EM Toxicology 1 (Pearls 1)

Question 1

MOA of clonidine

Answer 1

alpha2 adrenergic agonist

Question 2

distinguishing feature of serotonin syndrome

Answer 2

myoclonus

Question 3

most clinically significant toxic metalloid

Answer 3

arsenic

Question 4

most common hallucination in alcohol withdrawal

Answer 4

tactile

Question 5

most toxic methylxanthine

Answer 5

theophylline > caffeine > theobromine

Question 6

most common arrhythmia in digoxin toxicity

Answer 6

PVC and bradycardic rhythm

Question 7

most common cause of drug-induced liver failure

Answer 7

acetaminophen

Question 8

most prevalent endocrine dysfunction associated with chronic lithium use

Answer 8

hypothyroidism

Question 9

Most common overdose that produces anticholinergic toxicity

Answer 9

antihistamine

Question 10

most commonly used alpha 2 adrenergic agonist

Answer 10

clonidine

Question 11

Cyanide antidote kit

Answer 11

AMYL NITRITE - crack vial and inhale over 30 seconds, or place in chamber of ventilation bag and use 30 s on / 30 s off
åSODIUM NITRITE (3% sol’n) - 10 mL IV
ßSODIUM THIOSULFATE (25% sol’n) - 50 mL IV

å 3% means 3 grams per 100mL, or 30mg per 1 mL; therefore 10mL is 300 mg

ß 25% means 25 g per 100mL; therefore 50mL is 12.5 g

Question 12

Remarks on cyanide toxicity

Answer 12

smell of bitter almonds
bradycardia and hypotension
profound metabolic acidosis and elevated lactic acid levels

Question 13

remarks on nitroprusside and cyanide toxicity

Answer 13

as long as the nitruprusside infusion rate is not above 2-5 mcg/kg/min, the cyanide is usually of little consequence, because it is immediately metabolized by rhodanese to thiocyanate, a much less toxic metabolite

Question 14

sources of cyanide

Answer 14

sodium nitroprusside
illicit phencyclidine manufacturing
cigarette smoke
vehicle exhause
photography
solvents