Top Etiologic Agents

Acute gastroenteritis Norwalk-like virus > S. aureus > B. cereus. Noninflammatory diarrhea ETEC (traveler's diarrhea) > Vibrio cholerae. Inflammatory diarrhea Campylobacter spp. > Shigella spp. Persistent diarrhea Cryptosporidium parvum > Cyclospora cayetanensis. Neurologic manifestations Botulismbw, OP poisoningcw. Systemic illness Listeria monocytogenes > Bru-cella spp.bw.

Examples Chlorine and Phosgene

Both gases are frequently transported by rail for use in drinking water purification, and chemical and plastic manufacturing, and are ubiquitously available as potential, simple chemical weapons. Phosgene gas caused 85 of all gas deaths in World War I. The intentional use of either microorganisms or toxins produced by a variety of living organisms including viruses (smallpox), bacteria (C. botu-linum), fungi (mycotoxins), and plants (ricin) to cause dysfunction or death in people, livestock,...

Isopropanol

Toxicity Gastrointestinal > dermal > CNS Gastrointestinal Caustic hemorrhagic gastroenteritis, necrotic mucosal ulcerations, late esophageal stricture. Dermal Caustic burns, contact dermatitis (iodophor), ioderma acne (iodide). CNS Metabolic acidosis, delirium, vasomotor collapse. Treatment No emesis careful aspiration lavage with starch, milk, or sodium thiosulfate to reduce most toxic elemental iodine (I2) to the least toxic iodide (I-) activated charcoal (AC) and early endoscopy....

Neurotoxic Shellfish Poisoning

Agent Gymnodinium (Karenia) breve, formerly Phytodiscus brevis. Toxins Brevetoxins (polycyclic ethers). LD50 Unknown no human fatalities. Mechanism Forced opening of Na channels with increased Na influx and prolonged depo larization (opposite of saxitoxin and tetrodo-toxin TTX ). Vectors Clams > oysters. Incubation 15 minutes to 3 hours. Symptoms Mild ciguatera-like symptoms with perioral paresthesias and temperature reversal rarely nausea and diarrhea unique conjunctivitis, rhinitis, and or...

Mechanisms of Placental Transfer

Factors promoting increased passive diffusion across the placental barrier Low molecular weight High lipid solubility Low ionization Reduced protein binding Ion trapping of weak acids in the lower pH of fetus (7.25-7.30) Valproate (valproic acid), phenytoin, isoretinoin (isoretinoic acid), thalidomide. Near-term maternal changes Increased levels of free fatty acids (FFAs) release maternal fat-stored drugs. Example benzodiazepines (BZs). Near-term fetal changes Increased serum albumin increased...

Chronic Marijuana toxicity

Marijuana is an oily, dried fibrous material obtained from the Indian hemp plant, Cannabis sativa. The most commonly used illegal substance in the United States. The most commonly abused substance in the world after nicotine, alcohol, and caffeine. Considered a gateway drug by the DEA, NIDA, and the Substance Abuse and Mental Health Services Administration SAMHSA . Tolerance and dependence Resulting from repeated use. Withdrawal syndrome Irritability, restlessness, Congenital toxicity Neonatal...

Cannabinoids

Herbal teas e.g., Health Inca Tea, HIT, deco- 61 cannabinoids in marijuana. delta-9-Tetrahydrocannabinol THC is the psy-choactive constituent. 11-NOR-THC-9-carboxylic acid is the major metabolite in urine. Have at least 20 other oxygenated metabolites, including hydroxylated compounds, other monocarboxylic acids, and dicarboxylic acids. Pattern of metabolites may depend on type of user

Epidemiology

Transmission Fecal-oral, drinking water gt food person-to-person transmission unlikely. Vehicle Human feces-contaminated water, food. Warning Travel to tropical, developing areas, especially by immunocompromised susceptibles AIDS . Transmission Fecal-oral gt food pork, lamb, venison . Vehicle Cat feces raw and undercooked pork, lamb, venison. Inoculum High. Incubation 6-10 days. Warning Pregnancy, outside cat litter boxes, wild feral cats.

Endogenous Endotoxins Primary Sources

Scombrotoxins Produced by gut bacteria-catalyzed L-histidine decarboxylation to histamine and its primary metabolite, saurine, in decomposing deep-sea finfish, especially scombroid species tuna, mackerel, albacore, skipjack, and bonito , and even non-scombroid species mahi mahi, wahoo, cobia, and amberjack . Tetrodotoxin Produced by endosymbiotic bacteria in all pufferfish porcupine fish, globefish, balloon fish, blowfish, toadfish , marine sun-fish, and many other marine animals stored in fish...

Acute vs Chronic Amphetamine Toxicity

CNS gt cardiovascular gt pulmonary CNS Mydriasis, anorexia, euphoria, psychosis, hyperthermia diaphoresis, headache, agitation-hyperactivity tremor, seizures muscle rigidity choreoathetosis rhabdomyolysis myoglobinuria acute tubular necrosis acute renal failure. Cardiovascular Hypertension, tachycardia, tachydysrhythmias, vasospasm, angina, myocarditis, and myocardial infarction MI . Pulmonary Tachypnea, pulmonary vasoconstriction, and pulmonary hypertension. Cardiovascular and pulmonary...