TOXICOLOGY
1. Fundamentals of Toxicology
1.1 Principles of toxicology (dose–response, kinetics,
dynamics)
1.2 Toxicokinetics (absorption, distribution, metabolism, elimination)
1.3 Toxicodynamics (mechanisms of injury)
1.4 Exposure pathways (ingestion, inhalation, dermal, injection)
1.5 Factors affecting toxicity (age, comorbidity, genetics)
1.7 Body Stuffing / Body Packing
2. Toxidromes (Major Clinical Syndromes)
2.1 Sympathomimetic toxidrome
2.2 Anticholinergic toxidrome
2.3 Cholinergic toxidrome
2.4 Opioid toxidrome
2.5 Sedative-hypnotic toxidrome
2.6 Serotonin syndrome
2.7 Neuroleptic malignant syndrome (NMS)
2.8 Hallucinogenic syndrome
2.9 Withdrawal syndromes (opioid, benzodiazepine, alcohol)
3. Poisoning Assessment & Diagnostics
3.2 Secondary survey
3.3 Use of laboratory tests (BMP, LFT, ABG, lactate)
4. Decontamination
4.1 Gastrointestinal decontamination
- Activated
charcoal
- Gastric
lavage
- Whole
bowel irrigation
- Endoscopic
removal of foreign body
4.2 Dermal/ocular decontamination
4.3 Inhalation exposure management
5. Antidotes (Comprehensive Section)
5.1 General principles
5.2 Antidote list by toxin
- N-acetylcysteine
- Naloxone
- Flumazenil
(use & risks)
- Digoxin-specific
Fab fragments
- Physostigmine
- Atropine
& pralidoxime (2-PAM)
- Methemoglobinemia
antidotes (methylene blue)
- Cyanide
antidote kit (hydroxocobalamin, sodium thiosulfate)
- Iron
antidote (deferoxamine)
- Lead
(EDTA, succimer)
- Mercury/arsenic
antidotes
- Beta-blocker/calcium
channel blocker antidotes (glucagon, calcium, HIE)
- Antidotes
for toxic alcohols (fomepizole)
- Antidotes
for APAP, warfarin, heparin, DOACs
5.3 Antidote availability & stocking guidelines
5.4 Indications vs contraindications
6. Enhanced Elimination
6.1 Urine alkalinization
6.2 Hemodialysis indications
6.3 Hemoperfusion
6.4 Multi-dose activated charcoal
6.5 Lipid emulsion therapy
7. Specific Poisonings: Pharmaceuticals
7.1 Analgesics
- Acetaminophen
(paracetamol)
- Aspirin
(salicylates)
- NSAIDs
- Acute Opioid Toxicity
- Opioid Use Disorder
7.2 Cardiovascular Drugs
- Beta-blockers
- Calcium
channel blockers
- Digoxin
- ACEI/ARB
- Anti-arrhythmics
7.3 Sedatives & Hypnotics
- Benzodiazepines
- Barbiturates
- Z-drugs
7.4 Stimulants
- Amphetamines
- Cocaine
- MDMA
- Caffeine
7.5 Psychiatric Medications
- SSRIs/SNRIs/tricyclic
antidepressants
- Antipsychotics
- Lithium
poisoning
7.6 Endocrine & Metabolic Drugs
- Insulin
overdose
- Metformin-associated lactic acidosis
- Sulfonylureas
7.7 Antimicrobials
- Isoniazid
- Dapsone
- Antimalarials
7.8 Chemotherapeutic Agents
- Methotrexate
- 5-FU
- Cyclophosphamide
- Immune
checkpoint inhibitors (toxic immunologic effects)
8. Specific Poisonings: Non-Pharmaceutical Toxicants
8.1 Alcohols & Glycols
- Ethanol
- Methanol / Ethylene glycol
- Isopropyl
alcohol
8.2 Gases & Fumes
- Inhalant misuse
- Carbon
monoxide
- Cyanide
- Hydrogen
sulfide
- Smoke
inhalation
8.3 Heavy Metals
- Acute Iron poisoning
- Lead
- Mercury
- Arsenic
- Thallium
8.4 Household Agents
- Bleach
- Acute Hydrocarbon Exposure
- Corrosives
(acid/alkali)
8.5 Industrial Chemicals
- Organophosphates
- Carbamates
- Solvents
- Pesticides
9. Environmental & Biological Toxins
9.1 Envenomation (Comprehensive)
- Snake
envenomation (hematotoxic, neurotoxic, myotoxic species)
- Scorpion
stings
- Spider
bites
- Marine
envenomation (jellyfish, stingray, cone snail)
9.2 Plant Toxins
- Oleander
- Castor
bean (ricin)
- Aconitum
- Mushroom
poisoning (amatoxin, gyromitrin)
9.3 Foodborne Toxins
- Ciguatera
- Tetrodotoxin
- Scombroid
- Botulism
9.4 Bacterial & Biological Agents
- Bioterrorism
toxins (anthrax, botulinum, ricin)
10. Pediatric Toxicology
- Differences in toxicokinetics
- Common pediatric exposures
- Ingestions: button batteries, magnets
- Dosing errors
- Child-resistant packaging
- Substance-Exposed Child (SEC) / Drug-Endangered Child
11. Toxicology in Special Populations
11.1 Pregnancy & lactation
11.2 Geriatric toxicology
11.3 Renal failure
11.4 Hepatic failure
11.5 Critical illness / ICU patients
12. Toxicologic Emergencies (ER/ICU)
12.1 Seizure in poisoning
12.2 Cardiac arrest in poisoning
12.3 Hypotension & shock
12.4 Hyperthermia syndromes
12.5 Ventricular arrhythmias
12.6 Severe metabolic acidosis
12.7 Airway management in toxicology
12.8 Intravenous lipid emulsion rescue
13. Approach to Unknown Poisoning
13.1 Clinical pattern recognition
13.2 Toxidrome-based diagnosis
13.3 QRS/QTc abnormalities
13.4 Osmolar gap approach
13.5 Empiric antidotes
13.6 When history is unreliable
14. Occupational & Environmental Health
14.1 Workplace exposures
14.2 Radiation toxicity
14.3 Heat stroke & cold injury (toxicology-associated)
14.4 Hazardous materials (HAZMAT) management
Performance-enhancing supplement
15. Toxicology Procedures
15.1 Gastric lavage technique
15.2 Activated charcoal administration
15.3 Whole bowel irrigation protocol
15.4 Intralipid therapy procedure
15.5 Indications for intubation in poisoned patients
15.6 Hemodialysis access considerations
16. Toxicology Laboratory & Poison Control Systems
16.1 Toxicology panels
16.2 When to obtain specialized assays
16.3 Poison control center utilization
16.4 Hospital toxicology team guidelines
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