Acute Intoxication & OD

Question 1

tx wernickes encephalopathy

Answer 1

thiamine (B1)

Question 2

tx opiod od

Answer 2

narcan - naloxone

Question 3

tx hypoglycemia

Answer 3

glucose

Question 4

if pt is tachypnea think OD from___

Answer 4

salicylates

Question 5

if pt is bradypnea think OD from __

Answer 5

opiods

Question 6

shallow breaths?

Answer 6

opiod OD

Question 7

kussmaul like breaths?

Answer 7

salicylates

Question 8

large pupils mean…

Answer 8

anticholinergic or sympathomimetic toxidrome

Question 9

small pupils

Answer 9

opioid

Question 10

nystagmus horizontal think..

Answer 10

ethanol, ketamine

Question 11

nystagmus rotary or vertical think..

Answer 11

PCP, some stimulants

PCP (phencyclidine)

Question 12

hyperpyrexia goes with what 4 toxidromes?

Answer 12

anticholinergic, stimulants, serotonin syndrome, sympathomimetic

Question 13

hypothermic toxidrome goes with

Answer 13

opioid, sedative-hypnotics

Question 14

if their dry its..

Answer 14

anticholinergic

Question 15

if they are moist think

Answer 15

cholinergic

Question 16

everything up think..

Answer 16

sympathomimetic, anticholinergics, stimulants , hallucinogens

Question 17

everything physiologically down think

Answer 17

depressed temp, HR, BP, RR, lethargy/coma

Question 18

mixed effects? BP and HR up but RR down…

Answer 18

polysubstance, metabolic poisons, salicylates

Question 19

before giving activated charcoal what do you have to consider?

Answer 19

MS, risk of aspiration and airway

Question 20

concern for __ with using activated charcoal

Answer 20

bezoars

Question 21

when is hemodialysis used to detox?

Answer 21

salicylates, methanol, ethylene glycol, lithium, mushrooms, isopropyl alocohol

Question 22

MATHS mnemonic is ..

Answer 22

Sx for any sympathomimetic toxidrome 
mydriasis 
agitation 
tachycardia 
hypertension 
seizure (and sweating)

Question 23

when are BB avoided?

Answer 23

if suspected sympathomimetic OD .. concerns of unopposed alpha stimulation

Question 24

toxic dose of APAP

Answer 24

150 mg/kg

Question 25

sx stage I APAP OD

Answer 25

N/V, most asymptomatic

Question 26

sx stage II APAP OD

Answer 26

latent stage 24-48 hrs

RUQ pain, increased AST/ALT/bilirubin INR

Question 27

sx stage III APAP OD

Answer 27

liver failure, RUQ pain, V, jaundice, coagulopathy, hypoglycemia, renal failure, metabolic acidosis

Question 28

sx stage IV APAP OD

Answer 28

resolution of hepatic dysfunction

OR death / transplant

Question 29

tx APAP od

Answer 29

n-acetylcysteine - no CI

Question 30

NAC loading dose IV

Answer 30

150 mg/kg

Maintance rate: 50 mg/ kg over 4 hours

Question 31

when do you stop NAC dose?

Answer 31

stop when APAP is undetectable, AST/ALT less than 100 and INR is less than 1.5

OR there is transplant or death

if given within 8 hours, hepatotoxicity is uncommon and death is rare

Question 32

when admit APAP od pts?

Answer 32

known toxicity / potential tox level 
hepatic damage lab evidence
unknown time of ingestion 
unknown ingestion time with APA 
if it was intentional self harm

Question 33

toxic dose of salicylates

Answer 33

over 150 mg / kg

Question 34

lethal dose of salicylates

Answer 34

480 mg / kg

Question 35

antidote for salicylates

Answer 35

NONE .. there is none

Question 36

early sx salicylate od

Answer 36

N/V, tinnitus, diaphoresis, confusion, deafness, tachypnea, vertigo, respiratory alkalosis (direct stimulation)

Question 37

late sx salicylated od

Answer 37

anion gap met. acidosis, ALOC, pulmonary edema, hypoglycemia (severe), hepatic and renal dysfunction, seizures, death

Question 38

fastest way to kill pt with ASA overdose is__

Answer 38

sedation for agitation

Question 39

ASA tx

Answer 39

activated charcoal with sorbitol
empiric dextrose
bicarb, supplemental K+

Question 40

start dialysis for many reasons including if ph is less than

Answer 40

7.19

Question 41

barbiturate od tx

Answer 41

abc/acls

aggressive fluids, pressors prn, supportive care etc

Question 42

____ causes permanent retinal injury, blindness and parkinsonian syndrome

Answer 42

methanol OD

Question 43

___ od causes fruity breath ketosis without acidosis

Answer 43

isopropanol

Question 44

2nds most common alcohol od

Answer 44

isopropanol

Question 45

with ___ od urine may flouresce

Answer 45

ethylene glycol (antifreeze)

Question 46

fatal dose ethylene glycol

Answer 46

2 ml / kg

Question 47

sx first 12 hours antifreeze od

Answer 47

CNS depression, vomiting, sz, coma, tetany

Question 48

sx 12-24 hours antifreeze od

Answer 48

cardiopulmonary, hypotension, tachydysrhythmias, ARDS

Question 49

sx 24-73 hrs

Answer 49

nephrotoxic, oliguria, renal failure, ATN, calcium oxalate cyrstalluria