Poisonings Flashcards
What intoxications are likely to respond to urinary alkalinization?
- Salicyclate
2. Phenobarbital
What drug toxicities are likely to response to forced saline diuresis?
- Cyclophos
- Cisplatin
- 5-FU
- Lithium
When might you use haemoperfusion over haemodialysis?
May be more efficient than HD in removing lipid soluble and protein-bound drugs
What are the complications of haemoperfusion?
- Thrombocytopaenia
- More heparin required = increased risk bleeding
- Does not treat metabolic disturbances
What drugs are not amenable to removal by EC methods?
- TCAs
- Barbituates
- Paracetamol
- Narcotics
What factors increase risk of Li toxicity?
- Volume depletion
- Thiazide diuretics
- ACEi
- NSAIDs
What are the ECG changes associated with Li toxicity?
- QT prolongation
2. ST and T wave changes
What are the components of treatment for Li intoxication?
- Forced saline diuresis
- SPS
- HD
What other type of crystals are present in ethylene glycol poisoning?
- Calcium oxalate
2. Hippurate
What differentiates methanol from EG intoxication?
Methanol poisoning is associated with papilloedema
What is the rationale for (1) thiamine and pyridoxine in EG poisoning, (2) folate in methanol poisoning?
Thiamine: shunts metabolism of glyoxalic acid to a-hydroxy-b-ketoadipic acid; Pyridoxine: glyoxalic acid to glycine
Folate: Enhances elimination of formic acid
What are the EXTRIP recommendations for HD in methanol poisoning?
- Coma, seizures, new vision problems
- Met acidosis (pH <7.15)
- AG >24
What is unique about isopropanol intoxication?
It generates an osmolal gap but has no metabolic acidosis or anion gap.
What is the Trinder spot test?
A urine spot test (turns purple) for salicylates
What is the main utility of haemoperfusion?
It is thought to be superior to hemodialysis in paraquat poisoning. For all other poisonings with lipid soluble and highly protein bound substances high-flux hemodialysis is recommended.
