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PATH 407 > Epidemiology and Clinical Management of Poisoning > Flashcards

Epidemiology and Clinical Management of Poisoning Flashcards

1
Q

What is the difference between poison and toxin?

A

Poison: substances that cause harm to organisms when sufficient quantities are absorbed, ingested or inhaled

Toxin: considered a specific type oof poison - a poisonous substance produced within living cells or organisms

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2
Q

What is the definition of toxidrome?

A

Collection of symptoms and signs that consistently occur after ingestion of a particular toxin or drug class

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3
Q

List some differences of poisoning in different age groups (children vs teenage vs adults).

A

Children/teen - unintentional poisoning
Adults - take more supplement than they need

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4
Q

What are the common toxidrome for sympathomimetic?

A

Increased RR, BP, HR, T
Pupils: Mydriasis
Mental status: Agitated
Bowel sounds: Increased
Skin: Warm, clammy
Complications: hyperthermia, tachyarrhythmias

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5
Q

What are the common toxidrome for anticholinergic? (5)

A

Incr/~ RR, Incr/~ BP, Incr HR, Incr T
Pupils: Mydriasis
Mental status: confused
Bowel sounds: Decreased
Skin: Dry!
Complications: hyperthermia

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6
Q

What are the common toxidrome for cholinergic? (5)

A

Incr/~ RR, ~BP, Decr HR, ~T
Pupils: Miosis
Mental status: Lethargic
Bowel sounds: Increased
Skin: Wet!
Complications: Bradycardia, bronchospasms

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7
Q

What are the common toxidrome for opioid?

A

Decreased RR, BP, HR and T
Pupils: Miosis
Mental status: depressed
Bowel sounds: Decreased
Skin: normal/cold
Complications: respiratory depression

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8
Q

What are the common toxidrome for sedative-hypnotic?

A

Decreased RR, BP, HR and T
Pupils: Normal
Mental status: depressed
Bowel sounds: Decreased
Skin: normal/cold
Complications: respiratory depression

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9
Q

What are the causes of anticholinergic syndrome, cholinergic syndrome, sympathomimetic syndrome and sedative syndrome?

A

Anticholinergic syndrome: Atropine

Cholinergic syndrome: Organophosphates

Sympathomimetic syndrome: Cocaine & amphetamines

Sedative syndrome: Opiates, barbiturates, & benzodiazepines

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10
Q

What are the ABCs of poisoning?

A

ABCDE
A - Airway
B - Breathing
C - Circulation
D - Dextrose/decontamination
E - EKG/Expert advice

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11
Q

What is the approach to an overdose patient?

A

History - may be unavailable/fragmentary/intentionally misleading

Physical - toxidrome

Other - Lab test

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12
Q

How to calculate anion gap?

A

Na - (Cl + HCO3)

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13
Q

What are the causes of anion gap acidosis?

A

GOLDMARK
Oxoproline ➔ acetaminophen metabolized
L-lactate ➔ starvation

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14
Q

What is fomepizole?

A

4-methylpyrazole

Competitive inhibitor of alcohol dehydrogenase
Not a substrate

First-order pharmacokinetics

$$$$$

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15
Q

How does alcohol metabolism vary based on food?

A

Ethanol gone from body relatively faster after eating compared to not eating

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16
Q

What are the specific lab tests and antidote for carbon monoxide?

A

Lab test:
Blood gas and CO-oximetry

Antidote:
Oxygen

17
Q

What are the specific lab tests and antidote for acetaminophen?

A

Lab test:
Serum acetaminophen

Antidote:
N-acetylcysteine (NAC)

18
Q

What are the specific lab tests and antidote for methanol and ethylene glycol?

A

Lab test:
Alcohol and metabolites

Antidote:
Ethanol or fomepizole

19
Q

What are the specific lab tests and antidote for opioids?

A

Lab test:
Urine drug testing

Antidote:
Naloxone

20
Q

What are the specific lab tests and antidote for organophosphates?

A

Lab test:
Plasma cholinesterase activity

Antidote:
Atropine

21
Q

What are the specific lab tests and antidote for digoxin?

A

Lab test:
Serum digoxin

Antidote:
Digibind

22
Q

What are the specific lab tests and antidote for arsenic, lead and mercury?

A

Lab test:
Serum heavy metals

Antidote:
Chelation therapy

23
Q

What are the specific lab tests and antidote for nitrites and nitrates?

A

Lab test:
CO-oximetry

Antidote:
Methylene blue

24
Q

What is the best test to detect all drugs? Why?

A
  1. Immunoassays - or POC devices
    - Detect only what you looking for
    - Can be automated/cheap enough to allow multiple parallel assays
    - Impractical to test for everything
    - All findings generally need to be confirmed
  2. Gas chromatography mass spectrometry
    - Comprehensive drug screen, confirmatory testing bc turnaround time slow
25
Q

Which sample type is best for DUI?

A

Breath

26
Q

Which sample type is best for drug monitoring?

A

Urine

27
Q

Which sample type is best for acute toxicity, DUI and forensic investigation?

A

Blood (WB, serum)

28
Q

Which sample type is best for forensic investigation?

A

Vitreous fluid, hair

PATH 407 (7 decks)

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