Poisoning and Environmental Exposure 1

Question 1

Infant Botulinum classically occurs in what age group with what classic exposure?

What is the classic presentation (3 main symptoms?)

Answer 1

< 1yo with ingestion of honey OR lives in rural area (soil exposure)

Classic Presentation =

1. Constipation (GI smooth muscle dysfunction)
2. Ocular bulbar weakness (Ptosis, impaired pupil constriction, decreased gag)
3. Descending Flaccid paralysis involving respiratory muscles.

Question 2

How to you diagnose Infant Botulism?

How do you TRX infant Botulism?

Answer 2

DX = stool C. Botulinum spores or toxin

TRX = Botulinum Immunoglobulin

Question 3

CO poisoning can manifest initially as HA, nausea, malaise, dizziness, and progress to coma, seizures, cardiac ischemia and lactic acidosis.

HOW do you DX?

HOW do you TRX?

Answer 3

DX = ABG - Carboxyhemaglobin levels (elevated)

TRX = 100% high flow O2 +/- Hyperbaric chamber if severe.

Question 4

Licorice root is sued as herbal remedy to stomach ulcers and viral URIs. What are the three main symptoms of Licorice Root toxicity?

Answer 4

1) HTN
2) HypoK, metabolic alkalosis
3) Suppression of Renin-Angiotensin-Aldosterone system.

Question 5

What is the mechanism of Organophosphate poisoning?

How do you treat organophosphate poisoning?

Answer 5

Acetylcholinesterase inhibition, causing toxic cholinergic build up.

TRX:

1) Activated charcoal is < 1 hour of ingestion
2) Atropine (Competitive inhibitor of Ach) and Pralidoxime (cholinesterase reviving agent)

Question 6

Symptoms of Organophosphate Poisoning “DUMBELS” stands for?

Answer 6

Defication
Urination
Miosis "pinpoint"
Bronchospasm/Bradycardia
Emesis 
Lacrimation 
Salivation

Question 7

What is Kava (natural supplement) used for?

Possible SE you should worry about?

Answer 7

Used for anxiety and insomnia.

SE = Severe liver damage.

Question 8

What are the following herbal supplements used for and what are their potential SE?

Ginkgo Biloba?
Ginseng?
Saw Palmetto?

Answer 8

Ginko Bilaoba - memory enhancement, SE = platelet dysf.

Ginseng - increased mental performance, SE = platelet dysf.

Saw Palmetto - BPH, SE = mild stomach discomfort and increased bleeding risk.

Question 9

What are the following herbal supplements used for and what are their potential SE?

Black Cohosh?
Echinacea?
Ephedra?

Answer 9

Black Cohosh: Postmenopausal symptoms, SE = hepatic injury.

Echinacea: Flu/Cold, SE = anaphylaxis especially in asthmatics.

Ephedra: Weight loss, SE = htn, arrhythmia, sudden death, stroke, seizure.

Question 10

What is the first line treatment for Heat Stroke?

Answer 10

Evaporative cooling (spray them with water and put many fans on them)

Ice packs, cold lavage and cold IVF are helpful adjuncts but NOT first line.

Question 11

What should you do if a child has a positive (above cutoff) level of lead on capillary blood sample?

How do you treat Lead poisoning? (mild vs moderate vs severe?)

Answer 11

Confirm with Venous blood Lead levels.

TRX:
Mild poisoning < 45ug/dL = Extensive counseling about environmental modification. REPEAT PB level < 1 month.

Mod poisoning 45-70ug/dL = ORAL Chelating agent (SUCCIMER/DMSA )

Severe Poisoning > 70ug/dL = IM Dimercaprol followed by IV EDTA.

Question 12

What are the three classic symptoms of Lead poisoning?

XRAY shows?
Peripheral Smear shows?

Answer 12

1. Abd pain/constipation
2. Cognitive impairment - can manifest later.
3. Behavioral problems (ADHD) - can manifest later.

XRAY = lead line
Peripheral Smear = Basophilic stippling

Question 13

If you suspect Lead poisoning. What four blood test should be your first step in work up?

Answer 13

1. CBC
2. Reticulocyte count
3. Ferritin
4. Serum Iron levels.

(Will allow you to detect anemia and iron deficiency)

Question 14

What are the temperature values and key symptoms of

Mild vs Moderate vs Severe Hypothermia?

Answer 14

MILD hypothermia (32-35 C) :

• Tachycardia, Tachypnea
• Increased Shivering.

MODERATE hypothermia (28-32 C)

• Bradycardia, Hypoventillation
• HypoTN
• Lethargy
• Atrial arrhythmia
• Decreased Shivering

SEVERE hypothermia (< 28 C)

• Coma
• CV collapse
• Ventricular arrhythmia

Question 15

What are the 3 general principles of treating hypothermia?

What is the goal rewarming rate?

How do you TREAT hypothermia if mild vs moderate vs severe?

Answer 15

General principles:

• Used warmed IVF if hypoTN
• Intubate if Comma
• Warm (choice based on severity)

Goal rewarming rate - 1-2 C/hr

Mild –> passive warming (remove wet clothes, blanket)
Moderate –> Active external warming (warm blanket, heat pack)
Severe–> Active internal core warming (warm humidified o2, warm peritoneal/pleural lavage).