Lecture 11 - Poison Control Pt 3

Question 1

How does lab testing fit into poison control

Answer 1

help confirm diagnosis, determine extent of intoxication, mange the patient

Question 2

What are examples of lab testing that might be done

Answer 2

blood gas
electrolytes
salicylate level
acetaminophen level
ethanol level, osmolality
anion gap, osmolar gap
tox screen

Question 3

What results are included in the blood gas

Answer 3

pH, hemoglobin, electrolytes, glucose, lactate, carbon monoxide, methemoglobin

Question 4

What can cause a high anion gap and metabolic acidosis

Answer 4

methanol
uremia
diabetic ketoacidosis
paraldehyde
iron, isoniazid
lactic acidosis
ethylene glycol
salicylates

Question 5

What can cause an increased osmolar gap

Answer 5

mannitol
alcohols
sorbitol
acetone
polyethylene glycol
propylene glycol
glycerol
maltose

Question 6

What is the argument against tox screen

Answer 6

don’t screen for many substances
drugs found on screen not necessarily the cause of the symptoms
falsely reassuring
high false pos and false neg

Question 7

What medications are extremely harmful to children

Answer 7

cardiac medications, antidepressants, antimalarials, isoniazid, iron, sulfonylureas, recreational drugs, opiates, oil of wintergreen

Question 8

What do we see with ASA ingestion

Answer 8

respiratory alkalosis that develops into an elevated anion gap and metabolic acidosis

Question 9

What is the clinical presentation of ASA

Answer 9

vomiting, hyperpnea, lethargy, tinnitus

Question 10

What can severe ASA intoxication cause

Answer 10

coma, seizure, hypoglycemia, hyperthermia, pulmonary edema

Question 11

What are the steps for treating ASA

Answer 11

ABC
D: gastric decontamination
E: Urinary alkalinization and hemodialysis can occur if needed
F: None

Question 12

What are the phases of acetaminophen poisoning

Answer 12

I - anorexia, nausea/vomiting, malaise
II - most symptoms resolve, upper right quadrant pain, increased AST, ALT, bilirubin, INR
III - hepatic necrosis, renal failure, myocardial dysfunction
IV - can either completely resolve, need liver transplant or death

Question 13

How do we determine treatment of acetaminophen

Answer 13

using a nonogram

Question 14

What are the steps for treatment of acetaminophen

Answer 14

ABC
D: activated charcoal
F: NAC

Question 15

What causes carbon monoxide poisoning

Answer 15

incomplete combustion of fossil fuels or methylene chloride

Question 16

What are the clinical symptoms of carbon monoxide poisoning

Answer 16

headache, nausea, blurred vision, altered LOC, ataxia, seizures, coma

dyspnea, weakness, angina, palpitations, hypotension, mycoardial infarction, dysrhythmias

Question 17

What is the treatment for carbon monoxide poisoning

Answer 17

remove from source
ABC
F: 100% oxygen

Question 18

What labs are run if suspected carbon monoxide poisoning

Answer 18

COHb level
access end-organ damage
pregnanacy test

Question 19

What is the clinical presentation of ethylene glycol poisoning

Answer 19

I - acute neurologic (inebriation, slurred speach, ataxia, vomiting)
II - cardiopulmonary (hypertension, tachycardia, tachypenea, ARDS, cardiovadcular collapse)
III - renal (flank pain, hematuria, proteinuria, oliguria)

Question 20

What labs are run for suspected ethylene glycol poisoning

Answer 20

osmolar gap (elevated)
anion gap (elevated)
calcium (decreased)

Question 21

What are the clinical findings for methanol

Answer 21

inebriation, visual changes, abdominal complaints

Question 22

What labs are run for suspected methanol poisoning

Answer 22

anion gap (high)
metabolic acidosis (without lactate or ketones)
osmolar gap (high)

Question 23

How to treat toxic alcohol

Answer 23

block alcohol dehydrogenase with ethanol or fomepizole

sodium bicarb to correct acidosis
dialysis