Intoxications of the Nervous System Flashcards
Tetanus
Exotoxin MOA
Binds interneurons of brain, brainstem, and spinal cord and prevents the release of inhibitory NTs GABA and Glycine
Leads to MOTOR DISINHIBITION
Tetanus
How is it acquired?
Produced anaerobically
Acquired in dirty wounds, unsterile needles
Tetanus
Symptoms
Motor disinhibiiton
Painful spasms in muscles near wound, or generalized spasms
Generalized convulsive seizures
Tetanus
Treatment
ICU care, Neuromuscular blockade, Sedation, Anticonvulsants, Tetanus immune globulin, ABX
Botulism
Exotoxin MOA
Binds presynaptic nerve terminals and prevents Ach release
Causes flaccid paralysis
Botulism
How is it acquired?
Exotoxin produced anaerobically in improperly canned or prepared food
Botulism
Symptoms
Ptosis, diplopia, dysphagia
Facial, limb, resp weakness
Lead Poisoning
How is it acquired?
Workplace paint, Lead batteries, ingestion of flakes of lead based paint
Lead Poisoning
Symptoms in Adults vs. Kids
Adults – peripheral neuropathy
Kids – encephalopathy, abdominal pain
Organic Solvents Poisoning
How is it acquired? Symptoms?
Chemical plant exposure, Glue sniffers
Encephalopathy or peripheral neuropathy
Carbon Monoxide (CO) Symptoms of CO Poisoning
Early headache, vomiting, blurred vision
Later coma, seizures, cardiopulmonary arrest
CO Poisoning
MOA
Odorless gas with a higher affinity for Hgb than O2
Sources are heaters, unventilated auto garages
CO Poisoning
Diagnosis and Treatment
Diagnosis: elevated CO blood level
Treatment: hyperbaric O2 chamber
Stroke syndromes in younger patients may be drug related. What is the MOA and some common drugs that may cause this?
Vasoconstriction or abrupt HTN causes cerebral infarction or hemorrhage
Cocaine is most common; also amphetamines, PCP, LSD
Symptoms of Acute Alcohol Intoxication
Social disinhibition, impaired consciousness, cerebellar dysfunction
Secondary head trauma
Alcohol Withdrawal Syndrome
What are the two stages (early and later)?
Early: Hypersympathetic (tremulous, sweaty, tachycardia)
Late: Delirium tremens (fluctuating motor and autonomic activity, confusion, hallucinations)
Alcohol Withdrawal Syndrome
What is Delirium tremens?
3-4 days after drinking stops
Fluctuating autonomic and motor activity
Confusion and Hallucinations
How do you treat Alcohol Withdrawal Syndrome?
Benzodiazepines for sedation and seizure control
Hydration and metabolic support
Thiamine
When might seizures occur after alcohol withdrawal?
Seizures should occur within 3 days of alcohol withdrawal
If longer than that, worry about something else
Wernicke Korsakoff Syndrome
What are the acute and chronic symptoms?
Acute Wernicke Encephalopathy (nystagmus, ophthalmoplegia, gait ataxia, confusion)
Chronic Korsakoff psychosis (amnesia, confabulation)
How should Acute Wernicke Encephalopathy be treated?
Thiamine supplements
