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Tox > Acute Poisonings > Flashcards

Acute Poisonings Flashcards

1
Q

Vomit

A
  • alkaloid: syrup of ipecac, stimulates CTZ
  • don’t give if tox: hydrocarbon, corrosive, acidic, causative, patient not alert
  • not recommended!
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2
Q

Activated charcoal

A

Carbon powder, large surface area to absorb substances

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3
Q

When activated charcoal is not given?

A

If Poison is polar compound with low mol weight (methanol, ethylene glycol), metals (iron, lead), highly ionized salts (lithium, cyanide); p cannot drink, if poison is inhaled

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4
Q

Gastric lavage

A

Orogastric or nasogastric tube inserted through mouth or nose, saline/water added, solution of poison is aspirated back until returning fluid is clear

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5
Q

When gastric lavage doesn’t work?

A

Late tablets or concentrations may not pass up the tube

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6
Q

Whole bowel irrigation (WBI) useful in

A

Large ingestion, ingestion of sustained release or enteric coated preparations, and metal poisoning

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7
Q

WBI procedure

A

Flushes gi lumen with polyethylene glycol electrolyte to speed elimination (1-2L/h for several hrs until rectal effluent is clear)

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8
Q

When do you target metabolism of toxins?

A

When drug is absorbed and gets bioactivated to toxic species - inhibit metabolism to limit toxicity
(Eg: ethylene glycol, methanol)

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9
Q

Drug used in Methanol poisoning

A

Alcohol or fomepizole

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10
Q

Alcohol/fomepizole mechanism

A

Inhibit alcohol dehydrogenase. Inhibit conversion of methanol to formaldehyde (for mic acid - blindness) or inhibit production of oxalis acid from ethylene glycol that can cause metabolic acidosis

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11
Q

Methanol or ethylene glycol poisoning symptoms

A
  • first few hours: inebriation, metabolic acidosis
  • post 6-8 hrs: severe met acidosis, retinal toxicity (methanol), renal toxicity (ethylene glycol), seizures, coma , death
  • look for metabolic acidosis (low pH, low bicarbonate and osmol gap)
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12
Q

Osmol gap

A
  • anion gap: Na-Cl-HCO3= (8-12 mEq/L)

- osmol gap = measured Osm - calculated Osm = measured Osm - (2Na + glucose + urea)= usually less than 10 mOsm/L

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13
Q

Elevated anion gap acronym

A

Methanol
Uraemia
Diabetic ketoacidosis

Paraldehyde
Iron, isoniazid
Lactic acidosis 
Ethylene glycol 
Salicylates
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14
Q

Elevated osmolar gap

A

Methanol
Ethylene glycol

Diuretics (mannitol)
Isopropyl alcohol
Ethanol

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15
Q

Acetaminophen overdose

A

Facilitate glutathione detoxification by giving thiol donor. (n acetylcysteine)
- don’t try to inhibit CYP activation step

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16
Q

Acetaminophen metabolism

A

Phenolsulfotransferase, UDP- glucuronyltransferase

NAPQI- toxic binds to renal and hepatic protons, detoxified by GSH (glutathione)

17
Q

Facilitate elimination of weak acids

A

With sodium bicarbonate, use HHequation, ion trapping: pKa - pH = log [HA]- [A]
- hemodialysis to remove chemical and to correct fluid and electrolyte imbalances

18
Q

Some antidotes and chelators

A 
Fomepizole (methanol, EG)
N-acetylcysteine (acetaminophen)
Fab fragments (digibind)
Desferoxamine (iron)
Atropine (cholinergic excess)
Naloxone (opioid)
Hydrocobalamine (for cyanide)
Flumazenil - bzd
19
Q

Competitive antagonism

A

Naloxone for morphine opioid R
Oxygen for carbon monoxide at hemoglobin
Flumazenil for BZD at GABAR

20
Q

Non competitive antagonism

A

Atropine for cholinesterase inhibitors

Diazepam for strychnine (ant of glycine)

21
Q

Sympathetic toxidrome

A
  • pupil dilation
  • low salivary production
  • low mucus production
  • high heart rate and force
  • bronchial m relaxed
  • low peristalsis In stomach
  • low motility in intestines
  • liver: high conversion of glycogen to glucose
  • kidney: low urine secretion
  • adrenal medulla: NEpi and Epi secreted
  • bladder: wall relaxed and sphincter closed
22
Q

Parasympathetic toxidrome

A
  • pupil constriction
  • high salivary production
  • high mucous production
  • low heart rate and force
  • bronchial m contracted
  • high gastric juice and motility in stomach
  • high digestion in small i
  • high secretion and motility in large I
  • no change in liver
  • high urine secretion In kidneys
  • no change I adrenal medulla
  • bladder wall contracted and sphincter relaxed
23
Q

Cholinergic stimulation

A

Direct on Receptors: muscarinic, nicotinic

Indirect: inhibit acetylcholinesterase

24
Q

Muscarinic receptor stimulation

A 
Salivation
Lacrimation (tearing)
Urination
Diarrhea 
Gi upset
Emesis

Or

Diarrhea
Urination
Mitosis,muscle weakness
Bronchospasm
Bradycardia
Emesis
Lacrimal ion
Salivation, sweating, seizures
25
Q

Nicotinic receptor stimulation

A 
Stimulation of skeletal muscle and ganglia:
Muscle fasciculations (twitching)
Cramping
Hypertension
Tachycardia
Pupil dilation
Pallor
Or 
Monday - mydriasis
Tuesday - tachycardia
Wednesday - weakness
THursday - hypertension 
Friday - fasciculations/cramping
26
Q

Anti cholinergic mnemonic

A 
Mad as a hatter (delusional)
Dry as a bone
Red as a beet (flushed)
Hot as a hare (temp)
Blind as a bat (visual disturbances)
27
Q

Decontamination ways

A
  • remove source, wash
  • activated charcoal
  • gastric lavage
  • whole bowel irrigation
28
Q

Ecstasy mechanism

A

Elevated serotonin, norepinephrine, dopamine

Metabolized by CYP2D6

29
Q

Ecstasy symptoms

A 
Hypertension
Tachycardia
Jaw clenching, bruxism
Hyponatremia 
Liver toxicity
Neurotoxicity

Tox (2 decks)

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