JNTU Pharm. D IV Year CLINICAL TOXICOLOGY Previous Question Paper (April/May - 2019 - R08)

Barbiturates: Clinical features include CNS depression ranging from lethargy to deep coma, respiratory depression, hypotension, hypothermia, and absent deep tendon reflexes. Management involves airway protection, mechanical ventilation if necessary, and fluid resuscitation for hypotension. Urinary alkalinization (using sodium bicarbonate) may enhance elimination of phenobarbital. Benzodiazepines: Symptoms include ataxia, slurred speech, confusion, and drowsiness; severe cases may present with coma, though respiratory depression is typically mild unless combined with other CNS depressants. Management is primarily supportive, focusing on airway maintenance and hemodynamic stability. Flumazenil is a specific competitive antagonist but should be used with extreme caution due to the risk of precipitating seizures, particularly in chronic users or patients with co-ingestion of pro-convulsant drugs.

Clinical symptoms of petroleum product poisoning are primarily respiratory and neurological. Inhalation or aspiration leads to chemical pneumonitis, characterized by coughing, choking, tachypnea, cyanosis, and hemoptysis. Neurological effects include dizziness, confusion, lethargy, and in severe cases, seizures or coma. Management is strictly supportive as there is no specific antidote. Emesis is strictly contraindicated due to the high risk of aspiration and subsequent pneumonitis. Gastric lavage is generally avoided unless a massive amount has been ingested, and only after securing the airway with a cuffed endotracheal tube. Treatment focuses on supplemental oxygen, bronchodilators for bronchospasm, and monitoring for secondary bacterial pneumonia. Prophylactic antibiotics and corticosteroids are not routinely recommended.