Epidemiology and Clinical Management of Poisoning Flashcards
What is the difference between poison and toxin?
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
What is the definition of toxidrome?
Collection of symptoms and signs that consistently occur after ingestion of a particular toxin or drug class
List some differences of poisoning in different age groups (children vs teenage vs adults).
Children/teen - unintentional poisoning
Adults - take more supplement than they need
What are the common toxidrome for sympathomimetic?
Increased RR, BP, HR, T
Pupils: Mydriasis
Mental status: Agitated
Bowel sounds: Increased
Skin: Warm, clammy
Complications: hyperthermia, tachyarrhythmias
What are the common toxidrome for anticholinergic? (5)
Incr/~ RR, Incr/~ BP, Incr HR, Incr T
Pupils: Mydriasis
Mental status: confused
Bowel sounds: Decreased
Skin: Dry!
Complications: hyperthermia
What are the common toxidrome for cholinergic? (5)
Incr/~ RR, ~BP, Decr HR, ~T
Pupils: Miosis
Mental status: Lethargic
Bowel sounds: Increased
Skin: Wet!
Complications: Bradycardia, bronchospasms
What are the common toxidrome for opioid?
Decreased RR, BP, HR and T
Pupils: Miosis
Mental status: depressed
Bowel sounds: Decreased
Skin: normal/cold
Complications: respiratory depression
What are the common toxidrome for sedative-hypnotic?
Decreased RR, BP, HR and T
Pupils: Normal
Mental status: depressed
Bowel sounds: Decreased
Skin: normal/cold
Complications: respiratory depression
What are the causes of anticholinergic syndrome, cholinergic syndrome, sympathomimetic syndrome and sedative syndrome?
Anticholinergic syndrome: Atropine
Cholinergic syndrome: Organophosphates
Sympathomimetic syndrome: Cocaine & amphetamines
Sedative syndrome: Opiates, barbiturates, & benzodiazepines
What are the ABCs of poisoning?
ABCDE
A - Airway
B - Breathing
C - Circulation
D - Dextrose/decontamination
E - EKG/Expert advice
What is the approach to an overdose patient?
History - may be unavailable/fragmentary/intentionally misleading
Physical - toxidrome
Other - Lab test
How to calculate anion gap?
Na - (Cl + HCO3)
What are the causes of anion gap acidosis?
GOLDMARK
Oxoproline ➔ acetaminophen metabolized
L-lactate ➔ starvation
What is fomepizole?
4-methylpyrazole
Competitive inhibitor of alcohol dehydrogenase
Not a substrate
First-order pharmacokinetics
$$$$$
How does alcohol metabolism vary based on food?
Ethanol gone from body relatively faster after eating compared to not eating
What are the specific lab tests and antidote for carbon monoxide?
Lab test:
Blood gas and CO-oximetry
Antidote:
Oxygen
What are the specific lab tests and antidote for acetaminophen?
Lab test:
Serum acetaminophen
Antidote:
N-acetylcysteine (NAC)
What are the specific lab tests and antidote for methanol and ethylene glycol?
Lab test:
Alcohol and metabolites
Antidote:
Ethanol or fomepizole
What are the specific lab tests and antidote for opioids?
Lab test:
Urine drug testing
Antidote:
Naloxone
What are the specific lab tests and antidote for organophosphates?
Lab test:
Plasma cholinesterase activity
Antidote:
Atropine
What are the specific lab tests and antidote for digoxin?
Lab test:
Serum digoxin
Antidote:
Digibind
What are the specific lab tests and antidote for arsenic, lead and mercury?
Lab test:
Serum heavy metals
Antidote:
Chelation therapy
What are the specific lab tests and antidote for nitrites and nitrates?
Lab test:
CO-oximetry
Antidote:
Methylene blue
What is the best test to detect all drugs? Why?
- 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 - Gas chromatography mass spectrometry
- Comprehensive drug screen, confirmatory testing bc turnaround time slow
