1. Lightning poison - cyanide
Poisons commonly found in movies can be inhaled orally or respiratorily, inhibiting cytochrome oxidase, making it impossible for tissues to breathe intracellularly, and the human body will die within a few seconds after poisoning (lightning death).
Immediately after cyanide poisoning, the antidote, methemoglobin-forming agent, should be used immediately (with emphasis) on an anticyanide first aid needle (10% 4-DMAP, 4-dimethylaminophenol) intramuscularly, followed by an intravenous injection of 25% sodium thiosulfate 20 mL at a rate of 2.5 to 5 mL/min. Repeat half or full amount after 1 h if necessary. Orally, gastric lavage is given 0.2% potassium permanganate or 5% sodium thiosulfate, other symptomatic treatment.
2. Street poison - poisonous rats are strong
Chemical name tetramethylenedisulfonamide, strong neurotoxicity, human oral oral half of the lethal amount of 0.1 mgp. Within half an hour after poisoning, the poisoned person has a general convulsive seizure, a state of seizures, and even respiratory and (or) cardiac arrest. Patients with unexplained intoxication and sudden seizures should be considered for toxic rat poisoning. Agitation, fear, and delusions of victimization occur within a few days after convulsive control, and it is easy to be misdiagnosed as schizophrenia.
Once poisoning of poisonous rats is found, it is necessary to immediately decontaminate the gastrointestinal tract of the poisoned person, drain the blood perfusion and detoxification, and at the same time dehydrate the urine to reduce the cerebral edema caused by poisoning and hypoxia. Patients with convulsions are given diazepam 0.2 to 0.5 mgp/intravenous injection to stop shock. Sodium dimercaptosulfonate 5 mgp, 2.5 mg intramuscularly depending on the condition, every 6 to 8 hours for 3 to 4 days. Convulsions, convulsions in severe cases plus diazepam 0.5 mgp.
After the control of a large seizure, it is recommended to continue to promote recovery with AEDs such as sodium dimercaptosulfonate or sodium phenobarbital.
3. Deadly delicacy – tetrodotoxin
Tetrodotoxin is found in the ovaries, liver and blood of pufferfish and is 1250 times more toxic than potassium cyanide, and can be fatal at 0.48 mg. After poisoning, it is manifested by numbness of the whole body, paralysis of the limbs, paralysis of breathing, arrhythmias, etc. Tetrodotoxin is a non-protein neurotoxin that can be destroyed by cooking with sodium ferrousate or heating at 120°C for 30 minutes.
Tetrodotoxin poisoning should be timely decontamination of the gastrointestinal tract, rehydration and detoxification, there is no specific antidote, there are reports that early detoxification with cysteine drugs, such as L-cysteine hydrochloride injection static drip, can also use the corresponding drugs to antagonize the neurotolytic effect, such as neostigmine 1 mg 1 time / day intramuscular injection.
Recently, the neurotoxicity of the use of hyoscarpine against toxins has been reported, and the reference dose is 1 to 2 mg of atropine each time, intravenously administered, each time at an interval of 15 to 30 minutes, to the degree of "chemical amount", the actual dose can be determined by the condition, and the dose is reduced for 1 to 2 days after improvement. Other symptomatic treatments, such as artificial respiration support, can be used to boost blood pressure such as norepinephrine and dopamine in people with decreased blood pressure.
4. Spy Exclusive - Ricin
The mature seeds present in castor are extremely toxins, 6000 times that of cyanide, 1 g can kill tens of thousands of people, and 70 to 100 μg is enough to kill. Ricin has a toxic effect on all mammalian nucleated cells, inhibiting protein synthesis, inducing cytokine damage, lipid peroxidation, and inducing apoptosis.
The main manifestations after poisoning are edema, bleeding, necrosis, etc., and in severe cases, they will die due to paralysis of the respiratory and vasomotor centers, but the incubation period is longer 4 to 8 hours.
So far, there is no specific antidote to ricin, and the clinic generally carries out gastric lavage and diarrhea immediately according to the cause, so that the residual toxins in the body can be discharged as soon as possible. Simultaneous rehydration diuresis, with blood perfusion or plasma exchange to remove absorbed toxins from the body. Liver protection, kidney protection, and prevention of heart failure. Regular monitoring of blood routines, coagulation function, and, if necessary, supplementation of blood components and coagulation factors and other treatments.
5. Into the bone acacia - acacia toxin
"Linglong dice an red bean, into the bone acacia do not know"
Acacia seeds are acacia beans, also known as red beans, if taken internally, 2-3 pieces are fatal. Acacia toxin is the most toxic phytotoxin, more than 70 times more toxic than ricin, and the lethal amount in adults is 5 to 7 μgp. After poisoning, red blood cells can be agglutinated and thrombotic, resulting in liver and kidney function damage, myocardial myofiber degeneration, and ulceration of the gastrointestinal tract (visceral ulceration), which has an irritating effect on the skin and mucous membranes.
In the treatment, the gastrointestinal tract should be defouled in time, intravenous fluids, and injections of acacia toxin antitoxin. In order to prevent the deposition of hemoglobin and products in the kidneys, baking soda can be taken daily 5 to 15 g, hydrocortisone can be added for hemolysis, severe hemolysis and asphyxia can be respiratory support, small blood transfusions and the use of central stimulants, pay attention to correct electrolyte disorders and acid-base imbalances.
6. Invisible Killer - VX Nerve Agent
It is one of the nerve agents, odorless and tasteless, 10 times more toxic than sarin, released in a gaseous and misty state, absorbed through the skin and respiratory tract, and 500 mL of VX can kill tens of thousands of people. VX inhibits acetylcholinesterase in vivo, resulting in generalized tremor, miosis, acute pulmonary edema, respiratory depression, and circulatory failure.
After poisoning, it is necessary to defluge the gastrointestinal tract and skin mucosa in time, and detoxification agents such as atropine, iodophosphoridine, chlorphosphatadine, and double phosphorus can be used for mild poisoning; moderate or severe poisoning requires the combination of atropine and antidote, and it is recommended to use double phosphorus. Anticonvulsants can be used with caution with regard to diazepam, barbiturates, and other drugs that have respiratory depression such as morphine. Other symptomatic treatment and correction of electrolyte and acid-base imbalances may be appropriate with the use of respiratory center stimulants. In addition, the supply of calories and vitamins is guaranteed.
7. The King of Poisons - Botulinum toxin
The King of Poison King, the most poisonous natural poison in the world, there are food- type, infantile and wound-type poisoning, causing human poisoning of serotypes A, B, E3, adult lethality of 10-9 mgp, 0.5g can kill all humans. The toxic effect is to block the release of acetylcholine from the presynaptic membrane of the peripheral cholinergic nerve endings, resulting in neuromuscular conduction disorders, continuous paralysis of skeletal muscles throughout the body, and respiratory failure.
For its treatment, the use of antitoxin within 24 hours is a specific therapy, the existing neurological damage can not be reversed, but can delay the deterioration of the disease, the use of pro-allergy test, negative can be used multivalent antitoxin (A, B, E type) 50,000 to 100,000 U intravenous slow injection or intramuscular injection, if necessary, 6 hours after the same amount of repeated 1 time. Specific toxic serotypes are known to be treated with monovalent antitoxins.
It has been reported that guanidine hydrochloride is taken orally twice a day by 15 to 30 mgp to improve the neuromuscular block of poisoned patients. There have been domestic reports of the use of neem decoction to relieve neuromuscular blockade. Others are symptomatic supportive therapy, and care should be taken with caution to use aminoglycosides and sedatives to avoid aggravating neuromuscular blockage.
bibliography
Li Mei, Song Jiazhen. Neem plus comprehensive therapy for botulinum poisoning[J]. Chinese Journal of Emergency Medicine, 2003, 23(10): 718-718.
2. Practical manual for the treatment of acute poisoning[M]. Beijing:People's Military Medical Publishing House,2012.]
3. Practical Acute Poisoning Encyclopedia[M]. Beijing:People's Medical Publishing House,2003.]
4. Wang JH,Gao S,Xin WW, et al. A novel recombinant vaccine protecting mice against abrin intoxication [J] . Hum Vaccin Immunother,2015,11(3):1-7.
5. Poisoning first aid manual[M]. Shanghai:Shanghai Science and Technology Press,2007.]
6. Detoxification pharmacotherapeutics[M]. Beijing:People's Medical Publishing House,2007.]
7. Qiu Zewu, Niu Wenkai. Diagnosis and treatment of acute ricin poisoning[J]. Chinese Journal of Emergency Medicine, 2006, 15(7): 669-670.
8. ZHANG S, Suga Xiangdong, WU Qiang, et al. A case of shock caused by castor bean poisoning[J]. Chinese Electronic Journal of Health Emergency, 2(3): 194-194.)