Classification by Organ-Tissue Tropism (Part 1)
Neurotropic Poisons These are a vast group of substances that selectively affect the nervous system. Their impact leads to severe consequences: profound disturbances in mental activity, convulsive syndromes, and paralysis develop. The list of representatives is extremely wide. It includes narcotic substances (cocaine, opium, lysergic acid diethylamide), sleeping pills, as well as alcohol and its various surrogates. Organophosphorus compounds (OPCs), such as chlorophos and malathion, the alkaloids nicotine and anabazine, and isoniazid derivatives possess a strong neurotropic effect. In addition, this group includes carbon monoxide and nerve chemical warfare agents (sarin, VX, BZ).
Cardiotropic Poisons These toxins have a specific tropism for the myocardium. Their main pathological manifestation is the impairment of myocardial contractility and cardiac arrhythmias. In severe poisonings, toxic myocardial dystrophy develops. Typical representatives include cardiac glycosides, barium and potassium salts, and dangerous plant poisons found in quinine and aconite.
Pulmonotoxic Poisons The target of these substances is the respiratory system. Toxic exposure leads to acute respiratory failure (ARF) and the development of toxic pulmonary edema. Classical representatives of pulmonotoxicants include nitrogen oxides and suffocating chemical warfare agents such as phosgene and diphosgene.
Classification by Organ-Tissue Tropism (Part 2)
Hepatotoxic Poisons Substances in this group selectively destroy liver cells. The result of their exposure is toxic hepatopathy, which predictably progresses to hepatic failure (HF). Hepatotoxic poisons include chlorinated hydrocarbons (e.g., dichloroethane), phenols, and aldehydes. Poisonous mushrooms, primarily the Amanita phalloides (death cap), pose a particular danger.
Nephrotoxic Poisons These compounds are filtered by the kidneys and cause direct damage to them. Toxic nephropathy develops, resulting in renal failure. The list of nephrotoxicants includes heavy metal salts, ethylene glycol, and oxalic acid.
Hemoglobinotropic Poisons This group of toxins interferes with the vital processes of oxygen transport and utilization by the blood. Pathological effects include hemolysis (destruction of erythrocytes) as well as the formation of pathological forms of hemoglobin—methemoglobinemia and carboxyhemoglobinemia. Such disorders are caused by aniline and its derivatives, nitrites, arsine, hydrocyanic acid and its derivatives. Carbon monoxide and the chemical warfare agent cyanogen chloride also fall into this category.
Skin-Resorptive Poisons The feature of these substances is the combined nature of the lesion. They cause pronounced local changes in the form of inflammation and tissue necrosis at the contact site, after which they are absorbed into the bloodstream and provoke severe general toxic phenomena. Skin-resorptive poisons include concentrated acids and alkalis, dichloroethane, hexachlorane, arsenic and its compounds, as well as mercury (corrosive sublimate). Among chemical warfare agents, sulfur mustard and lewisite possess such an effect.
Diagnosis and Treatment Principles
Diagnosis and Emergency Care The key goal of diagnostics in suspected poisoning is the identification of specific symptoms characteristic of a particular toxin's effect on the body. Understanding exactly which poison caused the lesion is of critical importance, as this is necessary to formulate adequate principles and methods of treatment.
When signs of poisoning are detected, urgent emergency measures are required. The first and most important step is the emergency hospitalization of the victim to a specialized medical facility. Delivery of the patient to specialized toxicology centers, where all conditions exist to provide targeted care, is considered optimal.
General Principles of Poisoning Treatment The main goal of all therapeutic measures is complete detoxification of the body. To achieve this, three main approaches are implemented in toxicology: etiotropic, pathogenetic, and symptomatic.
The main areas of treatment include:
- Active detoxification — a set of measures aimed at the most intensive elimination of toxic substances from the bloodstream and tissues.
- Specific (antidote) therapy — the administration of drugs capable of neutralizing a specific poison or blocking its action.