Lec 29/30 Toxicology Flashcards
What are two different treatments for cyanide poisoning?
give D50 and 100% O2 then:
- (amyl) nitrite + thiosulfate
- hydroxycobalamin
What acid/alk problem in TCA overdose?
mixed metabolic and respiratory acidosis –> decreased pH, decreased bicarb, decreased K, increase CO2
What is the treatment for TCA toxicity?
NaHCO3 for cardio toxicity
What is the treatment for methanol/ethylene glycol intoxiation??
fomepizole [inhibits alcohol dehydrogenase]
OR use ethanol IV infusion
What is the difference in presentation between asphyxiant gases and irritant gases?
asphyxiants: CO, cyanide, hydrogen sulfide = react with hemoglobin or cytochromes and cause lactic acidosis
irritants: sulfur dioxide, NOs, ozone, phosgene = act in upper airway cause bronchospasm/ irritation/ tearing –> eventually get into lower airway and cause edema
What is presentation of methanol poisoning?
blindness, aniona gap metabolic acidosis
What is presentation of ethylene glycol poisoning?
renal failure, anion gap metabolic acidosis
What is presentation of trichloroethyleme poisoning?
peripheral neuropathy, arrhythmias
What is the presentation of carbon tetrachloride poisoning?
hepatic dysfunction, cancer
What is the presentation of dioxin poisoning?
dermatitis, chloracne, non-hodgkins lymphomas
What is the presentation of benzene poisoning?
bone marrow depression
What is the presentation of toluene poisoning?
renal tubular acidosis, hypokalemia
Sympathomimetic toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?
- high BP/HR/HR
- high temp
- agitated
- dilated pupils
- increased bowel sounds
- wet skin
Cholinergic [nicotinic] toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?
- normal BP, high HR/RR
- normal temp
- agitated
- mydriasis = dilated
- increased bowel sounds
- no change in skin
Cholinergic [muscarinic] toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?
- normal BP/HR/RR
- no change temp
- agitated
- miosis
- increased bowel sounds
- wet skin
bronchospasma, bradycardia, bronchorrhea
Anticholinergic toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?
- normal BP/RR, increased HR
- increased temp
- agitated
- dilated pupils
- decreased bowel sounds
- dry skin
What is a toxicity associate with ipecac?
myocardial toxicity
What 5 toxins do not bind charcoal?
CHILE
- Caustics
- Hydrocarbons
- Iron
- Lithium
- Ethanol
What type of receptors on sweat glands?
ACh muscarinic
What is presentation of sedative hypnotic toxicity [barbituates, benzos, ambien, etc]?
decrease BP/HR/RR/temp
depressed mental status
dilated pupils
What is presentation of sedative hypnotic withdrawal [barbituates, benzos, ambien, etc]?
increase BP/HR/RR/temp
agitated mental status
no change in pupils
wet/sweaty skin
What is presentation of opioid toxicity?
decrease BP/HR/RR/temp depressed mental status pinpoint pupils decreased bowel sounds euphoria, resp and CNS depression, seizures [overdose]
What is presentation of opioid withdrawal?
increase BP/HR, no change RR/temp anxious dilated pupils increased bowel sounds wet/sweaty skin piloerection (cold turkey), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu-like)
What drug is associated with pinpoint pupils and respiratory depression?
opioids
