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Promo Boards > Antidotes and Toxidromes > Flashcards

Antidotes and Toxidromes Flashcards

1
Q

Tylenol OD

  • Toxic Path
  • Liver Zone
A

P450

Centrilobular (Zone III)

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2
Q

Tylenol Tx

A

NAC

PO: 140 mg/kg then 70 mg/kg q 4hrs

IV: 150mg/kg over 1 hr, then 50mg/kg over 4 h4, then 100mg over 16hr

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3
Q

ASA OD Pres

A
  • Nausea/vomiting
  • Tinnitus
  • Confusion
  • Hyperthermia
  • Respiratory alkalosis with Metabolic acidosis
  • Multiple organ failure
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4
Q

ASA Toxic Levels:

A

<150mg/kg = mild

>500mg/kg = Lethal

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5
Q

ASA Tx

A
  • Urinary Alkalinization
    • NaHCO3 2-3 amps IV
    • Then 3 amps in 1L D5W @ 1.5 maintentence
    • Goal urine pH 7.5-8.0
  • Treat hypoK
  • Dialysis
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6
Q

ASA Dialysis Indications

A
  1. Severe Acidosis
  2. End organ damage
  3. Level > 90
  4. Coma
  5. Levels rising with alkalinization
  6. Volume overload
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7
Q

CO Poisoning

  • Half Life
  • Treatment
A
  • CO-Hb t1/2:
    • Room air- 5 hours
    • 100% O2- 1.5 hours
    • Hyperbaric oxygen-0.5 hours
  • Tx: 100% O2 NRB til sx resolve
  • HBOT if…
    • CO > 25% (pregnant > 15%)
    • Neuro - AMS, FND, Sz,
    • Resp failure,
    • Infants,
    • CN tox,
    • pH < 7.2,
    • Cardiac ischemia or arrhythmia
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8
Q

Benzo Tx

A
  • Supportive
  • If Iatrogenic: Flumazenil
    • 0.2mg then increase by 01.mg q1min until effective or 5mg max
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9
Q

Cholinergic Toxidrome Pres

A

DUMBELLS

  • Diarrhea/Diaphoresis
  • Urination
  • Miosis
  • Bradycardia/Bronchospasm
  • Emesis
  • Lacrimation, Low BP
  • Salivation, Seizures
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10
Q

Cholinergic Tx

A
  • Atropine until secretions dry
    • 2 mg IV (0.02 mg/kg)
    • Double for IM
  • 2-PAM aka Pralidoxime 0.1mg/kg IV
  • Ativan for Sz
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11
Q

Anticholinergic Toxidrome

A

Sympatomimetic, but dry

  • Red as a beet (flushed)
  • Dry as a bone
  • Hot as a Hare (incr temp, BP, HR)
  • Blind as a Bat (mydriasis)
  • Mad as a Hatter (delirium)
  • Full as a flask (urinary retention)
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12
Q

Anticholinergic Tx

A

Benzos, Supportive

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13
Q

Narcan Dosing

A

Code Dose = 2mg

Start 0.04, double q 2 min

Drip at 2/3 effective rate per hour

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14
Q

Iron Toxicity

A
  • Gastric Lavage or WBI if early
  • Deferoxamine
    • Indications:
      • > 60 mg/kg ingested
      • Fe level > 500 mcg/dL or >300 with mod-severe sx.
    • Dose
      • 15 mg/kg/hr IV up to 45 mg/kg/hr (max 1g/hr)
        • watch for hypotension - if occurs, provide support for BP and continue deferoxamine
    • Vin rose-colored urine- red wine appearance after deferoxamine chelation
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15
Q

Toxic Alcohol with OG but no AG

A

Isopropyl Alcohol

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16
Q

Ethylene Glycol

  • Metabolite
  • Labs
  • Tx
A
  • Metabolite = Oxalic Acid
    • Anion gap, + osmolar gap, - ketones
  • Urine fluoresce under Wood’s lamp
  • Tx:
    • Fomepizole 15 mg/kg in 100 ml D5W over 30 min
    • Ethanol (competitive inhibitors for ADH)
    • Dialysis
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17
Q

Ethylene Glycol Hemodialysis Indications

A

Renal insufficiency

EG level >50 mg/dL

severe acidosis)

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18
Q

Isopropyl Alcohol

  • Metabolite
  • Labs
  • Tx
A
  • Metabolite → acetone
    • anion gap, + osmolar gap, +ketones
  • Dialysis (refractory hypotension, serum levels > 400-500)
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19
Q

Isopropyl Dialysis Indications

A

Refractory hypotension

Serum levels > 400-500

20
Q

Methanol

Metabolite

Labs

Tx

A
  • Toxic metabolite: formic acid
    • anion gap, + osmolar gap, - ketones
  • Tx: fomepizole 15 mg/kg
  • ethanol
  • dialysis (renal insufficiency, level >25 mg/dL, severe acidosis, visual symptoms)
21
Q

Fomepizole for…(2)

A

Ethylene Glycol

Methanol

22
Q

General Ind for Dialysis for Toxic Metabolites

A

ARF

Severe Acidosis

23
Q

Methanol Dialysis Indications

A

Renal insufficiency

Level >25 mg/dL

Severe acidosis

Visual symptoms

24
Q

ASA Dialysis Indications

A
  • Serum salicylate level :
    • > 120 mg/dL acutely
    • > 100 mg/dL 6 h post-ingestion.
  • Refractory acidosis.
  • Coma or seizures.
  • Noncardiogenic pulmonary edema.
  • Volume overload.
  • Renal failure.
25
Q

Beta Blocker OD

A
  • Glucagon 5-10mg IV, then 1-5/hr
  • HD Insulin (1u/kg bolus, then 1 u/kg/hr) + dextrose
  • Wide QRS –> Bicarb
  • Hypotension –> Pressors
  • Bradycardia –> Atropine
26
Q

Calcium Channel OD Tx

A
  • Calcium
    • CaGlu 3g (30mL of 10%)
    • Cl 1g (10 mL of 10%) - Through CVL
  • HD Insulin (1u/kg bolus, then 1 u/kg/hr) + dextrose
  • Wide QRS –> Bicarb
  • Hypotension –> Pressors, IVF
  • Bradycardia –> Atropine
27
Q

Cyanide

A
  • Almond smell
  • Blocks oxidative phosphorylation
  • Tx =
    • First Line - Hydroxycobalamin - 5gm IV
    • Old - CyanoKit
      • Amyl nitrite + Sodium Nitrite + Sodium Thiosulfate
28
Q

Elapidae Tx

A

Supportive

Follow NIF

29
Q

Crotalidae Tx

A
  • Labs: CBC (for Plt), Fibrinogen, Fibrin Split Products
  • Treatment:
    • Wound Care
    • Tetanus
    • Antivenom - CroFab
      • *
30
Q

CroFab Dosing

A
  • Same dose Peds vs Adults
  • Mild-Mod - 4 Vials​
    • ↑ swelling
    • Plts <100K
    • Fibrinogen <100
  • Severe - 6 vials ​
    • Rapidly ↑ swelling
    • Plts <25
    • Fibrinogen <25
    • ↓BP
    • Airway compromise
    • End organ damage
  • Repeat exam/labs 1hr after AV
    • Add 4V AV for:
      • ↑ swelling, plts/fibrinogen ↓ or not improved.
    • Add 6V AV for severe parameters.
  • Observe
31
Q

Opiate Withdrawal

A
  • Tx = Supportive, maybe Benzos
  • YAWNED - ​Y​awning, ​A​gitation, ​W​et, ​N​VD, pilo-​E​rection, ​D​on’t sleep
32
Q

ETOH Withdrawal

  • Pres
  • Treatment
A
  • Usually 6-24/48 hrs after
  • SSSHHT
    • S​weaty, ​S​z, ​S​hakes, ​H​TN, ​H​allucinations, ​T​achycardia
  • Treatment
    • Ativan
    • Phenobarb
    • Precedex
    • +/- Thiamine, Mag
    • +/- D50
33
Q

TCA OD Presentation

A
  • Anticholinergic
  • GABA inhibition (seizures)
  • Peripheral alpha blockade (vasodilation, hypotension),
  • Decreased cardiac contractility
  • K channel blockade (QT prolongation)
  • Na channel blockade (QRS widening, arrhythmia,sz)
34
Q

TCA EKG

A

Widened QRS

QT prolongation (>100-sz, >160- ventricular arrhythmia)

aVR:

  • Right axis deviation of terminal QRS (terminal R > 3 mm in aVR
  • R:S >0.7
35
Q

TCA Treatment

A
  • Decontamination: Actichar ± Gastric lavage
  • Bicarb:
    • Indications: If QRS > 100 msec, arrhythmia or ↓BP
    • Dose:
      • 2-3 amps (1-2 mEq/kg children) IV,
      • 3 amps in 1L D5W @ 1.5 x maintenance.
    • Goal: urine pH 7.5-8.0
  • If Szs…. Ativan 0.1 mg/kg IV
  • Refractory cases:
    • 3% saline
    • Lidocaine
    • NE for hypotension
    • Lipid therapy
    • Monitor hypokalemia
  • Contraindicated: Type Ia, Ic and III antiarrhythmics, beta blockers, flumazenil
36
Q

Dialyzable Drugs

A

STUMBLE

  • Salicylates
  • Theophylline
  • Uremia
  • Methanol
  • Barbiturates
  • Lithium
  • Ethylene Glycol
37
Q

Lead Toxicity

Ind to Treat

Tx

A

Lead Level > 70

Dimercaprol –> 2 hours later –> CaNaEDTA

38
Q

Charcoal CI Substances

A

CHAMPS

  • Caustic
  • Hydrocarbon
  • Alcohols
  • Metals
  • Pb (Lead)
  • Salts
39
Q

Physostigmine CI

A

TCA OD

(Avoid if Long QT, Long QRS)

40
Q

Hydrogen Sulfide

  • Locations

Presentation

Tx

A
  • Sewers, hot springs/volcanoes
  • HA, N/V, Resp Distress, Sz, Sudden LOC
  • Tx
    • Remove from environment
    • 100% O2
    • Sodium Nitrite –> Induce Methemaglobinemia
      • 10mL of 3% solution over 2 min
    • +/- HBO
41
Q

Hydrofluoric Acid

  • Source
  • Pres
  • Tx
A
  • Etching
  • Pres:
    • Dermal = liq. necrosis, pain-out-of-proportion
    • Pulmonary = Pulmonary Edema/ARDS
    • Ingestion = N/V, abdominal pain, perf
    • Systemic = HypoCa, HypoMg, Hyper K, VF/Torsades, Met Acidosis
  • Tx:
    • Remove clothes and irrigate
    • Skin - CaGlu Gel or SubQ
    • Inhalation - CaGlu Neb
    • Electrolyte Replacement - Will need CVL and CaCL + Mg
42
Q

INH

  • Pres
  • Tx
A

Seizure

Pyridoxine 4g

43
Q

Digitalis

  • Sources

Symptoms

Treatment

A
  • Source
    • Acute - Digoxin
    • Chronic - Foxglove/Oleander
  • Symptoms
    • yellow-green vision
    • fatigue
    • N/V/D
    • palpitations
    • syncope
    • AMS
    • arrhythmias
  • Treatment - Digibind
    • Acute Emergency = 10 vials adult/kids
    • Chronic Emergency = 4 adults, 2 kids
    • If Level Known
      • # Vials = Dig Level x Kg / 100
44
Q

Methemoglobinemia

  • Source
  • Pres
A
  • Nitrites, nitrates, dapsone, phenazopyridine, benzocaine
  • Pres
    • Cyanosis
    • Chocolate brown blood
    • Need co-oximetry analysis, pulse ox reads 85%
  • Tx:
    • Methylene blue 1-2 mg/kg IV of 1% sol
    • If doesn’t improve consider sulfa-Hb
45
Q

Serotonin Syndrome

  • Serotonergic Drugs
  • Pres
  • Tx
A
  • SSRIs, MAOIs, others
  • Pres = Rapid
    • Sympathomimetic
    • Mydriasis
    • Myclonus
  • Tx
    • Stop agent
    • Cyproheptadine 8mg PO
    • Supportive
46
Q

NMS

  • Cause
  • Pres
  • Treatment
A
  • Cause - Antipsychotics - new or recent dose change
  • Pres = Slow
    • Sympathomimetic
    • Rigid
    • Normal pupils
  • Treatment
    • Supportive
      • Hyperventilation, fluid resuscitation, cool, paralyse
    • Bromocriptine, amantadine (Dopamin antagonists)
    • Dantrolene
47
Q

Malignant Hyperthermia

  • Cause
  • Pres
  • Treatment
A
  • Inhaled anesthetics (genetic predisposition)
  • Spasm/rigidity, acidosis, rhabdo
  • Treatment
    • Dantrolene
    • Anesthesia consult

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