Poisoning Flashcards
Give the antidote to the ff toxin/poison:
Black widow spider
Latrodectus antivenin
SUBSTANCES POORLY ADSORBED BY ACTIVATED CHARCOAL
Alcohols Caustics: alkalis and acids Cyanide Heavy metals (e.g., lead) Hydrocarbons Iron Lithium
- Charcoal is most likely to be effective when given within 1hr of ingestion
Give the antidote to the ff toxin/poison:
Botulinum toxin
Botulin antitoxin
Give the antidote to the ff toxin/poison:
Calcium channel antagonists
Glucagon and/or insulin and glucose
Give the antidote to the ff toxin/poison:
Dystonic reactions
Diphenhydramine and/or benztropine
Give the antidote to the ff toxin/poison:
Fluoride, calcium channel blockers
Calcium salts
Give the antidote to the ff toxin/poison:
Heparin
Protamine
Give the antidote to the ff toxin/poison:
Methotrexate, trimethoprim, pyrimethamine
Folinic acid
Give the antidote to the ff toxin/poison:
Rattlesnake envenomation
Crotab-specific Fab antibodies
Give the antidote to the ff toxin/poison:
Sodium channel blockade (tricyclic antidepressants, type 1 antiarrhythmics)
Sodium bicarbonate
What poison/toxin is associated with the following PE finding?
Odor of Bitter almonds
Cyanide
What poison/toxin is associated with the following PE finding?
Odor of acetone
Isopropyl alcohol, methanol, paraldehyde, salicylates
What poison/toxin is associated with the following PE finding?
Odor of Alcohol
Ethanol
What poison/toxin is associated with the following PE finding?
Odor of Wintergreen
Methyl salicylate
What poison/toxin is associated with the following PE finding?
Odor of Garlic
Arsenic, thallium, organophosphates, selenium
Toxin associated with the ff OCULAR SIGNS:
Miosis
Opioids (except propoxyphene, meperidine, and pentazocine), organophosphates and other cholinergics, clonidine, phenothiazines, sedative-hypnotics, olanzapine
Toxin associated with the ff OCULAR SIGNS:
Mydriasis
Atropine, cocaine, amphetamines, antihistamines, TCAs, carbamazepine, serotonin syndrome, PCP, LSD, post-anoxic encephalopathy
Toxin associated with the ff OCULAR SIGNS:
Nystagmus
Phenytoin, barbiturates, sedative-hypnotics, alcohols, carbamazepine, PCP, ketamine, dextromethorphan
Toxin associated with the ff OCULAR SIGNS:
Lacrimation
Organophosphates, irritant gas or vapors
Toxin associated with the ff OCULAR SIGNS:
Retinal hyperemia
Methanol
Cutaneous signs manifested with ingestion of the ff toxins:
Organophosphates, salicylates, cocaine and other sympathomimetics, serotonin syndrome, withdrawal syndromes
Diaphoresis
Cutaneous signs manifested with ingestion of the ff toxins:
Thallium, arsenic
Alopecia
Cutaneous signs manifested with ingestion of the ff toxins:
Boric acid, elemental mercury, cyanide, carbon monoxide, disulfuram, scombroid, anticholinergics
Erythema
Cutaneous signs manifested with ingestion of the ff toxins:
Methemoglobinemia (e.g., benzocaine, dapsone, nitrites, phenazopyridine), amiodarone, silver
Cyanosis (unresponsive to oxygen)
Oral signs manifested with ingestion of the ff toxin:
Organophosphates, salicylates, corrosives, ketamine, PCP, strychnine
Salivation
Oral signs manifested with ingestion of the ff toxin:
Corrosives, oxalate-containing plants
Oral Burns
Oral signs manifested with ingestion of the ff toxin:
Lead, mercury, arsenic, bismuth
Gum lines
GI symptom associated with ingestion of the ff toxin:
Antimicrobials, arsenic, iron, boric acid, cholinergics, colchicine, withdrawal
Diarrhea
GI symptom associated with ingestion of the ff toxin:
Arsenic, iron, caustics, NSAIDs, salicylates
Hematemesis
Cardiac signs associated with ingestion of the ff toxins:
Sympathomimetics (e.g., amphetamines, cocaine), anticholinergics, antidepressants, theophylline, caffeine, antipsychotics, atropine, salicylates, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), withdrawal
Tachycardia
Cardiac signs associated with ingestion of the ff toxins:
β-Blockers, calcium channel blockers, digoxin, clonidine and other central α2 agonists, organophosphates, opioids, sedative-hypnotics
Bradycardia
Cardiac signs associated with ingestion of the ff toxins:
Sympathomimetics (amphetamines, cocaine, LSD), anticholinergics, clonidine (early), monoamine oxidase inhibitors
Hypertension
Cardiac signs associated with ingestion of the ff toxins:
β blockers, calcium channel blockers, cyclic antidepressants, iron, phenothiazines, barbiturates, clonidine, theophylline, opioids, arsenic, amatoxin mushrooms, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), snake envenomation
Hypotension
CNS signs associated with ingestion of the ff toxins:
Alcohol, anticonvulsants, benzodiazepines, barbiturates, lithium, dextromethorphan, carbon monoxide, inhalants
Ataxia
CNS signs associated with ingestion of the ff toxins:
Opioids, sedative-hypnotics, anticonvulsants, cyclic antidepressants, antipsychotics, ethanol, anticholinergics, clonidine, GHB, alcohols, salicylates, barbiturates
Coma
CNS signs associated with ingestion of the ff toxins:
Sympathomimetics, anticholinergics, antidepressants (especially TCAs, bupropion, venlafaxine), isoniazid, camphor, lindane, salicylates, lead, organophosphates, carbamazepine, tramadol, lithium, ginkgo seeds, water hemlock, withdrawal
Seizures
CNS signs associated with ingestion of the ff toxins:
Sympathomimetics, anticholinergics, LSD, PCP, hallucinogens, lithium, dextromethorphan, steroids, withdrawal
Delirium/psychosis
CNS signs associated with ingestion of the ff toxins:
Lead, arsenic, mercury, organophosphates
Peripheral neuropathy
SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS
ANION GAP METABOLIC ACIDOSIS (MNEMONIC = MUDPILES)
Methanol, metformin Uremia* Diabetic ketoacidosis Paraldehyde, phenformin Isoniazid, iron, massive ibuprofen Ethylene glycol, ethanol Lactic Acidosis (i.e. cyanide, carbon monoxide) Salicylates
SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS
ELEVATED OSMOLAR GAP
Alcohols: ethanol, isopropyl, methanol, ethylene glycol
SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS
HYPOGLYCEMIA (MNEMONIC = HOBBIES)
Hypoglycemics, oral: sulfonylureas, meglitinides Other: quinine, unripe ackee fruit Beta Blockers Insulin Ethanol Salicylates (late)
SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS
RADIOPAQUE SUBSTANCE ON KUB (MNEMONIC = CHIPPED)
Chloral hydrate, calcium carbonate Heavy metals (lead, zinc, barium, arsenic, lithium, bismuth, as in Pepto-Bismol) Iron Phenothiazines Play-Doh, potassium chloride Enteric-coated pills Dental amalgam
COMMON AGENTS CAUSING SEIZURES (MNEMONIC = CAPS)
Camphor, carbamazepine, carbon monoxide, cocaine, cyanide
Aminophylline, Amphetamine, anticholinergics, antidepressants (cyclic)
Pb (lead) [also lithium], pesticide (organophosphate), phencyclidine, phenol, phenothiazines, propoxyphene
Salicylates, strychnine
Triad of altered mental status, autonomic instability, and neuromuscular hyperactivity (hyperreflexia, tremors, clonus in the lower extremities more than the upper extremities)
serotonin syndrome
Two antidotes are useful in treating cholinesterase inhibitor poisoning (organophosphates and carbamates)
atropine and pralidoxime
- DUMBBELS
- Clinical manifestations of organophosphate and carbamate toxicity relate to the accumulation of acetylcholine at peripheral nicotinic and muscarinic synapses and in the CNS
Give the antidote:
Acetaminophen/Paracetamol
N-Acetylcysteine PO
*Most effective if given within 8 hr of ingestion
Give the antidote:
Anticholinergics ie ipatropium
Physostigmine IV/IM
Note: Do not use if conduction delays on ECG
may cause Bradycardia, asystole, seizures, bronchospasm, vomiting, headache
Give the antidote:
Benzodiazepines
Flumazenil IV
Give the antidote:
β-Blockers
Glucagon IV
Give the antidote:
Calcium channel blockers
Insulin IV (Follow serum potassium and glucose closely) Calcium salts IV
Give the antidote:
Carbon monoxide
Oxygen inhalational
Give the antidote:
Cyanide
Amyl nitrate inhalational
Sodium nitrate IV
Sodium thoisulfate IV
Hydoxocobalamin IV (adults)
Give the antidote:
Digitalis
Digoxin-specific Fab antibodies (Digibind; Digifab) IV
Give the antidote:
Ethylene glycol
Methanol
Fomepizole IV
Infuse slowly over 30 min; increase doses to q4h if being dialyzed
If Fomepizole is not available, treat with an ethanol infusion
Give the antidote:
Iron
Deferoxamine IV
Give the antidote:
Isoniazid (INH)
Pyridoxine IV
Give the antidote:
Lead and other heavy metals (e.g., arsenic, inorganic mercury)
- BAL (dimercaprol) deep IM
- *Local injection site pain and sterile abscess, nausea, vomiting, fever, salivation, nephrotoxicity
- Caution: Prepared in peanut oil; contraindicated in patients with peanut allergy - Calcium disodium EDTA IV
- Dimercaptosuccinic acid (succimer, DMSA, Chemet) PO
Give the antidote:
Methemoglobinemia
Methylene blue, 1% solution IV
Give the antidote:
Opioids
Naloxone IV
Give the antidote:
Organophosphates
- Atropine IV/ET
- Tachycardia, dry mouth, blurred vision, urinary retention - Pralidoxime (2PAM) IV
- Nausea, dizziness, headache, tachycardia, muscle rigidity, bronchospasm (rapid administration)
Give the antidote:
Salicylates
Sodium bicarbonate IV
- Follow potassium closely and replete as necessary
- Avoid severe alkalosis (pH >7.55)
Give the antidote:
Sulfonylureas
Octreotide IV/SC
Give the antidote:
Tricyclic antidepressants
Sodium bicarbonate
*Indications: QRS widening (>100 ms), hemodynamic instability
Avoid severe alkalosis (pH >7.55) Follow potassium