Question

Current situation: 60-year-old adult man, begins to present diarrhea (> 3 days), dizziness, drowsiness, headache (strong), movement problems, vomiting (bloody), numbness and tingling of the extremities. He is taken by his wife to the hospital, in the triage consultation, he states that, due to chronic back pain, he self-medicated (for more than 3 months) with high doses (500mg / day) of a supposedly natural over-the-counter pain reliever . Unfortunately, this medication was found to contain diclofenac sodium.

1. what is Toxicokinetics. In this case, identify the phases of toxicokinetics in NSAID poisoning, explain step by step the mechanism of action and toxicity of diclofenac sodium by means of a diagram

2. What does Triage consist of? What is the assessment and general examination performed on the patient in this case of diclofenac sodium poisoning?

3.Consult the symptoms of sodium diclofenac poisoning, according to the time elapsed since ingesting the drug in poisoning by this drug. Please explain briefly what are its uses and its pharmacodynamics.

4. What are the complementary tests to identify diclofenac sodium poisoning? Consult and explain the clinical utility of a toxicological study, in which cases should a toxicological analysis be performed?

Answer 1

1. Toxicokinetics

Toxicokinetics is the changes in concentrations of a toxicant over time due to the uptake, biotransformation, distribution and elimination of toxicants in the body.

Phases of toxicokinetics in NSAID poisoning

• Ulcer FORMATION IN STOMACH
• Bleeding in the stomach
• Injury to the kidneys
• Seizures and coma.

Mechanism of action

IT works by reducing substances in the body that cause pain and inflammation. It works by inhibition of prostaglandin synthesis by inhibition of the transiently expressed prostaglandin-endoperoxide synthase-2 (PGES-2) also known as cycloxygenase-2 (COX-2).

Non-steroidal Anti-inflammatory Drugs - Mechanism of Action NSAIDs Cydowymises Inhibition coxlox2 Prostaglandins Prostaglandins Topical irritation of the gastric epithelium inhibit gasitic acid secretion stimulate synthesis of Gl mucus maintain renal blood flow enhances platelet atpegation inflammation pain, fever, & edema) Anticoagulant decreases by the use of enfeic-coated tablets parenteral or rectal preparation Epigastric distress Ulceration Hemorrhage Na & water retention Edema & 'Hyperkalemin Interstidon nephritis Anti-inflammatory Analgesic Antipyretic

2.Triage

It is the assignment of illnesses to decide the order of treatment of a large number of patients or casualties.

Assessment and general examination

• Observe the respiration
• Monitor hydration level
• Asses the neuro status
• Asses the characters of stool and vomitus for the signs of GI bleed.

Uses

To relieve pain, swelling (inflammation), and joint stiffness caused by arthritis.

Pharmacodynamics
Diclofenac reduces inflammation and by extension reduces nociceptive pain and combats fever. It also increases the risk of developing a gastrointestinal ulcer by inhibiting the production of protective mucus in the stomach.

3.Tests to identify diclofenac sodium poisoning

• Liver function test
• Renal function test
• Respiratory assessment
• GI endoscopy

Clinical interventions

Manage patients with symptomatic and supportive care following an NSAID overdosage. There are no specific antidotes. Consider emesis and/or activated charcoal (60 to 100 grams in adults, 1 to 2 grams per kg of body weight in child) and/or osmotic cathartic in symptomatic patients seen within four hours of ingestion or in patients with a large overdose (5 to 10 times the recommended dosage). Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion may not be useful due to high protein binding.