Page 1033 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 56 Introduction to Toxicology: Occupational & Environmental 1019

Storm JE, Rozman KK, Doull J: Occupational exposure limits for 30 organophos- Warheit DB: How to measure hazards/risks following exposures to nanoscale
phate pesticides based on inhibition of red blood cell acetylcholinesterase. or pigment-grade titanium dioxide particles. Toxicol Lett 2013;
Toxicology 2000;150:1. 220:193.
Trabert B et al: Maternal pregnancy levels of trans-nonachlor and oxychlordane Warner M et al: Diabetes, metabolic syndrome, and obesity in relation to serum
and prevalence of cryptorchidism and hypospadias in boys. Environ Health dioxin concentrations: The Seveso women’s health study. Environ Health
Perspect 2012;120:478. Perspect 2013;121:906.
Vieira VM, et al: Perfluorooctanoic acid exposure and cancer outcomes in a Wigfield YY, McLenaghan CC: Levels of N-nitrosodimethylamine in nitrogen
contaminated community: A geographic analysis. Environ Health Perspect fertilizers/herbicide mixtures containing 2,4-D present as dimethylamine
2013;121:318. salt. Bull Environ Contam Toxicol 1990;45:847.

C ASE STUD Y ANSWER

The child presents with classic signs (and history) of carbon than 50%, hyperbaric oxygen treatment (if available) may be
monoxide (CO) exposure. Pulse oximetry is unreliable in considered. The electrocardiogram should be continuously
CO poisoning, although newer instruments may distinguish monitored for arrhythmias. Anticonvulsant drugs may be
between carboxyhemoglobin (CO-Hgb) and oxyhemoglo- required if seizures occur. Neurologic damage due to CO
bin. Institute the ABCDs of poisoning (see Chapter 58). exposure may be subtle and long-lasting; the child should be
Immediate high-flow oxygen is mandatory and should be followed for years if necessary. The fetus is particularly sus-
administered via a tight-fitting face mask or endotracheal ceptible to hypoxia, and if the mother is pregnant, her blood
catheter. A blood sample for blood gases and carboxyhemo- gases and CO-Hgb should be measured. If the latter is high,
globin content should be obtained. If the CO-Hgb is greater hyperbaric oxygen therapy should be considered.