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Respiratory Drugs Poisoning
By Sadia Saeed (PMC)
The most common drugs that are used in respiratory problem are
· Beta-agonist
· Theophylline
BETA-2 RECEPTORS:
These includes
1. fenoterol
2. pirbuterol
3. remiterol
4. salbutamol
5. terbutaline
the poisoning case may occur due to confusion about the difference between oral and parenteral
doses, may be deliberate and accidental ingestion.
CLINICAL FEATURES:
Include a feeling of excitement, agitation accompanied by palpitations, tachycardia, tremor and
peripheral vasodilation. More serious complications include
· hypokaleamia
· ventricular tacharrhythmias
· myocardial ischemia
· pulmonary oedema
· convulsions
· hyperglyceamia
TREATMENT:
The treatment include GASTRIC LAVAGE and giving ACTIVATED CHARCOAL,25-100 mg,
if appropriate, together with symptomatic and supportive measures.
Hypokaleamia should be corrected and a cardioselective Beta-blocker should be given.
THEOPHYLLINE:
This is also a commonly used drug and its overdose cause various kind of toxicity.
Convulsions tend to occur with plasma levels above 50mg/ litre in some patients but some
patients remain free of neurological and cardiological complications despite very high plasma
Theophylline concentrations.
CLINICAL SEQUELAE AND MECHANISM OF TOXICITY IN THEOPHYLLINE POISONING:
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CLINICAL
SEQUELAE
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MECHANISM
OF TOXICITY
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Nausea
and vomiting
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Stimulation
if medullary vomiting centre; local gastrointestinal effect
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Abdominal
pain and cramps
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Local
gastrointestinal effect
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Diarrhea
and gastrointestinal haemorrhage
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Local
gastrointestinal effect
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Supraventricular
ventricular arrhythmias
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Myocardial
stimulation and increased catecholamine release; hypokaleamia
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Hypotension
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Decrease
in peripheral resistance
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Restlessness,
irritability, headache, convulsions
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CNS
stimulations
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Hyperventilation
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Stimulation
of respiratory centre
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Acute
renal failure
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rhabdomyolysis
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Metabolic
acidosis
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Hypotension,
post-ictal
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Repiratory
alkalosis
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hyperventilation
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Rhabdomyolysis
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convulsions
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TREATMENT:
GASTRIC LAVAGE should be used in patients who has arrived within 6-8 hours.
ACTIVATED CHARCOAL 50-100g reduces absorption of Theophylline and increase elimination when given in repeat doses,12.5 hourly.
Theophylline is eliminated by Peritoneal dialysis and heamodialysis more slowly than
endogenous clearance, thus these procedures are more recommended.
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