Medical Toxicology Intro Dr. Peters (video)

Question 1

What are the first things to care for in critical patients?

Answer 1

Stabilization

-ABC (airway, breathing, circulation) - may need intubation

-vital signs (pulse, cardiac arrest, hypotensive, hypoxia) - may need vasopressor, fluids, oxygen

-IV access: administration of supportive care or antidotes, access to obtain labs to identify the degree of toxicity

Question 2

What are factors the determine the degree of detoxification (“Exposure”)?

Answer 2

the medication/illicit substance
-the dose
-time of ingestion

estimate the amount of the toxic substance if the patient is not responsive
-Family/EMS report
-pill count

Question 3

The concentration of which substances are often checked in patients with ingestion toxicity?

Answer 3

APAP and Salicylate concentration

-commonly available and cheap
-often seen in toxicities

Question 4

How does Activated Charcoal work as a Decontamination agent?

Answer 4

prevents absorption by 44-95% by absorbing (binding) the toxic agent

Question 5

When would Activated Charcoal be a good choice for a Decontamination agent?

Answer 5

time-related toxications (sustained released drugs), to reduce the amount of exposure

doesn’t help with:
-cation ingestion (lithium, potassium)
-EtOH ingestion
-and many more…

Question 6

When should Activated Charcoal be avoided?

Answer 6

-can be hard to administer (bad taste)

-should not be used if the airway is unprotected (if they are not awake enough or not intubated they can vomit and aspirate it causing pneumonitis)

-a limited window of effectiveness (within 1-2 hours of ingestion, most patients don’t qualify)

Question 7

What is the recommended dose for Activated Charcoal?

Answer 7

1-2 g/kg of actual body weight
or 50-100 g in adults

Question 8

How do Cathartics work as Decontamination agents?
Name an example and the dose.

Answer 8

decrease GI transit time (speed the GI up, and accelerate elimination)

-Sorbitol 70% solution
-1-2 ml/kg up to 1g/kg

Question 9

When may Polyethylene Glycol be used as a Decontamination agent?

Answer 9

-Sustained-release products
-body-packers, stuffers (transport of substances in the body)
-iron, lithium ingestion

-patient should remain seated on a bedside toilet
-treat until clear rectal effluent

Question 10

What is the recommended dose of Polyethylene Glycol?

Answer 10

500 ml/hr if 9 months to 6 years old
1000 ml/hr: 6y to 12y
1000-2000 ml/hr: adolescents or adults

Question 11

What does the EXTRIP workgroup do?

Answer 11

Medical toxicologists who provide recommendations for extracorporeal treatments such as

-Renal replacement therapy (HD, CRRT, PD)
-Plasma exchange
-Exchange transfusion