10 Tox

Question 1

Acetaminophen toxic doses

1. mg /kg
2. how grams in a typical adult
3. chronic daily dose

Answer 1

150 mg/kg

about 10g in an adult

chronic is >3g/day (variable)

Question 2

acetaminophen:

what is name of toxic metabolite

Answer 2

NAPQI

requires glutathione to metabolize

Question 3

jimson weed

what toxicity

Answer 3

aka nightshade

anticholinergic

Question 4

why do botulism pts have a dry throat

Answer 4

similar mech to anticholinergic (botulism prevents Ach release)

Question 5

bidirectional VT, think what

Answer 5

Dig toxicity (can have othe EKG findings as well)

Question 6

How does TCA poisoning kill?

(3)

Answer 6

3 killers:

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

Question 7

Normal CO levels in blood

• healthy people
• smokers
• What level to do hyperbaric treatment?

Answer 7

healthy: 2-3%
smokers: 5-10

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

Question 8

CO halflife on:

room air vs 15L NRB vs hyperbaric chamber

Answer 8

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

Question 9

CO toxicity

indications for hyperbaric tx

which indication(s) are proven?

Answer 9

multiple indications, include:

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

Question 10

You have patient with opioid OD with bradycardia/hypotension

think what

Answer 10

Think this might be clonidine OD

Question 11

Cyanide poisoning

-what do you see in VBG

Answer 11

VBG is same values as ABG

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

Question 12

cyanide tx

Answer 12

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

Question 13

Sewer worker becomes unconscious, think what

Answer 13

hydrogen sulfide tox

Question 14

What is sudden sniffing death

Answer 14

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

treat this VT/VF with beta blocker

Question 15

ED pt with painful hand, out of proportion to exam

think what toxic exposure

Answer 15

think hydrofluoric acid

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

Question 16

hydroflouric acid

• how does this kill
• give what

Answer 16

arrhytmia from Hypocalcemia and hyperkalemia

give Ca

Question 17

Iron toxicity

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

Answer 17

>20 mg/kg is toxic,

>60 mg/kg can be lethal

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

Question 18

Iron toxicity

stages

Answer 18

1. GI: vomiting, abd pain, diarrhea
2. Latent period
3. Multiorgan failure, shock, met acidosis, lactic acidosis
4. resolution with GI scarring

Question 19

iron toxicity

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

Answer 19

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

Question 20

Iron tox

-tx? at what level

Answer 20

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

also do whole body irrigation. charcoal ineffective

Question 21

lithium OD:

signs sxs?

Answer 21

GI: n/v/d

neuro: tremors, coma, convulsions

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

Question 22

metal fume fever

Answer 22

metal welder, flu like ilness beginning of week

‘monday morning fever’

cxr normal

Question 23

methemoglobin–what meds can cause this (think 4)

Answer 23

local anesthetics

dapsone

pyridum

metoclopramide

Question 24

ASA toxicity

what levels to dialyze: chronic vs acute

Answer 24

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

Question 25

asa toxicity:

on boards, you alkalanize for what purpose

in real life, what is main effect

Answer 25

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

Question 26

serotonin syndrome vs NMS, distinguish

Answer 26

SS: more acute, tremor/hyperreflex/clonus

NMS: days-weeks, lead pipe rigid

Question 27

you have Heroin user with what looks like ‘awake seizures.’ think what.

how to tx

Answer 27

styrchnine poisoning.

adulterant in heroin. similar to tetanus (strychnine blocks receptors, tetanus inhibitis release)

Tx with BZD

Question 28

what is K2/spice

Answer 28

synthetic THC

causes more psychosis/agitation

aka incense, potpurri

Question 29

bath salts–what are they

Answer 29

sympathamimetic, similar to mdma/meth

Question 30

snakes: crotalid physical features

shape of head, pupils, and facial features

Answer 30

diamond/triangle head

cat pupils

facial pits

Question 31

crotalids:

when is crofab indicated ?

Answer 31

(speaking with poison control)

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

Question 32

brown recluse:

• physical features–#eyes, body ID features
• where in usa

Answer 32

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

Question 33

in USA what scorpion to be aware of

what is the sxs

Answer 33

Bark scorpion (centuroides), in arizona

Neurotoxin–bulbar findings, incl upsoclonus, blurry vision, dysphagia, etc. rare resp arrest. 1-2 intubations/yr in arizona

Question 34

All marine toxins are ____

how to treat

Answer 34

All are heat -labile

give warm/hot water

Question 35

“Loose teeth”, think what

Answer 35

ciguatera

along with hot/cold sensations, etc

Question 36

paralytic shellfish poisoning

what is this

how to avoid

Answer 36

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

Question 37

Irukandji

what is this

Answer 37

Type of jellyfish

killed some navy SEALs

catechol release, pulm edema/MI

Question 38

Bleach and ammonoia make this

Answer 38

chloramine gas

think person that resp arrests in bathroom cleaning

Question 39

Botulism clinical presentation:

what is a common initial presentation that is missed initially?

Answer 39

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