Clinical Toxicology

Question 1

Activated Charcoal are ineffective for?

Answer 1

Iron, Lead, Lithium, Simple alcohols, Corrosives

Question 2

Pre-hospital Care general approach to treating a patient with an acute poisoning

Answer 2

ABC
First Aid
Poison Control Center

Question 3

ABC

Answer 3

Airway
Breathing
Circulation

Question 4

First Aid

Answer 4

Decontaminate and remove poison

Question 5

Ipecac syrup

Answer 5

Not used since the 1960s - negligible benefit

Question 6

Hospital Care general approach to treating a patient with an acute poisoning

Answer 6

Recognition & Assessment
Supportive & Symptomatic Care

Question 7

Recognition & Assessment

Answer 7

Suspect poisoning and drug overdose in any patient with:
Sudden, unexplained illness
Puzzling combination of signs and symptoms
Evaluate and identify toxidromes

Question 8

Supportive & Symptomatic Care

Answer 8

Airway, breathing, circulation
Management of complications
Use of antidotes when available
Methods to increase excretion of the drug

Question 9

GI Decontamination

Answer 9

Most effective within the first hour of ingestion
Activated Charcoal
Whole Bowel Irrigation
Gastric Lavage
Surgical or Endoscopic Removal

Question 10

Activated Charcoal

Answer 10

Highly purified, adsorbent form of carbon binding to the drugs
Reduction of toxin absorption
Most effective within the first hour, but may use up to 4 hours

Question 11

Gastric Lavage

Answer 11

Placement of an orogastric tube and washing out the gastric contents
NOT recommended for routine use
May be considered for potentially life-threatening ingestions within 1 hour

Question 12

Gastric Lavage contraindications

Answer 12

Ingestion of a corrosive or hydrocarbon agents

Question 13

Whole Bowel Irrigation

Answer 13

Administration of polyethylene glycol solutions continuously through a nasogastric or duodenal tube for 4-12 hours
When the ingestion occurred several hours prior to hospitalization
Drug is still suspected to be in the GI tract

Question 14

Surgical or Endoscopic Removal

Answer 14

Rarely indicated for most acute poisoning
Prolonged toxicity due to pharmacobezoar formation may be resolved by endoscopic removal

Question 15

Acetaminophen Mechanism of Toxicity

Answer 15

APAP converted by CYP2E1 into NAPQI/Toxic
Would turn into Cysteine and mercapturate conjugates (non-toxic) but there is Saturation of Glutathione
Hepatocellular necrosis

Question 16

Acetaminophen Toxicity General Management

Answer 16

GI Decontamination - Activated charcoal if within the first 1-2 hours of ingestion
Supportive Care - Management of acute hepatic and kidney injury
Antidote - Administration of N-acetylcysteine

Question 17

Antidote: N-Acetylcysteine (NAC)

Answer 17

100% effective if started within 8 hours of ingestion Duration can vary depending on the patient characteristics and risk

Question 18

When is IV NAC preferred

Answer 18

APAP toxicity in pregnant women
APAP-induced hepatic failure
Intractable vomiting or intolerance to PO NAC

Question 19

Rumack-Matthew Nomogram

Answer 19

Used to determine if need to treat with NAC

Question 20

When to draw plasma APAP level

Answer 20

No sooner than 4 hours after ingestion
Unknown time of ingestion:
If AST is elevated, regardless of APAP level, treat with NAC

Question 21

Limitations of the Rumack-Matthew Nomogram:

Answer 21

Presentation >24 hours
Overdose with extended-release formulations
IV APAP overdose
Chronic overdose

Question 22

Opioid Toxicity

Answer 22

respiratory depression and sedation

Question 23

Opioid Mechanism of Toxicity

Answer 23

Action at theµ-opioid receptor

Question 24

Opioid Toxicity antidote

Answer 24

Naloxone

Question 25

Naloxon MOA & Goal of Therapy

Answer 25

Competitive opioid receptor antagonist
To restore an adequate spontaneous respirations
(NOT to completely restore normal consciousness)

Question 26

CCB and BB Toxicity clinical presentation

Answer 26

within 1-2 hours of ingestion
Hypotension
Bradycardia
Early: Fatigue, Dizziness, Lightheadedness
Severe: Syncope, Altered mental status, Coma, Cardiogenic shock
Others: Nausea, vomiting, Hyperglycemia, Pulmonary edema