Approach to the Poisoned Patient Flashcards
key questions about the history when involving toxicology
- time of ingestion
- amount ingested; do a pill count
- liquids; concentration and volume.
- route of exposure
- co-ingestions; did you take the drugs with alcohol?
outline a toxicological physical exam
involves all the bodily symptoms
Anion gap equation
Na- (Cl and HCO3-)
causes of anion gap
MUDPILES
M= methanol, metformin
U= uremia
D= DKA/AKA/SKA
P= paraldhehyde, pyroglutamic acidemia, propylene glycol
I= iron, isoniazid
L= lactate
E= ethylene glycol
S= salicylates
Osmolar GAP equation
Calculated OSMOL: 2NA+BUN + glucose + (1.25xethanol)
Osmolar gap= OSM (measured) -OSM (calculated)
Ddx osmolar gap (KAMCCPS)
- toxic alcohols ; methanols, ethylene glycol, isopropanol
- ketoacidosis/elevated lactate; would see a small elevation osmolar gap
- mannitol, sorbitol
- contrast agents
- CKD
- pseudohyponatremia
- Sick cell syndrome
ABCDEF toxicology approach
airway, breathing circulation, decontamination, elimation of any other toxin, find an antidote
leading cause of acute liver failure– what’s it’s toxic dose?
acetaminophen overdose. 150mg/kg toxic dose.
treatment for acetaminophen overdose
NAC; n- acetylcysteine 21 hour protocol.
in toxicological exposures, muscle ridigity can be a finding of toxicity. what limbs are more affected?
lower limbs are more likely to be effected.
general protocol
- history
- ABCDEF and physical exam
- labs; LFTs, toxic labs like ethanol and acetaminophen levels, CBC, urine analysis.
- continue ABCDEF when you have more information
sick cell syndrome
leaky cells, causing ions and anions and contents leaking out to the environment. causes an abnoraml osmole gap
factors to consider when thinking about hemodialysis for poisonin
- size
- volume of distribution
- water/lipid solubility
- degree of protein binding
- endogenous clearance.
common dialyzable toxins (SMELTV)
S; salicytes
m: methanol
E; ehtylene glycol
L; lithium
T; theophylline
V; valproic acid
indications for gastric lavage
pumping patients stomach. for patients who have taken an overdose wehre you think its going to kill them, even with a bunch of pressors. pumping patient stomach will prevent the absorbtion
whol bowel irrigation indicatsion
for overdose of extended release medications, or if a bezoir of pills/toxin forms. allows you to flush it out the other end.
what is a toxidrone
collection of signs and symptoms associated with exposure to a specific toxin.
outline opioid presentation in terms of CNS, pupils, CVS, resp, GI and vital sign symptoms
CNS; drowsy, low LOC
pupils: miosis
CVS: normo/bradycardic, normo/hypotension
resp: low resp rate.
GI; decreased bowel sounds
bital signs; depressed BP and HR, decreased RR, SpO2. decreased temperature
there are lots of symptoms that could indicate an opioid overdose presentation. What is the triad toxidrome?
drowsy/low LOC, miosis, and respiratory depression
antidose for opioid toxicity
naloxone
toxidrome symptoms of serotonin toxicity
- akathisia, tremor, clonus, altered mental status, sustained clonus, musclular hypertonicity, hyperthermia.
serotonin syndrome toxidrome
increased bowel sounds, autonomic instability (often hypertensive), tachycaria, agitation, diaphoresis, mydriasis, clonus (especially in lower extremities) , tremor and hyperreflexia.
treatment for serotonin syndrome (ie, treat the symptoms)
cooling: cold IV fluids, ice packs in groin and axilla, water msting/evaporative cooling
decrease the rigidity; NEED BENZOS, paralysis to prevent over ridigity– you must intubate them if you paralyze them), CYPROHEPTADINE is a possible antitode but it’s not really good.
