BASIC TOXICOLOGY AND CLINICAL TOXICOLOGYLearning objectives :1. Explains how to assess each substance (xenobiotics, xeno = foreign) that can enter the body either as a poison or a drug2. Explaining toxicokinetic and toxikodynamic as toxicologic test substance, can explains the mechanism of toxicity of a substance3. Knowing the type of examination, dosage, method and duration of administration of a substance in relation to the nature of the toxic substance.4. Knowing what is clinical toxicology and management of toxycologic cases5. Explaining the selection of therapy for clinical toxicology cases and the mechanism of action

IntroductionToxicology is the study of security and the nature of any toxic chemicals that come from a variety of sources and can enter into the human body.To assess the properties of chemical substances that are unfamiliar (xenobiotics) and the effect is not known certainly, we used of experimental animal. Safety assessment of chemicals on humans conducted by extrapolation data from animals to humans, so it is forecast. According paraselsus (1493-1541): All substances are poisons; there is none that is not a poison. The right dose differentiates a poison and a remedy ; so the dose determines whether a material / substance is toxin or drug. Examination of the toxicity of a substance / material should be based on the nature of the substance (chemical) that will be used and how their are used. It takes several tests to ascertain the effects and toxicity of a substance, including toxicokinetis test, toxicodynamics test. From the data obtained the results of toxicokinetic test, absorption, distribution, metabolism and excretion that can explain the toxicity of a substance. Toxicodynamic data can explain the toxic effects of a substance, as a continuation of therapeutical effects.Toxicity tests produce toxicity data that can be used as a basis for the use of chemical / natural materials as a drug, so it does not cause toxic effects.To study the toxic effect in accordance with their fields, toxicology divided into several areas of toxicology among other clinical toxicology, forensic toxicology, occupational toxicology, environmental toxicology and others.Clinical toxicology focuses on diseases that are caused by or are uniquely associated with toxic substances. Clinical toxicologists treat patients who are poisoned by drugs and other chemicals and develop new techniques for the diagnosis and treatment of such intoxications. Clinical toxicologist will treatpoisoned drugs patient and other chemicals and develop new techniques for the diagnosis and treatment of the intoxication. The most basic and important principle of clinical toxicology is symptomatic medical care that supports vital functions is the only strategy. Supportive therapy is the mainstay of the treatment of drug poisoning . "Treat the patient, not the poison". Intoxication treatment in accordance with the event whether acute or chronic intoxication.In acute intoxication, the goal is to maintain the vital functions, inhibit the absorption and increase the elimination of toxins. Furthermore, to fight the toxins in the target organ is administered antidote to counter toxicological effects of the poison. The treatment of chronic intoxication according to the toxic nature, signs and symptoms sufferers

Module task :Case 1 : A 16-year-old female presented to the emergency department with intoxication. She previously ingested a total amount 8 g of Acetaminophen to commit suicide. One hour after ingestion she initially looked for medical assistance in a country hospital from where the patient was transferred to our hospital. At admission she was complaining of abdominal pain and nausea. During physical examination her general condition was well, blood pressure and pulse rate were 130/90 mmHg and 90 bpm respectively. An intravenous line was inserted to start the infusion of isotonic solutions at 1500 ml for 24h . Patients was monitored and evaluated every hour.

Discuss the study :1. What are the factors affecting the bioavaibility of drug ?2. How the mechanism of action of acetaminophen (paracetamol) ?3. Why abdominal pain and nausea occured ?4. Describe some of the common ways of handling poisoning. What conditions need to be considered for each way of handling it.5. How do we deal with poisoning in cases 1 and 2 (the drug of choice, the basis for selecting and mode of administration). How do we evaluate the success of the poison control.