of all ANTISEPTICS. It paralyses and then destroys most forms of life, particularly organisms such as bacteria. It has been superseded by less penetrative and harmful antiseptics.... carbolic acid

One of the bile acids (see BILE), used in the treatment of cholesterol gall-stones for patients with mild symptoms when other modern techniques are unsuitable. (See GALL-BLADDER, DISEASES OF.)... chenodeoxycholic acid

This is responsible for the sharp taste associated with citrus fruits, such as lemons and limes, and other fruits such as currants and raspberries. Although chemically di?erent from, it is similar in action and appearance to tartaric acid, obtained from grapes and other fruits, and similar to malic acid, found in apples and pears.... citric acid

Cadmium poisoning is a recognised hazard in certain industrial processes, such as the manufacture of alloys, cadmium plating and glass blowing. Sewage sludge, which is used as fertiliser, may be contaminated by cadmium from industrial sources; such cadmium could be taken up into vegetable crops and cadmium levels in sewage are carefully monitored.

A tin-like metal, cadmium accumulates in the body. Long-term exposure can lead to EMPHYSEMA, renal failure (see KIDNEYS, DISEASES OF) and urinary-tract CALCULI. Acute exposure causes GASTROENTERITIS and PNEUMONITIS. Cadmium contamination of food is the most likely source of poisoning. The EU Directive on the Quality of Water for Human Consumption lays down 5 milligrams per litre as the upper safe level.... cadmium poisoning

Around 2,000 mushrooms (toadstools) grow in England, of which 200 are edible and a dozen are classi?ed as poisonous. Not all the poisonous ones are dangerous. It is obviously better to prevent mushroom poisoning by ensuring correct identi?cation of those that are edible; books and charts are available. If in doubt, do not eat a fungus.

Severe poisoning from ingestion of fungi is very rare, since relatively few species are highly toxic and most species do not contain toxic compounds. The most toxic species are those containing amatoxins such as death cap (Amanita phalloides); this species alone is responsible for about 90 per cent of all mushroom-related deaths. There is a latent period of six hours or more between ingestion and the onset of clinical effects with these more toxic species. The small intestine, LIVER and KIDNEYS may be damaged – therefore, any patient with gastrointestinal effects thought to be due to ingestion of a mushroom should be referred immediately to hospital where GASTRIC LAVAGE and treatment with activated charcoal can be carried out, along with parenteral ?uids and haemodialysis if the victim is severely ill. In most cases where effects occur, these are early-onset gastrointestinal effects due to ingestion of mushrooms containing gastrointestinal irritants.

Muscarine is the poisonous constituent of some species. Within two hours of ingestion, the victim starts salivating and sweating, has visual disturbances, vomiting, stomach cramps, diarrhoea, vertigo, confusion, hallucinations and coma, the severity of symptoms depending on the amount eaten and type of mushroom. Most people recover in 24 hours, with treatment.

‘Magic’ mushrooms are a variety that contains psilocybin, a hallucinogenic substance. Children who take such mushrooms may develop a high fever and need medical care. In adults the symptoms usually disappear within six hours.

Treatment If possible, early gastric lavage should be carried out in all cases of suspected poisoning. Identi?cation of the mushroom species is a valuable guide to treatment. For muscarine poisoning, ATROPINE is a speci?c antidote. As stated above, hospital referral is advisable for people who have ingested poisonous fungi.... fungus poisoning

See GABA.... gamma aminobutyric acid

An unsaturated fatty acid occurring widely in the glycerides of plants. It is an essential nutrient for mammals, including humans.... linoleic acid

The most common of naturally occurring fatty acids, being present in most fats and oils in the form of triglyceride. It is used in the preparation of OINTMENTS, but not eye ointments.... oleic acid

A yellow crystalline solid substance which is used as a ?xative for tissues being prepared for examination under a microscope; it is also used as a dye.... picric acid

See RNA.... ribonucleic acid

The toxic effect of mercury has been known since days of the medieval alchemists. Charles II presented all the symptoms we now recognise as mercurial poisoning, presumably the result of medication received over many years. Its symptoms simulate multiple sclerosis, when chronic. They are: constant fatigue, pins and needles in the limbs, resting tremor, nausea, dizziness, ataxia, pains in the bones and joints, drooling (excessive salivation), blue line along the gums. In children they may include all kinds of vague aches and pains, chorea, hyperthyroidism and facial neuralgia. Weakness, walking difficulties, metallic taste in the mouth, thirst, mental deterioration. It is now known to cause a number of serious nerve dystrophies.

Mercury has an affinity for the central nervous system. Soon it concentrates in the kidney causing tubular damage. A common cause is the mercurial content (50 per cent) in the amalgam fillings in teeth which, under certain conditions, release a vapour. Fortunately, its use in dentistry is being superceded by an alternative composite filling.

A common cause of poisoning was demonstrated in 1972 when 6,000 people became seriously ill (600 died) from eating bread made from grain treated with a fungicide containing methylmercury. For every fungus in grain there is a mercuric compound to destroy it. The seed of all cereal grain is thus treated to protect its power of germination.

Those who are hypersensitive to the metal should as far as possible avoid button cells used in tape recorders, cassette players, watch and camera mechanisms. As the mercury cells corrode, the metal enters the environment and an unknown fraction is converted by micro organisms to alkylmercury compounds which seep into ground waters and eventually are borne to the sea. When cells are incinerated, the mercury volatilises and enters the atmosphere. (Pharmaceutical Journal, July 28/1984)

Mercury poisoning from inhalation of mercury fumes goes directly to the brain and pituitary gland. Autopsies carried out on dentists reveal high concentrations of mercury in the pituitary gland. (The Lancet, 5-27-89,1207 (letter))

Treatment. For years the common antidote was sulphur, and maybe not without reason. When brought into contact sulphur and mercury form an insoluble compound enabling the mercury to be more easily eliminated from the body. Sulphur can be provided by eggs or Garlic.

Old-time backwoods physicians of the North American Medical School used Asafoetida, Guaiacum and Echinacea. German pharmacists once used Bugleweed and Yellow Dock. Dr J. Clarke, USA physician recommends Sarsaparilla to facilitate breakdown and expulsion from the body.

Reconstructed formula. Echinacea 2; Sarsaparilla 1; Guaiacum quarter; Asafoetida quarter; Liquorice quarter. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Chelation therapy.

Formula. Tinctures. Skullcap 2-15 drops; Pleurisy root 20-45 drops; Horehound 5-40 drops. Mercurial salivation. Thrice daily. (Indian Herbology of North America, by Alma Hutchens) Dental fillings: replace amalgam with safe alternative – ceramic, etc. Evidence of a link between tooth fillings containing mercury and ME has caused the use of dental amalgam to be banned in Sweden. ... mercury poisoning

A bisphosphonate drug used in the treatment of osteoporosis and Paget’s disease of bone. The most common side effect is inflammation of the oesophagus, which causes heartburn or difficulty in swallowing. Other side effects can include headache and abdominal pain.... alendronic acid

One of the fatty acids in the body that are essential for growth.... arachidonic acid

A topical drug used to treat mild to moderate acne.... azelaic acid

See ASPIRIN.... acetylsalicyclic acid

A drug used to treat hereditary angio-oedema (see under URTICARIA) – a serious anaphylactic (see ANAPHYLAXIS) reaction of the skin and respiratory tract resulting from a de?ciency in the body’s immunological defence mechanisms (see IMMUNITY).... aminocaproic acid

ASPIRIN is a commonly available analgesic (see ANALGESICS) which is frequently taken in overdose. Clinical features of poisoning include nausea, vomiting, TINNITUS, ?ushing, sweating, HYPERVENTILATION, DEHYDRATION, deafness and acid-base and electrolyte disturbances (see ELECTROLYTES). In more severe cases individuals may be confused, drowsy and comatose. Rarely, renal failure (see KIDNEYS, DISEASES OF), PULMONARY OEDEMA or cardiovascular collapse occur. Severe toxicity may be delayed, as absorption of the drug may be prolonged due to the formation of drug concretions in the stomach. Treatment involves the repeated administration of activated CHARCOAL, monitoring of concentration of aspirin in the blood, and correction of acid-base and electrolyte imbalances. In more severely poisoned patients, enhanced excretion of the drug may be necessary by alkalinising the urine (by intravenous administration of sodium bicarbonate – see under SODIUM) or HAEMODIALYSIS.... aspirin poisoning

See ATROPINE; BELLADONNA POISONING.... atropine poisoning

Atropa belladonna (deadly nightshade) is a relatively rare plant and severe poisoning is not common. The berries, which are black, ripen from August to October and are the most commonly ingested part of the plant. However, all parts of the plant are toxic. The berries contain ATROPINE and other unidenti?ed ALKALOIDS, the leaves HYOSCINE and atropine, and the roots hyoscine. All these alkaloids have an ANTICHOLINERGIC e?ect which may cause a dry mouth, dilated pupils with blurred vision, TACHYCARDIA, HALLUCINATIONS and PYREXIA. There may also be ATAXIA, agitation, disorientation and confusion. In severe cases there may be CONVULSIONS, COMA, respiratory depression and ARRHYTHMIA. Clinical effects may be delayed in onset for up to 12 hours, and prolonged for several days. Treatment is supportive.... belladonna poisoning

Chromic acid is used in several industries, particularly in chromium plating. Unless precautions are taken it may lead to dermatitis of the hands, arms, chest and face. It may also cause deep ulcers, especially of the nasal septum and knuckles.... chromic acid

Ergot poisoning, or ergotism, occasionally results from eating bread made from rye infected with the fungus, Claviceps purpurea. Several terrible epidemics (St Anthony’s Fire), characterised by intense pain and hallucinations, occurred in France and Germany during the Middle Ages (see ERYSIPELAS). Its symptoms are the occurrence of spasmodic muscular contractions, and the gradual production of gangrene in parts like the ?ngers, toes and tips of the ears because of constriction of blood vessels and therefore the blood supply.... ergot poisoning

Cyanide inhibits cellular RESPIRATION by binding rapidly and reversibly with the ENZYME, cytochrome oxidase. E?ects of poisoning are due to tissue HYPOXIA. Cyanide is toxic by inhalation, ingestion and prolonged skin contact, and acts extremely quickly once absorbed. Following inhalation of hydrogen cyanide gas, death can occur within minutes. Ingestion of inorganic cyanide salts may produce symptoms within 10 minutes, again proceeding rapidly to death. On a full stomach, effects may be delayed for an hour or more. Signs of cyanide poisoning are headache, dizziness, vomiting, weakness, ATAXIA, HYPERVENTILATION, DYSPNOEA, HYPOTENSION and collapse. Loss of vision and hearing may occur, then COMA and CONVULSIONS. Other features include cardiac ARRHYTHMIA and PULMONARY OEDEMA. Patients may have a lactic ACIDOSIS. Their arterial oxygen tension is likely to be normal, but their venous oxygen tension high and similar to that of arterial blood.

Treatment Administration of oxygen when available is the most important ?rst-aid management. Rescuers should be trained, must not put themselves at risk, and should use protective clothing and breathing apparatus. In unconscious victims, establish a clear airway and give 100 per cent oxygen. If breathing stops and oxygen is unavailable, initiate expired-air resuscitation. If cyanide salts were ingested, mouth-to-mouth contact must be avoided and a mask with a one-way valve employed instead. Some commercially available ?rst-aid kits contain AMYL NITRATE as an antidote which may be employed if oxygen is unavailable.

Once in hospital, or if a trained physician is on the scene, then antidotes may be administered. There are several di?erent intravenous antidotes that may be used either alone or in combination. In mild to moderate cases, sodium thiosulphate is usually given. In more severe cases either dicobalt edetate or sodium nitrite may be used, followed by sodium thio-sulphate. Some of these (e.g. dicobalt edetate) should be given only where diagnosis is certain, otherwise serious adverse reations or toxicity due to the antidotes may occur.... cyanide poisoning

A potent diuretic, with a rapid onset, and a short duration (4–6 hours), of action. (See THIAZIDES; DIURETICS.)... ethacrynic acid

A preparation based on the thyroid (see THYROID GLAND) hormone triiodothyronine, which is prescribed to replace the lack of natural thyroid hormone (hypothyroidism). The drug is also used to treat goitre and cancer of the

thyroid gland. (See THYROID GLAND, DISEASES OF.)... liothyronine acid

Lysergic acid diethylamide belongs to the ergot group of ALKALOIDS. It has various effects on the brain, notably analgesic and hallucinogenic, thought to be due to its antagonism of 5hydroxytryptamine (5-HT). In small doses it induces psychic states, in which the individual may become aware of repressed memories. For this reason it may help in the treatment of certain anxiety states, if used under skilled supervision. LSD rapidly induces TOLERANCE, however, and psychological DEPENDENCE may occur, although not physical dependence. Serious side-effects include psychotic reactions, with an increased risk of suicide.... lysergic acid diethylamide (lsd)

When LYSOL is swallowed it burns the mouth and throat. Brown discoloration of the affected tissues, accompanied by the characteristic smell of lysol on the breath, is typical.

Treatment This is urgent. If the skin has been contaminated with the lysol, it must be washed with water, and any lysol-contaminated clothing must be taken o?. Do not make the victim vomit if he or she has swallowed a corrosive substance such as lysol or phenol. Call an ambulance and say what the victim has taken. See APPENDIX 1: BASIC FIRST AID.... lysol poisoning

Also known as mandelamine, a non-toxic keto-acid used in the treatment of infections of the urinary tract, especially those due to the Escherichia coli and the Streptococcus faecalis or Enterococcus. It is administered in doses of 3 grams several times daily. As it is only e?ective in an acid urine, ammonium chloride must be taken at the same time.... mandelic acid

MORPHINE and CODEINE are natural opium ALKALOIDS found in the opium poppy (Papaver somniferum). The other opioids are either synthetic or semi-synthetic analogues of these. Their main use is in the treatment of moderate to severe PAIN, but they are also used as antidiarrhoeal and antitussive agents. As a result of induced tolerance (see DEPENDENCE) and great individual variability, the amount of opioid substances required to cause serious consequences varies enormously.

The most common effects of opioid overdose are vomiting, drowsiness, pinpoint pupils, BRADYCARDIA, CONVULSIONS and COMA. Respiratory depression is common and may lead to CYANOSIS and respiratory arrest. HYPOTENSION occurs occasionally and in severe cases non-cardiogenic pulmonary oedema and cardiovascular collapse may occur. Cardiac ARRHYTHMIA may occur with some opioids. Some opioids have a HISTAMINE-releasing e?ect which may result in an urticarial rash (see URTICARIA), PRURITUS, ?ushing and hypotension. Activated CHARCOAL should be given following overdose and NALOXONE administered to reverse respiratory depression and deep coma.... opioid poisoning

One of the early antituberculous (see TUBERCULOSIS) antibiotics. It tended to cause DYSPEPSIA and has been replaced by newer antituberculous drugs with fewer side-effects. The ?rst-line drugs for tuberculosis are now rifampicin, isoniazid, and ethambutol.... para-amino salicylic acid

Paracetamol is one of the safest drugs when taken in the correct dosage, but overdose may occur inadvertently or deliberately. Initially there may be no symptoms or there may be nausea, vomiting, abdominal pain and pallor. Then, 16–24 hours after ingestion, liver damage becomes evident and by 72–120 hours the patient may have JAUNDICE, COAGULATION abnormalities, hepatic failure (see LIVER, DISEASES OF), renal failure (see KIDNEYS, DISEASES OF), ENCEPHALOPATHY and COMA. Treatment involves the administration of antidotes such as METHIONINE (within 8 hours) orally or intravenous ACETYLCYSTEINE.

An overdose of paracetamol is a common choice of those attempting to commit suicide. Since the government restricted the number of paracetamol tablets an individual may purchase over the counter, the incidence of people taking the drug in overdose with the intention of taking their lives has fallen sharply.... paracetamol poisoning

Poisoning by saxitoxin, a toxin present in some shellfish, usually in tropical or subtropical seas. Symptoms of respiratory arrest, or brain involvement occur in some 8% of cases, resulting in death. Saxitoxin is related to tetrodotoxin.... paralytic shellfish poisoning

... retinoic acid

This occurs from eating poorly preserved scromboid ?sh such as tuna, mackerel and other members of the mackerel family. In such ?sh, a toxic histamine-like substance is produced by the action of bacteria or histidine, a normal component of ?sh ?esh. This toxin produces nausea, vomiting, headache, upper abdominal pain, di?culty in swallowing, thirst, itching and sometimes URTICARIA. The condition settles as a rule in 12 hours. ANTIHISTAMINE DRUGS sometimes ameliorate the condition.... scrombotoxin poisoning

See POISONS.... self-poisoning

In the United Kingdom this occurs in two main forms. Shell?sh may be the cause of typhoid fever (see ENTERIC FEVER) as a result of their contamination by sewage containing the causative organism. They may also be responsible for what is known as paralytic shell?sh poisoning. This is caused by a toxin, or poison, known as saxotoxin, which is present in certain planktons which, under unusual conditions, multiply rapidly, giving rise to what are known as ‘red tides’. In these circumstances the toxin accumulates in mussels, cockles and scallops which feed by ?ltering plankton. The manifestations of such poisoning are loss of feeling in the hands, tingling of the tongue, weakness of the arms and legs, and di?culty in breathing. There is also growing evidence that some shell?sh poisoning may be due to a virus infection. (See also FOOD POISONING.)... shellfish poisoning

A healthy bloodstream depends upon maintenance of an acid-alkaline balance. Blood is always slightly alkaline. Only slight variations on either side are compatible with life. When this delicate balance is disturbed by faulty elimination of acid wastes, carbon dioxide, etc., a condition appears known as acidosis, a known precursor of chronic disease. A change of diet is indicated.

To help restore the acid-alkaline balance, any one of the following teas may assist: Iceland Moss, Bladderwrack (fucus), Kelp, Irish Moss, Slippery Elm, Calamus, Meadowsweet, or Dandelion (which may be taken as Dandelion coffee). ... acid-alkaline balance

Foods that produce acid when metabolised. Ash from these foods contains sulphur, phosphoric acid and chlorine, all essential for efficient metabolism. Breads, cereals, cheese, chicken, chocolate, cocoa, coffee, cranberries, eggs, fish, flour, fowl, grain products, lentils, meats (lean), nuts, oats, oatmeal, oysters, pasta, peanuts, peanut butter, pearl barley, plums, prunes, rhubarb, rabbit, rice (white), sugar, sweet corn, tea, veal, wholemeal bread, wheatgerm. ... acid foods

A polyunsaturated fatty acid; an essential ingredient in the body’s production of prostaglandins. Present naturally in mother’s milk. The body produces GLA from linoleic acid present in food as an essential fatty acid (EFA). Vital to growth, cell structure and cardiac health. Sources: Evening Primrose oil; Sunflower seed oil, Borage and Blackcurrant. Preparations from the fermentation of rotten carrots. Helps lower blood pressure and prevent cholesterol build-up in the blood. ... gamma linolenic acid (gla)

Acid rain air pollution is responsible for increased hospital admissions with respiratory illness when it hangs in a haze over a polluted area. The main components of acid rain are sulphates, salts of sulphur, known to cause breathing difficulties.

Alternatives. Teas: Alfalfa, Angelica leaves, Boneset, Catnep, Chamomile, Coltsfoot, Comfrey leaves, Dandelion leaves, Hyssop, Lemon Balm, Lime flowers, Milk Thistle, Mullein, White Horehound, Red Clover flowers, Sage, Violet leaves, Umeboshi tea.

Tablets/capsules. Chamomile, Echinacea, Iceland Moss, Irish Moss, Liquorice, Lobelia.

Powders. Formula. Equal parts: Echinacea, Barberry bark, Elecampane root. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Formula. Tinctures. Echinacea 2; Sarsaparilla 1; Fringe Tree half; Liquorice quarter. Mix. 1-2 teaspoons thrice daily. ... acid rain sickness

A Harvard study links coffee consumption with cancer of the pancreas. No association has been found between tea-drinkers and cancer. Some authorities claim coffee is not carcinogenic until roasted.

While an internal mechanism slows down the body, caffeine in tea, cola and coffee restores alertness. Caffeine acts by blocking the action of the compound, adenosine – one of the building blocks of DNA which promotes cell energy. Caffeine interferes with natural metabolic processes. In the aged, coffee increases production of uric acid, causing irritation of the kidneys, joint and muscle pains. vCaffeinism is responsible for a wide range of disorders. Increases the heart beat, promotes excessive stomach acid and increases flow of urine. It may give rise to birth defects and should be taken with caution in pregnancy.

Symptoms. Restlessness, nervous agitation, extreme sensitiveness. Intolerance of pain, nervous palpitation, all senses acute.

To antidote. Chamomile tea.

Practitioner. Tincture Nux vom BP: 10 drops to 100ml water. Dose: 1 teaspoon thrice daily. Inhalation: Strong spirits of Camphor.

Diet. Plenty asparagus. ... caffeine poisoning

The colourless, pungent, organic acid that gives vinegar its sour taste.

In medicine, acetic acid is an ingredient of antiseptic gels that are used for certain vaginal infections.... acetic acid

A combination of mechanisms that ensures that the body’s fluids are neither too acid nor too alkaline (alkalis are also called bases).

The body has three mechanisms for maintaining normal acid–base balance: buffers, breathing, and the activities of the kidneys. Buffers are substances in the blood that neutralize acid or alkaline wastes. Rapid breathing results in the blood becoming less acidic; slow breathing has the opposite effect. The kidneys regulate the amounts of acid or alkaline wastes in the urine.

Disturbances of the body’s acid–base balance result in either acidosis (excessive blood acidity) or alkalosis (excessive blood alkalinity).... acid–base balance

Regurgitation of acidic fluid from the stomach into the oesophagus due to inefficiency of the muscular valve at the lower end of the oesophagus. Also known as gastro-oesophageal reflux disease (GORD), acid reflux may inflame the oesophagus, resulting in heartburn due to oesophagitis. It may occur in pregnancy and often affects overweight people.... acid reflux

Most antifreeze in the contains ethylene glycol, which is poisonous.

Drinking antifreeze initially produces effects similar to alcohol intoxication, but vomiting, stupor, seizures, and coma may follow; acute kidney failure may occur within 24–36 hours.

Antifreeze poisoning requires immediate medical attention.... antifreeze poisoning

The toxic effects of chemicals present in some defoliant weedkillers. Ingesting chlorates can cause kidney and liver damage, corrosion of the intestine, and methaemoglobinaemia (a chemical change in haemoglobin in the blood). Small doses of chlorates can prove fatal. Symptoms of poisoning include ulceration in the mouth, abdominal pain, and diarrhoea.... chlorate poisoning

The toxic effects of plant poisons that cause leaves to drop off.

Defoliants are poisonous if swallowed.

Widely used defoliants include sodium chlorate, potassium chlorate, phenoxy herbicides, and paraquat.... defoliant poisoning

The toxic effects that occur as a result of swallowing the cleaning agents in shampoos, laundry powders, and cleaning liquids.... detergent poisoning

The harmful effects on the body as a result of an excessive dose of a drug. Accidental poisoning is most common in young children. In adults, it usually occurs in elderly or confused people who are unsure about their treatment and dosage requirements. Accidental poisoning may also occur during drug abuse. Deliberate self-poisoning is usually a cry for help (see suicide; suicide, attempted). The drugs that are most commonly taken in overdose include benzodiazepine drugs and antidepressant drugs. Anyone who has taken a drug overdose and any child who has swallowed tablets that belong to someone else should seek immediate medical advice. It is important to identify the drugs that have been taken. Treatment in hospital may involve washing out the stomach (see lavage, gastric). Charcoal may be given by mouth to reduce the absorption of the drug from the intestine into the bloodstream. To eliminate the drug, urine production may be increased by an intravenous infusion. Antidotes are available only for specific drugs. Such antidotes include naloxone (for morphine) and methionine (for paracetamol).

Drug poisoning may cause drowsiness and breathing difficulty, irregular heartbeat, and, rarely, cardiac arrest, fits, and kidney and liver damage.

Antiarrhythmic drugs are given to treat heartbeat irregularity.

Fits are treated with anticonvulsants.

Blood tests to monitor liver function and careful monitoring of urine output are carried out if the drug is known to damage the liver or kidneys.... drug poisoning

An essential fatty acid found in evening primrose oil and starflower oil (borage oil).

Gamolenic acid may be prescribed for breast tenderness, premenstrual syndrome, and eczema.

Very large doses may cause abdominal pain and loose stools.... gamolenic acid

The active ingredient of many sunscreen preparations. Its abbreviation is.... para-aminobenzoic acid

Poisons may be swallowed, inhaled, absorbed through skin, or injected under the skin (as with an insect sting).

Poisons may also originate in the body, as when bacteria produce endotoxins, or when metabolic disorders produce poisonous substances or allow them to build up.

Poisoning may be acute (a large amount of poison over a short time) or chronic (gradual accumulation of poison that is not eliminated quickly).

Unintentional poisoning occurs mainly in young children.

Adults may be poisoned by mistaking the dosage of a prescribed drug (see drug poisoning), by taking very high doses of vitamin or mineral supplements, by exposure to poisonous substances in industry, or by drug abuse.

Poisoning may also be a deliberate attempt to commit suicide.... poisoning

See food poisoning.... shellfish poisoning

See mushroom poisoning.... toadstool poisoning

see aspirin.... acetylsalicylic acid

a technique for creating a mechanical bond between resin-based materials and the enamel of teeth; it is used to retain and seal the margins of composite fillings, to retain brackets of fixed orthodontic appliances, and to retain resin-based *fissure sealants and adhesive bridges. Phosphoric acid is used to create a porous surface into which a bonding agent can flow.... acid-etch technique

adj. 1. describing bacteria that have been stained and continue to hold the stain after treatment with an acidic solution. For example, tuberculosis bacteria are acid-fast when stained with a *carbol fuchsin preparation. 2. describing a stain that is not removed from a specimen by washing with an acidic solution.... acid-fast

an organic compound containing an amino group (–NH2) and a carboxyl group (–COOH). Amino acids are fundamental constituents of all *proteins. They are classified as *essential amino acids, i.e. those that cannot be synthesized by the body, and nonessential amino acids, which can be synthesized by the body. Certain amino acids present in the body are not found in proteins; these include *citrulline, *ornithine, *taurine, and *gamma-aminobutyric acid.... amino acid

Strychnine is a poisonous chemical found in the seeds of Strychnos species (tropical trees and shrubs). Its main use is as an ingredient in some rodent poisons; most cases of strychnine poisoning occur in children who accidentally eat such poisons.

Symptoms begin soon after ingestion and include restlessness, stiffness of the face and neck, increased sensitivity of hearing, taste, and smell, and photosensitivity, followed by alternating episodes of seizures and floppiness. Death may occur from respiratory arrest.

The victim is given intravenous injections of a tranquillizer or a barbiturate, with a muscle-relaxant drug if needed.

Breathing may be maintained by a ventilator.

With prompt treatment, recovery usually occurs in about 24 hours.... strychnine poisoning

(aspartate) see amino acid.... aspartic acid

an antiseptic, active against fungi and bacteria, used as a preservative in foods and pharmaceutical preparations and, combined with salicylic acid, in the form of an ointment (Whitfield’s ointment) for the treatment of ringworm.... benzoic acid

(cholalic acid) see bile acids.... cholic acid

see Krebs cycle.... citric acid cycle

a drug that interferes with the *penicillinases that inactivate *beta-lactam antibiotics, such as *amoxicillin or *ticarcillin. Combined with the antibiotic, clavulanic acid can overcome drug resistance.... clavulanic acid

see bile acids.... deoxycholic acid

an *amino acid that is essential for normal growth and development but cannot be synthesized by the body. Essential amino acids are obtained from protein-rich foods in the diet, such as meat, fish, eggs, and dairy products. Adults require eight essential amino acids: leucine, isoleucine, valine, phenylalanine, threonine, methionine, tryptophan, and lysine. Children require an additional nine, as their body’s requirement is greater than can be synthesised by it: tyrosine, glycine, cysteine, arginine, proline, histidine, glutamine, serine, and asparagine.... essential amino acid

an organic acid with a long straight hydrocarbon chain and an even number of carbon atoms. Fatty acids are the fundamental constituents of many important lipids, including *triglycerides. Some fatty acids can be synthesized by the body; others, the *essential fatty acids, must be obtained from the diet. Examples of fatty acids are palmitic acid, oleic acid, and stearic acid. See also fat; saturated fatty acid; unsaturated fatty acid.... fatty acid

a derivative of folic acid involved in purine synthesis. It is used to reverse the biological effects of methotrexate and other *dihydrofolate reductase inhibitors and so to prevent excessive toxicity. This action is termed folinic acid rescue. Folinic acid has a potentiating effect with *fluorouracil, with which it is often used.... folinic acid

a sugar acid derived from glucose. Glucuronic acid is an important constituent of *chondroitin sulphate (found in cartilage) and *hyaluronic acid (found in synovial fluid).... glucuronic acid

(glutamate) see amino acid; neurotransmitter.... glutamic acid

(GAD) a common enzyme that, because of similarities to certain bacterial proteins, can provoke an autoimmune reaction against the beta cells of the pancreas (see islet cell antibodies) progressing to type 1 *diabetes mellitus.... glutamic acid decarboxylase

see bile acids.... glycocholic acid

a derivative of *histamine that was formerly used to test for acid secretion in the stomach in conditions involving abnormal gastric acid secretion, such as *Zollinger-Ellison syndrome.... histamine acid phosphate

a product formed during the metabolism of the amino acids phenylalanine and tyrosine. In normal individuals homogentisic acid is oxidized by the enzyme homogentisic acid oxidase. In rare cases this enzyme is lacking and a condition known as *alcaptonuria, in which large amounts of homogentisic acid are excreted in the urine, results.... homogentisic acid

an acid *mucopolysaccharide that acts as the binding and protective agent of the ground substance of connective tissue. It is also present in the synovial fluid around joints and in the vitreous and aqueous humours of the eye.... hyaluronic acid

(prussic acid) an intensely poisonous volatile acid that can cause death within a minute if inhaled. It has a smell of bitter almonds. See cyanide.... hydrocyanic acid

(5-HIAA) a metabolite of *serotonin, the most common secretion product of *carcinoid tumours. Measured over 24 hours in the urine, this is the most reliable screening test for such tumours.... 5-hydroxyindoleacetic acid

see essential fatty acid.... linolenic acid

a sulphur-containing compound that can be readily interconverted to and from its reduced form, dihydrolipoic acid. Lipoic acid functions in carbohydrate metabolism as one of the *coenzymes in the oxidative decarboxylation of pyruvate and other ?-keto acids.... lipoic acid

(LSD) an illegal hallucinogenic drug that was formerly used to aid treatment of certain psychological disorders. Side-effects include digestive upsets, dizziness, tingling, anxiety, sweating, dilated pupils, muscle incoordination and tremor. Alterations in sight, hearing, and other senses occur, psychotic effects, depression, and confusion are common, and tolerance to the drug develops rapidly. Because of these toxic effects, LSD is no longer used clinically. See Appendix 12 for a list of street names for illicit drugs.... lysergic acid diethylamide

a strong corrosive mineral acid, HNO3, the concentrated form of which is capable of producing severe burns of the skin. Swallowing the acid leads to intense burning pain and ulceration of the mouth and throat. Treatment is by immediate administration of alkaline solutions, followed by milk or olive oil.... nitric acid

see osmium tetroxide.... osmic acid

see fatty acid.... palmitic acid

(PAS reaction) a test for the presence of glycoproteins, polysaccharides, certain mucopolysaccharides, glycolipids, and certain fatty acids in tissue sections. The tissue is treated with periodic acid, followed by *Schiff’s reagent. A positive reaction is the development of a red or magenta coloration.... periodic acid–schiff reaction

see hydrocyanic acid.... prussic acid

see folate.... pteroylglutamic acid

(pyruvate) a compound, derived from carbohydrates, that may be oxidized via a complex series of reactions in the *Krebs cycle to yield carbon dioxide and energy in the form of ATP.... pyruvic acid

a *fatty acid in which all the carbon atoms are linked by single bonds and the molecule is unable to accept additional atoms (i.e. it cannot undergo addition reactions with other molecules). These fats occur mainly in animal and dairy products, and a diet high in these foods may contribute to a high serum cholesterol level, which may increase the risk of *coronary artery disease. Compare unsaturated fatty acid.... saturated fatty acid

an amino sugar. Sialic acid is a component of some *glycoproteins, *gangliosides, and bacterial cell walls.... sialic acid

see fatty acid.... stearic acid

a powerful corrosive acid, H2SO4, widely used in industry. Swallowing the acid causes severe burning of the mouth and throat and difficulty in breathing, speaking, and swallowing. The patient should drink large quantities of milk or water or white of egg; gastric lavage should not be delayed. Skin or eye contact should be treated by flooding the area with water.... sulphuric acid

see bile acids.... taurocholic acid

an *astringent used for a variety of skin conditions. It is also applied topically to produce sloughing, especially for the removal of warts.... trichloracetic acid

an antifungal agent, applied to the skin for the treatment of athlete’s foot.... undecenoic acid

a *fatty acid in which one (monounsaturated) or many (polyunsaturated) of the carbon atoms are linked by double bonds that are easily split in chemical reactions so that other substances can connect to them. These fats occur in fish and plant-derived foods, and a diet high in unsaturated fats is associated with low serum cholesterol levels. Compare saturated fatty acid.... unsaturated fatty acid

see sodium valproate.... valproic acid

(VMA) a metabolite of *catecholamines excreted in abnormal amounts in the urine in conditions of excess catecholamine production, such as *phaeochromocytoma. The measurement of VMA levels in a 24-hour urine sample was formerly used as a screening test for this condition, but in the UK it has been largely superseded by the urinary metanephrine test (see metanephrine and normetanephrine).... vanillylmandelic acid

(zolendronate) a *bisphosphonate drug that is used to treat Paget’s disease and malignant *hypercalcaemia and is also establishing a role in treating bone metastases, both in terms of symptom relief and preventing bone fractures.... zoledronic acid