Poisoning and Environmental Exposure 2

Question 1

What is the treatment of Ethylene Glycol Poisoning (Antifreeze)?

How does it work?

Answer 1

FOMEPIZOLE (also used to treat methanol poisoning)

Competitively inhibits Alcohol dehydrogenase, so ADH can’t metabolize ethylene glycol to poisonous substrates)

Question 2

What is Scombroid poisoning?

What are the symptoms or Scombroid poisoning?

Answer 2

Food poisoning that occurs when seafood is improperly stored. When seafood is stored in temperatures above 15 C, histidine and undergo decarboxylation to Histamine.

Flushing, throbbing HA, abdominal cramps, diarrhea and oral burning. Occurring 10-30 min after ingestion. Self-limiting.

Question 3

Hemodialysis is the most effective treatment for Lithium toxicity.

What are the three indications for HD in lithium toxicity?

Answer 3

1. Li lvl > 4
   2 Li lvl >2.5 + Renal failure
2. Increasing lithium levels despite adequate volume resuscitation with IVF.

Question 4

What are the six classic symptoms of ASA poisoning?

Answer 4

1. N/V
2. Tinnitus (early symptom = cochlear toxicity)
3. Tachypnea (initially causing respiratory alkalosis)
4. Metabolic Acidosis and lactic acidosis.
5. Hyperthermia
6. AMS

(Also see hepatitis and arrhythmias)

Question 5

What is the treatment of Salicylic Acid poisoning?

Answer 5

1. If < 2 hours activated charcoal.
2. Alkalization of blood and urine. (IV Sodium Bicarb)
3. +/- Dialysis

Question 6

How do you prevent cardiac arrhythmias from TCA poisoning?

Answer 6

IV Sodium Bicarbonate.

Question 7

What are the three hallmark S/S of opioid intoxication?

What is TRX?

Answer 7

1. Respiratory depression
2. Miosis “pinpoint pupils”
3. Depressed mental status

TRX = Naloxone