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Renal > Lec 29/30 Toxicology > Flashcards

Lec 29/30 Toxicology Flashcards

1
Q

What are two different treatments for cyanide poisoning?

A

give D50 and 100% O2 then:

  • (amyl) nitrite + thiosulfate
  • hydroxycobalamin
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2
Q

What acid/alk problem in TCA overdose?

A

mixed metabolic and respiratory acidosis –> decreased pH, decreased bicarb, decreased K, increase CO2

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3
Q

What is the treatment for TCA toxicity?

A

NaHCO3 for cardio toxicity

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4
Q

What is the treatment for methanol/ethylene glycol intoxiation??

A

fomepizole [inhibits alcohol dehydrogenase]

OR use ethanol IV infusion

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5
Q

What is the difference in presentation between asphyxiant gases and irritant gases?

A

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

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6
Q

What is presentation of methanol poisoning?

A

blindness, aniona gap metabolic acidosis

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7
Q

What is presentation of ethylene glycol poisoning?

A

renal failure, anion gap metabolic acidosis

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8
Q

What is presentation of trichloroethyleme poisoning?

A

peripheral neuropathy, arrhythmias

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9
Q

What is the presentation of carbon tetrachloride poisoning?

A

hepatic dysfunction, cancer

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10
Q

What is the presentation of dioxin poisoning?

A

dermatitis, chloracne, non-hodgkins lymphomas

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11
Q

What is the presentation of benzene poisoning?

A

bone marrow depression

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12
Q

What is the presentation of toluene poisoning?

A

renal tubular acidosis, hypokalemia

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13
Q

Sympathomimetic toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?

A
  • high BP/HR/HR
  • high temp
  • agitated
  • dilated pupils
  • increased bowel sounds
  • wet skin
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14
Q

Cholinergic [nicotinic] toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?

A
  • normal BP, high HR/RR
  • normal temp
  • agitated
  • mydriasis = dilated
  • increased bowel sounds
  • no change in skin
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15
Q

Cholinergic [muscarinic] toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?

A
  • normal BP/HR/RR
  • no change temp
  • agitated
  • miosis
  • increased bowel sounds
  • wet skin

bronchospasma, bradycardia, bronchorrhea

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16
Q

Anticholinergic toxicity: what vital signs, temp, mental status, pupil, bowel sounds, and skin [wet/dry]?

A
  • normal BP/RR, increased HR
  • increased temp
  • agitated
  • dilated pupils
  • decreased bowel sounds
  • dry skin
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17
Q

What is a toxicity associate with ipecac?

A

myocardial toxicity

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18
Q

What 5 toxins do not bind charcoal?

A

CHILE

  • Caustics
  • Hydrocarbons
  • Iron
  • Lithium
  • Ethanol
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19
Q

What type of receptors on sweat glands?

A

ACh muscarinic

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20
Q

What is presentation of sedative hypnotic toxicity [barbituates, benzos, ambien, etc]?

A

decrease BP/HR/RR/temp
depressed mental status
dilated pupils

21
Q

What is presentation of sedative hypnotic withdrawal [barbituates, benzos, ambien, etc]?

A

increase BP/HR/RR/temp
agitated mental status
no change in pupils
wet/sweaty skin

22
Q

What is presentation of opioid toxicity?

A 
decrease BP/HR/RR/temp
depressed mental status
pinpoint pupils
decreased bowel sounds
euphoria, resp and CNS depression, seizures [overdose]
23
Q

What is presentation of opioid withdrawal?

A 
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)
24
Q

What drug is associated with pinpoint pupils and respiratory depression?

A

opioids

25
Q

What is a major side effects of TCAs [amitriptyline, other -iptylines + -ipramines + doxepin and amoxapine]?

A

a1 blocking = anticholinergic
postural hypotension, atropin-like side effects [tachycardia, urinary retntion, dry mouth
tri-C –> convulsions, coma, cardiotoxicity (arrhythmias), hyperpyrexia

26
Q

What is the mech of action TCAs [major mech + other side mechanisms]?

A

block reuptake of NE and 5HT; block Na + alpha, anti-GABA, anti-cholinergic, anti-histaminic

27
Q

What is the mech of TCAs causing seizures?

A

bind picrotoxin site of GABA-A receptor and block Cl entering –> cause hyper-excitable site

treat: give benzos or barbiturates try to open the Cl channel again

28
Q

Why do you get wide QRS in TCA? treat?

A

block Na channels

treat –> give NaHCO3 to increase Na going in and reversal of Na blockade

29
Q

What is mech of action pralidoxime?

A

displaces anticholinesterase inhibitor from the target = preserves anticholinesterase action

30
Q

What is mech of action physostigmine?

A

inhibits acetylocholinesterase

31
Q

What can you see on xray in lead poisoning?

A

lead lines in bone

32
Q

What things cause anion gap met acidosis?

A

MUDPILES

  • Methanol
  • Uremia
  • DKA
  • Propylene glycol
  • INH/Iron
  • Lactic acidosis [cyanide,CO]
  • Ethylene glycol
  • Salicylates [late]
33
Q

What are indications for acute hemodialysis?

A
  • severe metabolic Acidosis
  • severe Electrolyte disorder [esp hyperkalemia]
  • drug Intoxication
  • refractory fluid Overload
  • Uremia

AEIOU

34
Q

What are top 3 things you can use acute dialysis for?

A

ethylene glycol
methanol
salicylates

35
Q

What is the use of intralipid?

A

lipid emulsion with different types of carbon chains –> creates a lipid compartment so when they overdose some of it goes into that compartment instead of target organ

36
Q

How do you treat salicylate intoxication?

A

give Na bicarbonate to alkalinize urine = ion trapping

37
Q

What is the body’s own chelator for Fe?

A

hemoglobin = has high affinity for iron

38
Q

What 3 big symptoms of metal poisoning?

A

GI: N/V/GI bleed
Nervous system
Renal toxicity as eliminated

39
Q

What acidosis/alkalosis change in iron toxicity?

A

metabolic acidosis

40
Q

What are symptoms of lead toxicity?

A 
butonian line in gums
lead lines in bone metaphysis growth plate
microcytic anemia
GI and kidney disease
mental deterioration, memory loss

lead palsy = leg drop with one leg

41
Q

What enzymes are inhibited by lead poisoning?

A

ferrochelatase, ALA dehydratase

42
Q

What substances are accumulated in lead poisoning?

A

protoporphyrin, d-ALA

43
Q

What is treatment for lead tox?

A

succimer if Pb

44
Q

What are some major sources of mercury poisoning?

A

jewelers, ceramic workers, paints

more potent = organic = more lethal
vs elemental and inorganic

45
Q

What are symptoms of organic mercury tox?

A

acrodynia/pinks disease = reddish hands

+ GI + CNS + renal

46
Q

What are sources of arsenic poinsoning?

A

pesticides, herbicides, well water

trivalent = most potent

47
Q

What is mech of arsenic poisoning?

A

alters thiol-containing protein and impairs mitochondrial respiration
inhibits succinic dehydrogenase

48
Q

What is presentation of arsenic tox?

A

GI/Renal/CNS

skin cancers, megaloblastic anemia, BM suppression

Renal (26 decks)

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