10 Tox Flashcards by Marcus Wong

Acetaminophen toxic doses

mg /kg
how grams in a typical adult
chronic daily dose

150 mg/kg

about 10g in an adult

chronic is >3g/day (variable)

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acetaminophen:

what is name of toxic metabolite

NAPQI

requires glutathione to metabolize

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jimson weed

what toxicity

aka nightshade

anticholinergic

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why do botulism pts have a dry throat

similar mech to anticholinergic (botulism prevents Ach release)

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bidirectional VT, think what

Dig toxicity (can have othe EKG findings as well)

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How does TCA poisoning kill?

(3)

3 killers:

alpha blockade–hypotension (use NE or epi as pressors)
QRS widening–ventricular dysrhythmia (sodium bicarb)
GABA blocking–seizure (give benzos)

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Normal CO levels in blood

healthy people
smokers
What level to do hyperbaric treatment?

healthy: 2-3%
smokers: 5-10

Hyperbaric treatment in blood level >25% (>15% in pregnant)

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CO halflife on:

room air vs 15L NRB vs hyperbaric chamber

4-6h, 1h, 20-30 min

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CO toxicity

indications for hyperbaric tx

which indication(s) are proven?

multiple indications, include:

neuro deficits (only proven one), AMS, seizure, pregnancy with COHgb >15%, COHgb >25%, MI

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You have patient with opioid OD with bradycardia/hypotension

think what

Think this might be clonidine OD

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Cyanide poisoning

-what do you see in VBG

VBG is same values as ABG

‘arteriolization’ of venous blood. O2 can’t be used by cells

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cyanide tx

new: hydroxocobalamin
old: nitrites (amyl, sodium), sodium thiosulfate (nitrites can cause methemoglobinemia)

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Sewer worker becomes unconscious, think what

hydrogen sulfide tox

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What is sudden sniffing death

Sniffing hydrocarbnons can lead to catecholamine surge, causing VT/VF

treat this VT/VF with beta blocker

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ED pt with painful hand, out of proportion to exam

think what toxic exposure

think hydrofluoric acid

give topical calcium. this pt at risk of arrhytmia from hypocalcemia and hyperkalemia

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hydroflouric acid

how does this kill
give what

arrhytmia from Hypocalcemia and hyperkalemia

give Ca

Iron toxicity

what mg/kg for toxic
what do you need to find out for dosage calculation

>20 mg/kg is toxic,

>60 mg/kg can be lethal

-must know type of iron pill and its elemental percentage to calculat dose

Iron toxicity

stages

GI: vomiting, abd pain, diarrhea
Latent period
Multiorgan failure, shock, met acidosis, lactic acidosis
resolution with GI scarring

iron toxicity

-why do you do abd XR, and what to be aware

XR may show swallowed Fe pills. Hoever, chewable iron are NOT radioopaque

Iron tox

-tx? at what level

Deferoxamine if Fe level >500 or if sxs with level >300

also do whole body irrigation. charcoal ineffective

lithium OD:

signs sxs?

GI: n/v/d

neuro: tremors, coma, convulsions

various arrhythmias (such as bradycardia, av blocks) but these are usu not serious

metal fume fever

metal welder, flu like ilness beginning of week

‘monday morning fever’

cxr normal

methemoglobin–what meds can cause this (think 4)

local anesthetics

dapsone

pyridum

metoclopramide

ASA toxicity

what levels to dialyze: chronic vs acute

acute: 100 ml/dl
chronic: 60 ml/dk

asa toxicity: on boards, you alkalanize for what purpose in real life, what is main effect

1. urine excretion, for urine ph 7.55 2. in real life, alkalinize serum to prevent CNS distribution

serotonin syndrome vs NMS, distinguish

SS: more acute, tremor/hyperreflex/clonus NMS: days-weeks, lead pipe rigid

you have Heroin user with what looks like 'awake seizures.' think what. how to tx

styrchnine poisoning. adulterant in heroin. similar to tetanus (strychnine blocks receptors, tetanus inhibitis release) Tx with BZD

what is K2/spice

synthetic THC causes more psychosis/agitation aka incense, potpurri

bath salts--what are they

sympathamimetic, similar to mdma/meth

snakes: crotalid physical features shape of head, pupils, and facial features

diamond/triangle head cat pupils facial pits

crotalids: when is crofab indicated ?

(speaking with poison control) 1. rapid progression of swelling (eg hand to chest in 1 h) 2. plt \<100 3. fibrinogen \<100

brown recluse: - physical features--#eyes, body ID features - where in usa

- 3 pairs of eyes, not 4. violin on body - south/SE USA

in USA what scorpion to be aware of what is the sxs

Bark scorpion (centuroides), in arizona Neurotoxin--bulbar findings, incl upsoclonus, blurry vision, dysphagia, etc. rare resp arrest. 1-2 intubations/yr in arizona

All marine toxins are \_\_\_\_ how to treat

All are heat -labile give warm/hot water

"Loose teeth", think what

ciguatera along with hot/cold sensations, etc

paralytic shellfish poisoning what is this how to avoid

Dinoflagellates, ("red tide") Rapid, \<30min: gastroenteritis, paresthesias, similar to ciguatera sxs. Can lead to paralysis and to resp arrest--supportive tx "only eat shellfish in months with an R" meaning avoice summer

Irukandji what is this

Type of jellyfish killed some navy SEALs catechol release, pulm edema/MI

Bleach and ammonoia make this

chloramine gas think person that resp arrests in bathroom cleaning

Botulism clinical presentation: what is a common initial presentation that is missed initially?

- pt comes with dry mouth and dysphagia (bc anticholingeric) - then on next visit has bulbar sxs, etc leading to resp arrest