Poisoning and drug toxicity

Question 1

Poisoning/drug toxicity

Answer 1

Most OD’s are treated with supportive care and treated symptomatically.
Get a history, 1st and formost.
Toxicology screen to rule out multiple ingested agents.

GI decontamination:
* Gastric lavage: Most beneficial within the first hour of ingestion.
* Activated charcoal: 1-2g/kg with max 100g, most beneficial within the first hour of ingestion.
* Cathartics: Not routinely indicated with acitvated charcoal.
-Sorbitol makes you poop out drug.
* Whole bowel irrigation (WBI): using polyethylene glycol may be used to treat enteric-coated or sustained release ODs.

Question 2

Acetaminophen intoxication

Answer 2

OD with:
* Acetaminophen
* Anacin-3
* Panadol

**S/S: **
* Usually asymptomatic in the early phase (0-24hrs)
* N/V and RUQ pain (24-48hrs)
* Clotting issues (72-96hrs)
* Hepatotoxicity: jaundice, elevated liver values, prolonged PT, AMS, delirium

Treatment:
* Activated charcoal (w/in 4 hrs)
* Mucomyst with a oral loading dose

Question 3

Aspirin toxicity

Answer 3

Aspirin

S/S:
* N/V
* Tinnitus
* Dizziness
* HA
* Dehydration
* Hyperthermia
* Apnea, cyanosis, metabolic acidosis
* Eleated LFTs
Respiratory alkalosis turns into metabolic acidosis.

Management: Activated charcoal and IV NaHCO3 to correct severe acidosis

Question 4

Organophosphate poisoning

Answer 4

Insecticides
* Malathion
* Parathion

S/S:
* N/V, cramping, diarrhea, excessive salivation, burred vision and miosis (constrict), bradycardia, mental confusion, slurred speech, coma.

Management:
* Wash skin thoroughly if external exposure.
* If ingested, activated charcoal
* Maintain airway
* Atropine is the drug of choice d/t bradycardia
* Benzos for seizures
* Pralidoxime for respiratory depression and weakness

Question 5

Antidepressant toxicity

Answer 5

Amitriptyline, fluoxetine, imipramine, buproprion

S/S: psych like
* Confusion, hallucination, blurred vision, urinary retention, hypotension, tachycardia, dysrhythmias, hypothermia, seizures

**Management: **
* Admit to ICU with evidence of CNS or cardiac toxicity
* Activated charcoal
* NahCO3 IV to counter dysrhythmias and maintina pH
* IV benzos PRN for seizures and rigors
* Cooling blanket to control temp
Serotonin syndrome treat with dantrolene sodium

Question 6

Opioid toxicity

Answer 6

Examples: codeine, heroin, morphine, opium

S/S:
Drowsiness, hypothermia, respiratory depression, shallow respirations, miosis (contrict), coma
Uppers such as cocaine cause mydriasis (dilation)

Management:
Emetics are contraindicated
Activated charcoal
Naloxone

Question 7

Benzodiazepine overdose

Answer 7

Diazepam, clonazepam, lorazepam

S/S:
Drowsiness, confusion, slurred speech, respiratory depression, hyporeflexia

Management:
Respiratory and blood pressure support
Flumazenil (romazicon) IV
Acitvated charcoal

Question 8

Beta-blocker overdose

Answer 8

Metoprolol, propanolol

S/S:
Hypotension, bradycardia, delirium, coma, bronchspasms

Management:
Charcoal if recent ingestion, glucagon (increases contractility), atropine if needed, stabilize airway.

Question 9

Ethylene glycol overdose

Answer 9

Sweet tasting chemical found in many household products such as antifreeze, detergents, paint, cosmetics.

S/S: 3 stages
Stage 1: 30min-12hrs
-Loss of coordination, HA, slurred speech, N/V

Stage 2: 12-24 hours
-Irregular HR, shallow breathing, changes in blood pressure. Shock appearance.

Stage 3: 24-72hours)
-Kidney failure, calcium oxalate crystals in urine

Management:
Maintain airway, fomepizole (antizol) IV or ethanol if fomepizole not available.