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Clinical Pathology > Chemistry 11 (Poisons) > Flashcards

Chemistry 11 (Poisons) Flashcards

1
Q

95% of lead ingested is distributed in

A

RBCs and bone

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2
Q

lead is toxic by ___ and ___

A

inhibiting enzymes with sulfhydrul group

toxic to mitochondria directly

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3
Q

in kidneys, lead is toxic to

A

renal tubular cells

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4
Q

lead inhibition of ___ in RBC precursors leads to buildup of ____

A

gamma-ALA-dehydratase and ferrochetalase

free etythrocytes protoporphyrin (FEP)

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5
Q

___ and ___ are increased in both lead poisoning and iron def

A

FEP and ZPP

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6
Q

lead inhibition of ___ causes increaqsed osmotic fragility of RBCs

A

sodium channel ATPases

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7
Q

2 ways iron def enhances lead tox

A

last step of heme synth (iron into protoporphyrin) inhibited by iron def
increased intestinal absorption of iron and lead

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8
Q

end stage renal manifestations of lead tox

A

aminoaciduria
glycosuria
phasphaturia

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9
Q

syndrome that looks like end stage lead tox on kidneys

A

Fanconi renal syndrome

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10
Q

classic peripheral neurpathic symptom of lead tox

A

bilatera wrist drop

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11
Q

preferred method for testing lead

A

atomic absorption spectrophotometry

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12
Q

blood level of lead that needs to be detected

A

10 microgram/dL

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13
Q

lead chelating agenst

A

dimercaprol (BAL), CaNa-EDTA, D-penicillamine, succimer

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14
Q

blood lead level indication for inpatient tx

A

> 70

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15
Q

CO has greater affinity for ___ than ____

A

Fetal than HbA

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16
Q

2 ways CO is toxic

A

directly to intracellular oxidative mechanisms

increased production of NP

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17
Q

CO levels in non-smoker and smoker

A

0.4-2%

2-6%

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18
Q

CO can be produced endogenously by

A

breakdown of heme

hepatic metabolism of dichloromethane (methylene chloride) in paint and removers

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19
Q

method that may give falsely reassuring O2 sat in CO poisoning

A

pulse-ox

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20
Q

In pt with CO poisoning from fire, should also test for

A

cyanide

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21
Q

T1/2 of CO on room air and 100% O2

A

6hrs, 1hr

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22
Q

Rumack-Matthew nomogram is for

A

acetaminophen

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23
Q

timing of initial blood sample for tylenol

A

4hrs post ingestion

24
Q

tx for tylenol tox

A

n-acetylcysteine

25
Q

any single tylenol level of ___ is high risk

A

> 5

26
Q

potentially toxic tylenol dose

A

> 150mg/kg

27
Q

non-toxic tylenol metabolite made by

A

conjugation with glucuronide or sulfate

28
Q

toxic tylenol metabolite made by

A

P450 system

N-acetyl-p-benzoquinoneimine(NAPQI)

29
Q

how is NAPQI normally detoxified

A

by glutathione

30
Q

histology of tylenol tox

A

centrilobular necrosis with periportal sparing

31
Q

mechanism of cyanide tox

A

inihibits cytochrome a3 to uncouple electron transport leading to severe anion gap lactic acidosis

32
Q

test for cyanide

A

thiocyanate

33
Q

other lab abnormality clue to cyanide tox

A

increased glucose

34
Q

decreased arterial venous O2 gap suggests

A

cyanide

35
Q

Tx for cyanide

A
  • sodium nitrite or amyl nitrite - forms methemoglobin which binds cyanide
  • then sodium thiosulfate combines with it to form thiocyanate which is non-toxic
36
Q

classic A/B disorder in aspirin tox

A

combined met acidosis and resp alkalosis

37
Q

mechanism for resp alkalosis in aspirin

A

stimulates resp center in medulla

38
Q

mortality of aspirin best correlated with

A

6hr plasma level >130mg/dL

39
Q

most toxic form of arsenic

A

Arsine gas

ARF with death in 24-48hr

40
Q

fate of ingested arsenic

A

excreted in urine, skin, hair, nails

41
Q

toxicity of arsenic via

A

inihibition of oxidating productiono f ATP

42
Q

symptoms of arsenic

A

n/v, bloody diarrhea, abd pain, cytopenias, basophilic stippling, peripheral neuropathy, nephropathy, skin hyperpigmentation and hyperkeratosis, “mees lines” in nails

43
Q

basophilic stippling seen in

A

lead, arsenic

44
Q

most reliable test for arsenic

A

quantitative 24hr urine

45
Q

urine arsenic falsely increased by

A

recent seafood ingestion

46
Q

toxic effects of tricyclics due to

A

anticholinergic effects (amytryptiline strongest)

47
Q

2 main adverse effects of tricyclics

A

CNS tox and widened QRS complex

48
Q

organophosphate and carbamate toxic by

A

inhibiting acetylcholinesterase

49
Q

“mescarinic toxidrome” =

A

organophosphate cholinergic effects

50
Q

test for organophosphate

A

erythrocytes cholinesterase activity or metabolites in urine

51
Q

elemental vs organic mercury in GI tract

A

elemental not absorbed via GI, organic is

52
Q

acute elemental mercury tox

A

resp distress and renal failure

53
Q

chronic elemental mercury tox

A

acrodynia or erethrism

54
Q

Acrydynia (Feer syndrome)

A

sweating, hemodynamic instability, desquamative erythematous rash on palms and soles, increased urinare catecholamines (like pheochromocytoma)

55
Q

erethism

A

personality change, fine motor disturbances

56
Q

organic mercury tox

A

visual field constriction, peripheral neuropathy, tremor, hearing lsos

57
Q

tests for mercury

A

elemental: 24 hr urinary
organic: while blood or hair

Clinical Pathology (59 decks)

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