Poisons Flashcards
Treatment for acetaminophen ingestion <4hrs
Activated charcoal
Tx for acetaminophen ingestion > 4 hrs
Acetaminophen level and plot on nomogram
If more than 140 mg/kg ingested then give N acetylcistine even without getting level
When can lfts become elevated after acetaminophen ingestion
3-4 days after
How do you manage salicylate ingestion
Activated charcoal
And sodium bicarbonate to alkalinize the urine
The acidosis is caused by a respiratory alkalosis
Address hypokalemia and consider glucose
How do you calculate anion gap
Sodium - (chloride + bicarb)
What level of ethanol do you worry for coma, respiratory depression and death
Greater than 0.4 g/dl
What do you monitor for in a pt with ethanol toxicity
Hypoglycemia and electrolyte imbalance
How does methanol toxicity present
Abdominal pain, vomiting, inebriation, severe metabolic acidosis, increased anion gap, cns depression
Where can you find methanol
Windshield washer fluid, cooking fuel, perfumes
Tx for methanol toxicity
Ethanol
Presentation of organophosphate
Cholinergic effect (parasympathetic) Dumbbels
Diarrhea Urination Miosis Beonchospasm Bradycardia Emesis Lacrimation Salivation
What are the two categories of cholinergic effects and how are they treated
Muscarinic - salivation, lacrimation, diarrhea, wheezing, bradycardia. Tx atropine
Nicotinic- weakness, paralysis, fasiculations. Tx with pralidoxime
What are anticholinergic effects (sympathetic system) and what’s a MED example
Blind as a bat, red as a beet, hot as a hare, dry as a bone, mad as a hatter and the heart runs alone
TCA, Benadryl
Findings in Ekg for tca intoxication
Widened qrs complex
Tx this with sodium bicarb boluses until qrs less than 100 msec
How does ingestion with hydrocarbons present
N/V, cough or wheezing
Lab findings will show hypoxemia
XRAY will show diffuse bilateral infiltrates
Tx for carbon monoxide poisoning
High flow oxygen even with normal pulse ox
Buzzword for cyanide poisoning
Smell of almonds
3 phases of ethylene glycol
1: náusea, vomiting, tachy, hypertension, metabolic acidosis and calcium oxalate crystals in urine
2: coma and cardiorrespiratorio failure due to acidosis and hypocalcemia
3: 1-3 days renal failure due to tubular necrosis with pt needing dialysis
What poisoning gives you garlic smell breath
Organophosphate
What gives you wintergreen odor on breath
Salicylate ingestion
Radio opaque materials on X-ray
Chips
Chloral hydrate Heavy metals Iron Phenothiazines Slow release enteric coated materials
What parts of body do alkali substances affect
Esophagus
What parts of body do acidic substances affect
Esophagus and stomach
Symptoms for lead level between 10-20 mcg/dl
Mild cognitive delay
Intervention for lead levels between 10-20 mcg/dl
Education, environmental control and monitoring
Symptoms for lead level greater than 70 mcg/dl
Severe toxicity, headaches, encephalopathy, lead lines on gingival and or anemia
Tx for lead levels greater than 70
Chelation
What are ways that kids are exposed to lead
Eat paint chips or exposed to household dust or soil
Phase 1 of iron ingestion
Within 6 hrs vomiting (often bloody), diarrhea, abdominal pain
Phase 2 iron ingestion
Quiescent and improvement over next 6-24 hrs
Phase 3 iron ingestion
Multi system, shock and organ failure
Metabolic acidosis, coagulopathy, cardiovascular collapse
Phase 4 iron ingestion
recovery. GI obstruction can be caused due to scarring and structures
Lab findings in iron ingestion
Serum iron > 350, WBC > 15k, glucose > 150
Indications for chelation with deferoxamine for iron ingestion
Severe symptoms along with anion gap acidosis, iron > 500, significant number of pills visible on abdominal XRAY
