Poisons and Antidotes Flashcards
What is poisoning
Poisoning is contact with a substance that results in toxicity
Causes of poisoning
Ingestion or exposure to poisonous substances
Young children mostly out of curiosity
Elderly due to confusion, poor sight, mental impairment, multiple prescriptions.
Suicide
Homicide or disabling/raping
Munchhausen syndrome by proxy
Pathogenesis
GIT - Liver - Kidney
Some form bezoars
List of anticholinergic symptoms
Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium
Causes of anticholinergic symptoms
Antihistamines, Atropine, Belladonna Alkaloids, Jimson weed Mushrooms (some), Psychoactive drugs (many), Scopolamine Tricyclic antidepressants
List of cholinergic muscarinic symptoms
SLUDGE syndrome (Salivation, Lacrimation, Urination, Defecation, GI cramps and emesis),
Miosis
Bronchorrhea,
wheezing,
bradycardia
Causes of cholinergic muscarinic symptoms
Carbamates
Mushrooms (some) Organophosphates
Physostigmine
Pilocarpine
Pyridostigmine
List of cholinergic nicotinic symptoms
Tachycardia,
hypertension,
fasciculations,
Abdominal pain,
paresis
Causes of cholinergic nicotinic
Black widow spider bites, Carbamates Insecticides (some) Nicotine
Sympathomimetic symptoms
Tachycardia, hypertension, mydriasis, agitation, seizures, diaphoresis, hyperthermia, psychosis (after chronic use
Causes of Sympathomimetic poisoning
Amphetamines
Caffeine
Cocaine
Ephedrine
MDNA
Phenylpropanolamine
Theophylline
List of withdrawal symptoms
Tachycardia
Hypertension
Mydriasis
Restlessness
Seizures
Hyperreflexia
Piloerection
Yawning
Abdominal cramps
Lacrimation
Hallucination
Substances that can lead to withdrawal symptoms
Alcohol
Barbiturates
Benzodiazepines
Opioids
Sedative
Opioid symptoms
Hyperventilation
Hypotension
Miosis
Sedation
Possibly
Hypothermia
List of available opioids
Diphenoxylate
Fentanyl
Heroin
Methadone
Morphine
Pentazocine
Propoxyphene
General Mgt of Poisoning Hxs
An informant in children, suicidal, comatose or psychotic pt
Rescue personnel
PMH
Drug and substance use
FH/ SH/ Psychiatric hxs
General Mgt of Poisoning PE
General exams
Check for signs suggestive of particular types of substance
Toxidromes
Breath odour
Needle tracts
Stigmata of chronic alcohol use
General Mgt of Poisoning Investigation
- Blood levels in PCM, ASPIRIN
- Altered consciousness or abnormal vital signs do BUN, Serum Osmolality, Plasma Glucose and ABG
- Plain abd xray in body packers - iron, lead, arsenic or metals, packs of cocaine et all
- ECG and Cardiac monitoring
- Investigate for a bezoar
General mgt - Tx
Initial stabilization:
General overview+ ABC
Airway- intubate
Breathing - Supplemental oxygen or mechanical ventilation
Circulation - IVF, Blood
Altered consciousness check RBS, IF low- IV dextrose 50mls of 50% A, 2-4mls/kg of 25%.
Hypotension: IVF, Vasopressors norepinephrine 0.5 -1 ug IV
General tx - others
Topical decontamination: Large amount of H20 or Saline
Activated Charcoal: 1-2g/kg C or 50-100g in A. 4-6hrly as a slurry in water or soft drinks. Adsorption, consider NG tube.
Gastric emptying: via gastric lavage within 1 hr of a life-threatening ingestion. Risk of pneumonitis in caustic subs ingestion. Ipecac
Whole bowel irrigation: flushes the Git, decrease transit time for pills and tablets. Sustained released preparations, heavy metals pack of cigarette or suspected bezoar.
Give polyethylene glycol and electrolyte at 1-2l A, 25-40mll/kg/hr
Til clear effluent
Supportive measures
Allaying anxiety
TC of hypotension/ Hyper
Tx of hypothermia and hyper
Tx arrhythmias
Acetaminophen poisoning
N-acetyl -p- benzo quinone imitation is the toxic metabolite.
Produced by cytochrome p450 and detoxified by glutathione in the liver.
Toxic dose 7.5g/15 tabs a day
Stages of acute alcohol overdose1 - >244
Stage 10-24 hrs anorea, nausea, vomiting.
24-72 heaRUQ pain, ASLT, ALT, BIlirubin, and PT elevated
72- 96 hrs vomiting and symptoms of hepatic failure, ast, alt,
