Prevention and Treatment of Poisoning Flashcards
What is a poison?
Any chemical capable of producing a deleterious response in a biological system, injuring function or producing death
What constitutes supportive care?
airway patency, O2 status cardiac monitoring IV fluids to tx hypotension Tx acid-base and electrolytes Use antidotes/antagonists to stabilize patient
What is the AMPS acronym for poisoning?
allergies, medications, past mediation history, situation at present
How are geriatric patients different from younger adults with toxicant distribution?
smaller body mass
increased adipose tissue = higher Vd of lipophilic
Decreased Total Body Water = lower Vd of hydrophilic
Reduced liver, kidney function
Reduced Cardiac Output
How are kids different than adults with toxicant distribution?
High total body water = high Vd for hydrophilic
Decreased adipose tissue = lower Vd for lipophilic drugs
Poor renal elimination
Slow liver metabolism of drug
Reduced plasma protein binding
How can you prevent absorption of a toxicant?
- decontaminate hair, nails, skin
- remove from source of toxicant
- Emesis with Serum of Ipecac (used infrequently)
- Gastric lavage - at best 2/3 removed
- Activated charcoal
When do you use Syrup of Ipecac?
use only if over 2 hours from ER, patient is over 6 months. Ipecac is cardiotoxic, neurotoxin.
What is activated charcoal?
inert, non-toxic with large surface area. Give 10x estimated weight of toxicant. CI with caustics, heavy metals, alcohols, cardiac drugs, aspirin, lithium. Use serial dosing.
How can you enhance elimination of a toxicant?
whole bowel irrigation - polyethyene glycol
Interruption of enterohepatic circulation - charcoal
Forced diuresis - trap ion in tubular lumen
Dialysis - use for chemicals with small Vd
What is the antidote for acetaminophen?
N-acetylcysteine, replenishes glutathione
What is the antidote for AChE inhibitors/organophosphates?
Atropine, followed by pralidoxime
What is the antidote for amphetmines?
Ammonium Chloride, NH4Cl - acidifies urine
What is the antidote for antimuscarinic, anticholinergic agents
Physostigmine, control hyperthermia
What is the antidote for benzos?
Flumazenil
What is the antidote for Beta Blockers
Glucagon
