Exam 3 - Digoxin and Alcohols Flashcards
How does an acute digoxin overdose typically present? (4)
GI issues, CNS (halos/colors), hyperkalemia, two phases (pre- and post-distribution)
What potassium level is concerning in acute digoxin toxicity?
5.0 mEq/dL or greater
What are characteristics of EKGs in an acute digoxin toxicity? (2)
prolonged PR interval, “Dali’s” mustache
What are treatments for acute digoxin toxicity? (4)
activated charcoal, digoxin specific FAB fragments, phenytoin, temporizing measures
What are the indications for acute digoxin toxicity treatment? (3)
potassium > 5 mEq/L, digoxin > 20 mcg/L, progressing signs of toxicity
What is the dosing for digifab in acute digoxin toxicity?
1 vial/0.5 mg digoxin ingested (or if unknown 10 vials)
What is the dosing for digifab in chronic digoxin toxicity?
acute = 2 vials, chronic = 1-2 vials titrated to effect, if unknown 5 vials adult 3 vials children
What is the formula for anion gap? What is a normal gap range?
anion gap = Na+ - (Cl- + HCO3); 4-12
What does MUDPILES stand for?
methanol, uremia, DKA/SKA/AKA, phenformin/paraldehyde, isoniazid, lactate, ethylene glycol, salicylates
Which alcohol has low volatility?
ehtylene glycol
How does an alcohol toxicity typically present (early and late)? (3)
early = GI distress and inebriation, late = high anion gap (metabolic acidosis) and visual changes
What is the toxic metabolite from methanol metabolism? Ethylene glycol metabolism?
formic acid; glycolic and glyoxylic acid
What is the treatment and dosing for alcohol toxicity?
4-methylpyrazole (fomepizole) 15 mg/kg loading dose (and for maintenance) then 10 mg/kg q12 hrs x 4
What are indications for hemodialysis in alcohol toxicity? (4)
levels of 25-50 mg/dL, high osmol gap, end organ manifestations, severe metabolic acidosis
What is the formula for osmol gap? What is a normal gap range?
osmol gap = measured osmolality - calculated osmolality; -14-10
