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Poison/Toxicology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Adult lead level: severe

A
  • Encephalopathy, wrist/foot drop, pallor/anemia, abdominal colic, nephropathy
  • > 100 mcg/dL
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2
Q

Adult lead level: moderate

A
  • HA, weakness, peripheral neuropathy, abdominal pain, constipation
  • 70-100 mcg/dL
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3
Q

Adult lead level: mild

A
  • Fatigue, confusion, somnolence, HTN, kidney impairment
  • <70 mcg/dL
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4
Q

Lead toxicity diagnosis

A
  • Environmental, occupational, recreational exposure, PICA
  • Blood Lead Level (BLL) = gold standard
  • CBC, CMP
  • X-rays can spot “lead lines” on bones
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5
Q

Lead toxicity treatment steps

A
  1. GI decontamination: WBI
  2. Chelation: start ASAP
  3. BZD if seizures
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6
Q

Lead toxicity treatment: overt encephalopathy

A

Dimercaprol & Calcium disodium EDTA

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7
Q

Lead toxicity tx: Symptoms suggestive of encephalopathy or >100 in adults, >69 in peds

A

Dimercaprol & Calcium disodium EDTA

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8
Q

Lead toxicity tx: mild symptoms or 70-100

A

Succimer

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9
Q

Lead toxicity tx: asymptomatic or <70 in adults or 45-69 in peds

A

Treat peds with succimer vs X in adults

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10
Q

Arsenic acute toxicity s/s

A
  • GI: N/V/D w/i mins to hrs
  • CV: tachy, HoTN, QTc prolongation
  • Encephalopathy: seizure, delirium, coma
  • Dermatologic: “mees lines”
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11
Q

Arsenic Chronic toxicity s/s

A
  • Neuropathy, malignancy, DM
  • Dermatologic: carcinomas, hyperpigmentation
  • Hepatic portal fibrosis
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12
Q

Arsenic toxicity diagnosis

A

24-hr urine level (gold standard)
- [Arsenic] >50
- Creatinine >100
- Total Arsenic >100

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13
Q

Arsenic toxicity tx: including mild vs severe

A
  1. GI decontamination: charcoal, WBI only if visible radiopacities
  2. Chelation:
    - Mild (N/V): succimer
    - Severe (encephalopathy/seizure): dimercaprol (BAL) IM
  3. Acute encephalopathy seizures: BZD
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14
Q

Mercury toxicity s/s: elemental

A

Tremor

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15
Q

Mercury toxicity s/s: inorganic

A

Tremor, erethism, GI ulcer, acute tubular necrosis (ATN), acrodynia

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16
Q

Mercury toxicity s/s: organic

A

Tremor, paresthesia, ataxia, dysarthria, tunnel vision, GI distress, AKI

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17
Q

Mercury toxicity diagnosis

A

24-hr concentration
- Normal: serum <10, urine <20
- Severe: serum >35, urine >150

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18
Q

Mercury toxicity tx

A
  1. WBI for inorganic
  2. Chelation:
    - Inorganic: Dimercaprol BAL
    - Inorganic or organic (able to take PO): succimer
    - 3rd line: d-penicillamine
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19
Q

Iron toxicity stage I s/s

A

0-6 hrs
- GI: N/V/D, abdominal pain
- Potential to recover or exhibit systemic toxicity
- Absence of vomiting in first 6 hrs decrease likelihood of toxicity

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20
Q

Iron toxicity s/s: stage II

A

6-24 hrs - Latent stage
- Resolution of GI
- Progressive systemic deterioration secondary to volume loss & worsening metabolic acidosis, lethargy

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21
Q

Iron toxicity s/s: stage III

A

24-48 hrs
- Shock, lactic acidosis
- Coagulopathy -> bleeding -> hypovolemia -> increased aPTT
- Renal failure, cardiomyopathy, elevated LFTs, encephalopathy

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22
Q

Iron toxicity s/s: stage IV

A

2-5 days
- Hepatotoxicity, lipid peroxidation
- Increased aminotransferase -> acute fulminant hepatic failure

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23
Q

Iron toxicity s/s: Stage V

A

4-6 weeks
- Sequela: gastric outlet obstruction due to corrosion of the pyloric mucosa

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24
Q

Iron toxicity diagnosis based on serum [ ] & clinical manifestation: 300-500 mcg/dL

A
  • Significant GI symptoms
  • Modest systemic toxicity
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25
Q

Iron toxicity diagnosis based on serum [ ] & clinical manifestation: 500-1000 mcg/dL

A

Metabolic acidosis, shock

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26
Q

Iron toxicity diagnosis based on serum [ ] & clinical manifestation: >1000 mcg/dL

A

Organ failure, mortality

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27
Q

Iron toxicity management: do not give

A

Ipecac syrup, AC, cathartics, oral sodium bicarbonate, phosphosoda

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28
Q

Iron toxicity management: WBI if…

A

Radiopacities present

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29
Q

Iron toxicity management: chelating agents indicated if…

A

Repeatedly V, HoTN, lethargic, acidotic, peak iron level >500 mcg/dL

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30
Q

Chelating agent (Antidote) for iron toxicity

A

Deferoxamine, (Vin Rose Urine- with deferoxamine)

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31
Q

OTC_Anticholinergic management

A

BZD, Physostigmine slow IV push

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32
Q

OTC_Loperamide (Imodium): symptoms

A

QRS, QTc prolongation, mono- & polymorphic (TdP) ventricular arrhythmias

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33
Q

CBD gummies toxicity symptoms

A

CNS depression, excitation, children = resp depression, seizures

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34
Q

Dinitrophenol (DNP) toxicity symptoms, management

A
  • Hyperthermia, agranulocytosis, tachycardia/pnea, maculopapular erythematous skin eruptions
  • Aggressive supportive care: cooloing, BZD
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35
Q

Pong Pong Seeds toxicity: symptoms, management

A
  • Continues vomiting
  • One dose AC, Digoxin-specific antibodies (Fab)
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36
Q

Dextromethorphan (Triple C’s, Robitussin) toxicity symptoms, management

A
  • Confused, hallucinating, behavioral & dissociative effects, false(+) urine test for PCP
  • Supportive care: BZD
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37
Q

Neptune’s Fix (Tianeptine) toxicity: symptoms, management

A
  • Unresponsive, AMS, naloxone-responsive resp depression, opioid-like withdrawal upon cessation of chronic use
  • Wean down detoxification, buprenorphine & clonidine
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38
Q

Hypoglycemic diagnosis: BG level, symptoms

A
  • <60 mg/dL
  • Decreased level of alertness, dizziness, confusion, seizures, tachy, bizarre behavior, tremors, hypothermia, diaphoresis, pallor, N
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39
Q

Hypoglycemic toxicity absorption prevention

A
  1. AC: w/i 2 hrs
  2. WBI: not generally recommended
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40
Q

Hypoglycemic treatment of symptomatic

A
  1. “Rule of 15” - glucose PO
  2. Dextrose 0.5-1 g/kg IV
  3. Glucagon IM
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41
Q

Hypoglycemic Sulfonylureas toxicity: causing agents, MoA, management, prophylaxis

A
  • 2nd gen: Glimepiride, Glipizide, Glyburide
  • Sulfonylureas are Insulin secretagogues (increase insulin)
  • Prolonged & delayed onset of hypoglycemia, rebound hypoglycemia
  • ABCDs, AC, octreotide for maintaining euglycemia
  • Not recommended
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42
Q

Hypoglycemic toxicity- Octreotide: indication, formulation

A
  • Inhibit release of insulin, glucagon, secretin, motilin -> maintain euglycemia
  • Single dose SQ/IV
43
Q

Hypoglycemia- Metformin toxicity: worsened by___, symptoms, treatment

A
  • Metabolic acidosis
  • N/V, myalgia, malaise, blindness, hypothermia, resp insufficiency, HoTN
  • ABCDs, vasopressors, fluids, Extracorporeal Treatment (ECTR: intermittent hemodialysis)
44
Q

Hypoglycemia- ECTR: recommendation including lactate, pH, comorbid conditions

A
  1. [Lactate] >20 mmol/L (>15 suggested)
  2. pH =<7.1 (=<7.0 suggested)
  3. Failure of standard supportive care
  4. Comorbid conditions: shock, liver failure decreased level of consciousness
45
Q

Hypoglycemia- Insulin toxicity: toxic MoA, management

A
  • Disproportionate depot effect -> delayed onset hypoglycemia
  • Initial bolus D50W, D10W -> maintain euglycemia with D5W, D10W
46
Q

Maintaining euglycemia target BG

A

100-150 mg/dL

47
Q

Vitamin A toxicity: clinical manifestations, treatment

A
  • Seizures: BZD
  • Hepatotoxicity: N-acetylcysteine
  • Idiopathic intracranial HTN (IIH): Acetazolamide, furosemide, high-dose steroids
48
Q

Vitamin D toxicity: clinical manifestations, treatment

A

Hypercalcemia
- IV fluids, calcitonin+Bisphosphonate
- Severe: hydrocortisone or prednisone

49
Q

Vitamin E toxicity: clinical manifestations, treatment

A
  • Coagulopathy
  • Symptomatic and supportive care
50
Q

Vitamin B6 toxicity: clinical manifestations, treatment

A
  • Incoordination, ataxia, seizures
  • BZD
51
Q

Niacin toxicity: clinical manifestations, treatment

A
  • NVD, hepatotoxicity, HoTN
  • Symptomatic and supportive care
52
Q

Iron toxicity antidote Deferoxamine indication

A

Continued vomiting, toxic appearance, lethargy, HoTN + shock/metabolic acidosis, [iron] >500 mcg/dL

53
Q

Iron toxicity antidote Deferoxamine: endpoint of therapy

A

X continue >24 hrs
- Clinically well appearing + normal vital signs
Resolution of anion gap metabolic acidosis
- No further change in urine color
- Serum [iron] ~100 mcg/dL

54
Q

Caffeine toxicity: clinical manifestations

A
  • GI N, intractable vomiting
  • Cardiopulmonary: tachy, HoTN, hyperventilation, resp failure
  • Neurological: HA, agitation, hallucinations, seizures
  • Musculoskeletal: tremor, fasciculation, hypertonicity, rhabdomyolysis
55
Q

Caffeine toxicity treatment

A
  1. ABCs
  2. GI decontamination = Gastric lavage (>50 mg/kg ingested + w/i 1 hr)
  3. Symptomatic & Supportive care:
    - Intractable vomiting: ondansetron, metoclopramide
    - HoTN: IV fluids, vasopressors (phenylephrine), BB
    - SVT: BZD + esmolol
    - Seizures: BZD > propofol or barbiturates
    - Electrolyte repletion
  4. Hemodialysis if indicated
56
Q

Caffeine toxicity treatment: HoTN - beta-blocker agents

A

Esmolol, propranolol, metoprolol tartrate

57
Q

Caffeine toxicity tx: Hemodialysis indication

A

[Caffeine] >100 mg/L, seizures, life-threatening dysrhythmias, shock

58
Q

Clenbuterol toxicity: clinical manifestations

A

In overdose, lose beta-2 specificity
- GI: gastritis, V
- CV: tachy, palpitations, chest pain, atrial fibrillation, myocardial infarction
- Electrolyte imbalance: hypokalemia, hypoMg, hypophosphatemia

59
Q

Clenbuterol toxicity management

A
  1. ABCs
  2. GI decontamination: AC
  3. Symptomatic & supportive
    - IV fluids
    - Tachy: BB (Esmolol, propranolol, metoprolol)
    - Electrolyte repletion
60
Q

Type I hypersensitivity

A
  • Immediate
  • IgE
  • Requires sensitization
  • Anaphylaxis, acute asthma, urticaria
61
Q

Type II hypersensitivity

A
  • Autoimmune
  • IgG or IgM
  • Hemolytic anemia, thrombocytopenia, agranulocytosis
62
Q

Type III hypersensitivity

A
  • Immune complex
  • IgG or IgM
  • Tissue damage, serum sickness
63
Q

Type IV hypersensitivity

A
  • Delayed-type
  • T-cell mediated
  • Typically dermatologic
64
Q

Clinical criteria for anaphylaxis

A
  1. Acute onset with skin-mucosal involvement &:
    - Resp compromise or
    - Decreased BP, syncope or collapse
  2. 2+ after exposure to likely allergen:
    - Skin-mucosal involvement
    - Resp compromise
    - Decreased BP, syncope, or collapse
    - GI
  3. Decreased BP after exposure to known allergen
65
Q

Anaphylaxis s/s

A

Angioedema, flushing, pruritus w/o rash, dyspnea, wheezing, HoTN, NVD

66
Q

Anaphylaxis EPI administration

A

IM; IV not recommended

67
Q

Anaphylaxis tx adjunctive therapy

A
  • Antihistamines: diphenhydramine (H1), Famotidine (h2)
  • Glucocorticoids: methylprednisolone
68
Q

ASA & NSAIDs hypersensitivity

A
  • Rhinitis, asthma, urticaria, angioedema, sinusitis, anaphylaxis, pneumonitis, aseptic meningitis
69
Q

Mast cell-mediated angioedema: presentation, treatment

A
  • Urticaria, pruritus
  • EPI 0.3-0.5 mg IM, antihistamines, glucocorticoids
70
Q

Bradykinin-mediated angioedema: presentation, treatment

A
  • GI mucosa w/ bowel edema; NOT urticaria, pruritus
  • Supportive care, C1 inhibitors (Berinert, Ruconest) or kallikrein inhibitors (Ecallantide)
71
Q

Hereditary Angioedema (HAE): characteristic, prophylaxis, treatment

A

Recurrent attacks
- Cutaneous angioedema w/o. AE and severe abdominal symptoms, genital bladder, muscle, joint swelling
- Mostly do not require routine prophylaxis: cinryze IV, haegarda, lanadelumab
- Berinert, Ruconest, Ecallantide, Icatibant

72
Q

TCA toxicity diagnosis

A
  • Lethargy, coma, seizures, CV collapse
  • QRS >100 msec, prolonged QTc
73
Q

TCA toxicity management

A
  1. ABC, IV access, stabilize vital sign, supportive care
  2. Contact poison control
  3. GI decontamination: gastric lavage, AC (w/i 2 hrs)
74
Q

1st line treatment for TCA-induced cardiac conduction defects, arrhythmias, HoTn

A

Sodium Bicarbonate

75
Q

TCA-induced ventricular arrhythmias tx

A

Lidocaine, hypertonic saline

76
Q

TCA-induced torsades de pointe tx

A

Magnesium

77
Q

TCA-induced HoTN tx

A

Crystalloids, NE

78
Q

TCA-induced seizures tx

A

BZD, propofol, barbiturate (avoid phenytoin)

79
Q

TCA-induced refractory symptoms tx

A

Lipid emulsion therapy (Intralipid)

80
Q

SSRI toxicity presentation

A
  • QT prolongation: citalopram >600, escitalopram >300
  • Seizures: dose related
81
Q

SNRI toxicity presentation

A
  • Tachy, HTN, tremor, mydriasis, mild-mod sedation
  • CV rare
  • Seizure: early after ingestion (venlafaxine)
82
Q

Trazodone toxicity symptoms, tx

A
  • CNS depression, ataxia, dizziness
  • Supportive care; improve w/i 6-12 hrs, resolve by 24 hrs
83
Q

Mirtazapine toxicity symptoms, tx

A
  • CNS depr, sedation, sinus tachy, mild HTN
  • Supportive care
84
Q

Bupropion toxicity symptoms, tx

A
  • Tachy, HTN, tremor, drowsiness, GI, agitation, seizures, QRS/QTc prolongation
  • Supportive care: AC, WBI, BZD, sodium bicarb, Mg sulfate, IV, emulsion therapy
85
Q

Serotonin Syndrome (SS) clinical presentation

A
  • Cognitive: insomnia, restlessness, anxiety, altered level of consciousness, agitation
  • Autonomic: Tachy, HTN, mydriasis, hyperthermia, diaphoresis
  • Neuromuscular: akathisia, incoordination, hyperreflexia, myoclonus, tremor
86
Q

SS treatment

A
  1. D/c offending agent
  2. Supportive care
  3. BZD if sedation
  4. Serotonin antagonist (antidote) = Cyproheptadine
87
Q

Neuroleptic Malignant Syndrome (NMS) presentation

A
  • Fever: x relieved w/ antipyretics
  • Muscular rigidity: Parkinsonian or “lead pipe”
  • AMS: confusion, stupor, coma, agitation
  • Autonomic dysfunction: tachycardia/pnea, BP lability
88
Q

NMS diagnosis

A
  • Increased creatinine kinase >1000 IU/L
  • Increased ALT/AST
  • Leukocytosis
  • Rhabdomyolysis, myoglobinuria
89
Q

NMS treatment

A
  1. D/c NMS-potentiating meds
  2. Supportive care: ventilation, oxygen, IV fluid rehydration, temp reduction, BZD
  3. Pharmacologic : Dantrolene, DA agonist (bromocriptine, amantadine)
90
Q

Carbon Monoxide (CO) toxicity management

A
  1. ABCs
  2. Oxygen therapy: supplemental oxygen delivery, hyperbaric oxygen
  3. IV fluids +/- vasopressors for HoTN
  4. Monitor & manage dysrhythmias/myocardial ischemia
91
Q

Cyanide (CN) gas characteristic

A

Bitter almond smell

92
Q

CN toxicity diagnostic testing

A

Significant lactic acidosis (>8), elevated venous oxygen saturation

93
Q

CN toxicity management

A
  1. ABCs
  2. Rapid identification: arterial blood gas, serum lactate
  3. Prompt antidotal therapy: hydroxocobalamin IV, sodium nitrite, -> sodium thiosulfate
94
Q

Methemoglobinemia toxicity

A
  • Iron Fe2+ loses 1 electron into Ferric Fe3+ = MetHb >1%
  • Anemia, CHF, resp disease
95
Q

MetHb diagnostic testing

A

Arterial blood gas
- Brown color if significant

96
Q

MetHb management

A
  1. ABC
  2. Supportive care, ABG, decontamination
  3. High flow O2
  4. MetHb level
    - <30%: asymptomatic -> observe; symptomatic -> methylene blue
    - >30% -> methylene blue
97
Q

Mushrooms: Cyclopeptide - Amatoxin, Phallotoxin

A
  • Amanita spp
  • Fatal due to hepatic toxicity
98
Q

Mushrooms: Gyromitrin

A
  • Gyromitra spp
  • False morel
  • Neurological symptoms
99
Q

Mushroom poisoning: acute onset <6 hrs: tx for dehydration, vomiting, agitation

A
  • Dehydration, electrolyte abnormalities, hypoglycemia -> IV fluids, electrolytes, glucose
  • Vomiting -> IV ondansetron
  • Agitation -> IV BZD
100
Q

Mushroom poisoning: delayed onset >6 hrs: tx for shock, renal insufficiency, agitation, liver/renal failure

A
  • Shock -> IV fluids, vasopressors
  • Renal insufficiency -> dialysis
  • Agitation, seizures -> IV BZD
  • Liver/Renal failures -> organ transplant
101
Q

Mushroom poisoning: hospitalization

A
  1. Delayed symptoms >6 hrs
  2. Early symptoms <3 hrs who remain symptomatic >6 hrs despite supportive care
  3. Rhabdomyolysis, liver toxicity, renal insufficiency
  4. Asymptomatic with amatoxin-containing mushrooms strongly suspected
  5. Asymptomatic whom follow-up at 24 hrs cannot be assured
102
Q

Mushroom poisoning: CNS antidote for gyromitrin

A

Pyridoxine + IV BZD if seizures present

103
Q

Cyanide poisoning causes

A
  1. Fruit pits and seeds: cherry, apricot, peach, plum, pear, almond, apple (amygdalin)
  2. Yuca
104
Q

Toxic plant and berry ingestion antidote

A
  • Anticholinergic: physostigmine
  • Cardiac glycoside: DigFab

Poison/Toxicology (3 decks)

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