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ACUTE EXPOSURE INFORMATION
- USES: Nitroglycerin is an organic nitrate that is used as a vasodilator to treat coronary artery disease and heart failure. It is used therapeutically in forms of tablets (sublingual and extended-release), lingual aerosol, transdermal and intravenously. It is also a high explosive and is used occasionally in the production of explosives, smokeless powders, rocket propellants and in combating oil well fires.
- EPIDEMIOLOGY: Nitroglycerin is a commonly prescribed drug and poisoning is relatively uncommon. Occupational exposure mainly occurs via dermal or inhalational exposure.
- PHARMACOLOGY: Its mechanism of action is stimulation of cGMP production, resulting in vascular smooth muscle relaxation. It relaxes veins at low doses and arteries at high doses.
- TOXICOLOGY: Toxicology is an extension of pharmacologic effects. Nitroglycerin is a nitrate, which can be converted to nitrites in the GI tract leading to oxidation of hemoglobin, methemoglobinemia, which may be more common in infants.
- WITH THERAPEUTIC USE
- ADVERSE EFFECTS: Headache, dizziness, and mild orthostatic hypotension are common adverse effects associated with nitroglycerin. WITHDRAWAL: Abrupt cessation of medical or occupational exposure may cause angina.
- INDUSTRIAL EXPOSURE (dermal and inhalation): nausea, vomiting, abdominal cramps, headache, confusion, delirium, bradypnea, bradycardia, paralysis, seizures, cyanosis, methemoglobinemia, circulatory collapse and death.
- WITH POISONING/EXPOSURE
- MILD TO MODERATE TOXICITY: Headache, flushing and orthostatic hypotension with reflex tachycardia can occur.
- SEVERE TOXICITY: Severe effects may include profound hypotension with tachycardia. Profound and prolonged hypotension can cause end-organ damage including cardiac ischemia, ischemic stroke, liver injury and renal failure. Fatalities are rare, but may occur after circulatory collapse and respiratory failure.
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