Poisoning

Question 1

standard approach in managing a pediatric patient presenting with poisoning (AsIDEAC)

Answer 1

Acute supportive care

• Prepare for rapid deterioration by:
  
  • Putting in resus room
  • Starting IV
  • Putting on monitor
  • Having drugs and intubation equiment at hand.

Identification: History, PE, metabolic acidosis, ECG, toxicology screen

Decontamination

Enhancement elimination

Antidotes

Call poison center

Question 2

acute stabilization of seizure

Answer 2

lorazepam, phenobarbitol

Question 3

can you use phenytoin for acute stbailiztion of seizures in kids?

Answer 3

no

Question 4

acute stabilization of hypotension

Answer 4

isotonic fluids, consider bolus of sodium bicarb, pressor (dopamine or NE)

Question 5

acute stabilization of ventricular arrhythmia

Answer 5

• Na Bicarb

lidocaine

Question 6

Gravol OD would present with ___ toxidrome

Answer 6

anti-cholinergic toxidrome:

Anti-Cholinergic Signs: Gravol OD

Central: agitated, decreased LOC, seizures, increased pupil size

Dry mouth and skin

Erythema (cheeks)

Increased HR and BP

Absent bowel signs

Question 7

cholinergic signs

Answer 7

cental: agitated, decreasde LOC, seizures,

increase secretions

presence of muscle fasciculations or paralysis

Question 8

outline the signs of sympathomimetic toxidrome:

Answer 8

Central: agitated, decreased LOC, seizures, increased pupil size

Moist skin

Increased HR and BP

Present bowel signs

Increase secretions and presence of muscle fasciculations or paralysis

Question 9

causes of metabolic acidosis

Answer 9

Causes: Renal failure, SKA< increased lactate secondary to decreased perfusion, MUDPILES

MUDPILES: salicylate, methanol/ethylene glycol, iron, theophylline, valproate, isoniazid

Question 10

key toxins that can cause an increased osmolar gap: how do you calculate an OG?

Answer 10

OG: 2Na+glc+BUN. normal should be under 10

methanol, ethylene glycol and ethanol all create an OF

Question 11

triad of opioid OD

Answer 11

pin-point pupils, decreased respiration, decreased LOC

Question 12

4 key methods of decontamination

Answer 12

1. activated charcoal
2. gastric lavage
3. whole bowel irrigation with PEG
4. Ipecac (wount use)

Question 13

activated charcoal is a good method of preventing absorption, but what poisons will it not work against?

Answer 13

Acid and alkaline ingestions, hydrocarbons

Iron, lithium, alcohols, late presentation over 6 hours.

• consider using a whole bowel irrigation instead if iron is ingested

Question 14

T/f you can use activated charcoal if someone ingested tyelnol 24 hours after

Answer 14

false. it can be used against acetaminophen but person must present within 6 hours

Question 15

gastric lavage is good for large ingestions of signifcant toxicities, but the person must present within ___ minutes to the hospital

Answer 15

60 mintes

Question 16

indications for whole bowel irrigation wtih pEG

Answer 16

iron, lithium (things that won’t word with activated charcoal), delayed release meds, body packers (mules)

Question 17

ways to enhance elimination of a toxin:

Alkalinization urine via sodium bicarbonate→ good for ___ and __

hemodialysis/hemoperfusion/other → good for salicylates, __, ___/___ glycol

Multiple dose activated charcoal → GUT dialysis only for drugs with optimal physicochemical properties. Drugs cross from blood across bowel lumen into gut.

Also blocks enterohepatic recirculation

Good for theophylline, digoxin, anticonvulsants.

Answer 17

Alkalinization urine via sodium bicarbonate→ good for TCAs and salicylates

hemodialysis/hemoperfusion/other → good for salicylates, lithium, methanol/ethylene glycol

Multiple dose activated charcoal → GUT dialysis only for drugs with optimal physicochemical properties. Drugs cross from blood across bowel lumen into gut.

Also blocks enterohepatic recirculation

Good for theophylline, digoxin, anticonvulsants.

Question 18

treatment of OD with TCA

Answer 18

Tricyclic Antidepressants: can cause rapid deterioration within minutes. Adverse effects include seizures, hypotension and cardiac dysrhythmias.

Treatment: NAHCO3

Question 19

treament of OD with acetaminophen

Answer 19

Acetaminophen Tylenol Overdose: N-acetylcysteine

Complications: acetaminophen OD can cause renal and hepatic toxicity. Can have a delayed time course.

For acute toxicity presenting 4-24 hours, use Rumack-Matthew Nomogram

For late presenting hepatotoxicity (increased INR, increased transaminases)

Mechanism of NAC: see image

Question 20

treatment of methanol OD

Answer 20

ethanol/fomepizole

Question 21

treament for beta blocker OD

Answer 21

glucagon, high dose insulin and glucose

Question 22

NAC helps acteminophen get converted to ___ and ___ rather than causing liver cell damage

Answer 22

cysteine and mercapturic acid