Chapter 19. Toxicology Flashcards
Gastric lavage or gastric gabage: This procedure can be used:
• Good for patient if unconscious • Depression • Seizures • Coma and convulsion CI in pts: ingested Acids, Alkali, Hydrocarbons, Risk of GI perforation
This method is used to evacuate GI tract. Give CIs.
Emesis -vomiting CI in pts: • Children less than 6 month • Strong acid and base • Depression • Unconsciousness • Seizures • Coma and convulsion • Extremely rapid onset of action • Emesis following ingestion • Sharp objects • Hydrocarbons, petroleum products
Syrup of Ipecac is administered within 60 min toxic dose ingestion (later has no benefit)
• Onset of emesis 30 min. Effect could last 2 hours.
• 3 episodes of emesis in 60 min
For emesis:
Adult: 15 to 30 ml po with 1 to 2 glass of water
Children: 10 to 15 ml po with 1 to 2 glass of water
As expectorant: Adult—1 to 2 ml po
Children— 0.25 to 0.5 ml po
• This method is preferable method of decontamination
• Higher the surface area of charcoal higher the adsorption
• Heating this increase adsorption
Also as colloidal dispersion form.
Not to be used for what? (Not adsorbed)
Activated Charcoal
NOT for (because not adsorbed) methanol, ethanol, iron, cyanide, ethylene glycol, mercury, organic solvents, potassium, strong acids and bases. Do not use if patient is vomiting.
Dosage: Adults 25 to 100 g. Children 1 to 12 years 25 to 50 g, 0 to 1 years. 1 g/kg
- Promotes the ionization of weak acids therefore prevents re-absorption by the kidney, facilitate excretion of weak acids. Example salicylic acids, ASA, phenobarbital, and barbiturates. GIVE DOSING.
- Used to promote elimination of weak bases. Example amphetamines, phencyclidines, quinidine derivative, and alkaloid drugs. GIVE DOSING.
Alkaline diuresis: Dosage of NaHCO3 50 to 100 mEq
• pH 7.3 to 8.5 (urine)
• Urine output 5 to 7 ml/kg/hr
NaHCO3 side effects: Metabolic alkalosis, hypernatremia, hyperosmolarity, and fluid overload.
Acid Diuresis: Dosage: Ascorbic acid 500 mg to 1 g and ammonium chloride 4 g every 2 hours serum electrolyte and pH should be monitored.
- Mild anorexia, nausea, vomiting, delayed jaundice, hepatic and renal failure Max dose 4 g/day. Max dose 2 g/day for chronic alcoholic, and hepatic disease Antidote is acetylcysteine, should be administered within 8 hours of overdose.
- Toxic features of antifreeze.
- Acetaminophen
- Toxic oxidized product has this is oxalic acid. Renal failure, crystals in urine, anion and osmolar gap, initial CNS excitation and eye examination normal
- Dysphagia, dysarthria, ophthalmoplegia, muscle weakness. Incubation period 12 to 36 hours.
- Coma, metabolic acidosis, retinal hemorrhages
- Bitter almond odor, seizures, coma, and abnormal ECG.
- Distinctive odor, coughing, pulmonary infiltrates on x-ray.
- Toxic features of Fe and Pb.
- Botulism
- Carbon monoxide
- Cyanide
- Gasoline
- Fe: Bloody diarrhea, coma, radiopaque material in gut (seen on x-ray), high leukocyte count, and hyperglycemia.
- Pb: Abdominal pain, hypertension, seizures, muscle weakness, metallic taste, anorexia, encephalopathy, delayed motor neuropathy, changes in renal and reproductive function. Gray mouth.
-Severe nausea and vomiting 8 hours after ingestion; delayed hepatic and renal failure
LSD, Mercury and Methanol toxic features
-Mushrooms (Amanita phalloides type)
LSD: Hallucinations, dilated pupils, and hypertension
Mercury: Acute renal failure, tremor, salivation, gingivitis, colitis, Erethism (fits of crying, irrational behaviour), nephritic syndrome.
Methanol: Rapid respiration, visual symptoms, osmolar gap, severe metabolic acidosis. Methanol toxicity gives blindness due to formic acid
-Oropharyngeal burning, headache, vomiting, delayed pulmonary fibrosis, and death
-Coma with eyes open, horizontal and vertical nystagmus, hyperacusis, myoclonic jerks, violent behaviour
-Toxic features of Plants Nightshade family—jimsonweed, Oleander and foxglove,
Predatory bean (rosary pea) has
- Paraquat
- Phencyclindine (PCP)
- Hallucinations, mydriasis, seizures (these plants contain atropine-like alkaloids)
- Digitalis poisoning
- Delayed severe gastrointestinal distress, seizures, hemolytic anemia, death
Antidotes for the ff:
-acetyl cysteine best given within 8 to 10 hours after overdose of
acetaminophen.
-Snakes, black widow spiders
-Cholinesterase inhibitors, organophosphates, carbamates.
- Acetylcysteine
- Antivenin
- Atropine
- Bicarbonate, sodium
- Deferoxamine
- Digoxin-specific Fab antibodies (Digifab)
- Membrane-depressant cardiotoxic drugs, e.g. Quinidine, TCA and ASA
- Iron salts
- Digoxin and related cardiac glycosides
-Caffeine, theophylline, metaproterenol -Methanol, and ethylene glycol -Benzodiazepines, zolpidem
- Esmolol
- Ethanol
- Flumazenil
These are antidotes for what? Glucagon EDTA Dimercaprol Hydroxocobalamine Penicillamine
Glucagon: Insulin, beta-blockers
EDTA:Lead
Dimercaprol: Lead, gold, arsenic, and mercury
Hydroxocobalamine: Cyanide
Penicillamine: Copper, lead, arsenic, gold and Wilson’s disease
- Opioid analg.(blocks mu receptors): Resp depression.
- Carbon monoxide
- Atropine (muscarinic antagonist), not tricyclics -Organophosphate cholinesterase inhibitors
- Naloxone
- Oxygen
- Physostigmine
- Pralidoxime
- Cyanide (Nitroprusside)
- Heparin/LMWH
- Warfarin
- Idarucizumab
- Methanol, ethanol, and ethylene glycol
- Sodium thiosulfite
- Protamine sulfate
- Vitamin K (Phytanodione)
- Dabigatran
- Fomepizol (alcohol dehydrogenase enzyme inhibitors)
