3. Management of the poisoned patient III. Enhancing of elimination of toxins

Question 1

What can enhance elimination of a toxin?

Answer 1

1. Urine alkalinization and acidification
2. Pure lipid bilayers are generally permeable only to small, uncharged solutes
3. permeability favors neutral species
4. Hemodialysisan extracorporeal circulation procedure - patient’s blood is pumped through a column containing a semipermeable membrane that allows the removal of many toxic compounds

Question 2

What is Antidote?

Answer 2

It’s a substance that counteracts the effect of a poison.

Question 3

what are Caustics and corrosives?

Answer 3

acidic or alkaline substances.

Question 4

What are the treatment options for caustics and corrosives?

Answer 4

1. Airway protection!!! - progressive airway edema
2. Fluid losses (vomiting and GIT bleeding) - may lead to hypovolemia and shock. Do not induce emesis
3. Do not attempt to neutralize by using a weak acid or base!!!
4. NaHCO3 iv in acidosis
5. Small amounts of a diluent (Water or milk) may be beneficial if administered
6. Corticosteroids
7. A third-generation cephalosporin or ampicillin/sulbactam may be considered -Ceftriaxone
8. Proton pump inhibitors reduce exposure of injured esophagus to gastric acid
9. Morphine

Question 5

What is the antidote for Acetaminophen?

Answer 5

Acetylcysteine, best given within 8-10 h of overdose.

Question 6

What is the antidote for cholinesterase inhibitors?

Answer 6

Atropine

Question 7

What is the antidote for Membrane depressant cardiotoxic drugs (eg, quinidine, tricyclic antidepressants)?

Answer 7

Bicarbonate, sodium

Question 8

What is the antidote for Fluoride and Calcium channel blockers?

Answer 8

Calcium

Question 9

What is the antidote for iron salts?

Answer 9

Deferoxamine

Question 10

What is the antidote for digoxin and related cardiac glycosides?

Answer 10

Digoxin Antibodies

Question 11

What is the antidote for caffeine, theophylline and sympathomimetics?

Answer 11

Esmolol

Question 12

What is the antidote for Methanol and Ethylene glycol?

Answer 12

1. Ethanol
2. Fomepizole

Question 13

What is the antidote for Benzodiazepines and Zolpidem?

Answer 13

Flumazenil

Question 14

What is the antidote for Beta Adrenoreceptor Blockers (Beta Blockers)?

Answer 14

Glucagon

Question 15

What is the antidote for Hypoglycemics?

Answer 15

Glucose

Question 16

What is the antidote for Cyanide poisoning?

Answer 16

Hydroxocobalamin

Question 17

What is the antidote for opioid analgesics?

Answer 17

Naloxone

Question 18

What is the antidote for carbon monoxide poisoning?

Answer 18

Oxygen

Question 19

What is the antidote for muscarinic receptor blockers, NOT tricyclics?

Answer 19

Physostigmine (suggested)

Question 20

What is the antidote for organophosphate cholinesterase inhibitors?

Answer 20

Pralidoxime

Question 21

What are the sources of acidic and alkaline substances?

Answer 21

Alkali:

1. Drain cleaners
2. Ammonia – containing products
3. Automatic dishwasher
4. Hair relaxers
5. Cement
6. Bleaches

Acidic:

1. Toilet bowl cleaners
2. Battery liquid
3. Rust-removers

Question 22

What are the pathological changes of caustics and corrosives (acidic and alkaline substances)?

Answer 22

1. Alkaline: liquefactive necrosis - PERFORATIONS
2. Acid ingestions cause tissue injury by coagulation necrosis - protect the underlying tissue from further damage

Question 23

What are the symptoms of poisoning with caustics and corrosives (acidic and alkaline substances)?

Answer 23

1. Dyspnea
2. Dysphagia
3. Oral pain and odynophagia
4. Chest pain
5. GIT symptoms: abdominal pain, nausea and vomiting

Question 24

What are the side effects of ingesting an acidic substance?

Answer 24

After significant acidic ingestions, the patient may develop metabolic acidosis, hemolysis, and multiorgan failure including acute renal failure.