Section 7: Household Activities Flashcards
7.1 Given an exposure, identify household products which may cause significant toxicity in small amounts.
- Consider antifreeze, windshield washing fluid, essential oils, flavoring extracts, camphor
- 2-7.3 Identify the toxicity and symptoms of exposure to ethanol, isopropyl alcohol, ethylene glycol, methanol.
- 10 Identify the treatment for ethylene glycol or methanol poisoning.
- Other Glycols (i.e. glycol ethers, ethylene glycol monobutyl ether)
- Ethanol
a. GABAa agonist
b. Mixed drinks absorb faster than straight shots
i. High concentration ethanol causes pylorospasm (delaying absorption)
c. Metabolites
i. Acetaldehyde
ii. Acetate
d. S/S
i. Slurred speech, ataxia, NYSTAGMUS, CNS depression
ii. Be aware of ethanol-induced hypoglycemia
iii. Be aware of AKA (alcoholic ketoacidosis)
e. Treatment
i. No antidote
ii. Supportive care
iii. No activated charcoal. Hemodialysis effective but rarely used
f. Withdrawal
i. Treat with high dose benzos
g. Abx that interact with ethanol (disulfiram-like reaction)
i. Some cephalosporins (Cefdinir, Keflex, Rocephin)
ii. Metronidazole (Flagyl)
iii. Nitrofurantoin (Macrobid)
- Isopropyl Alcohol
a. 2-3x more intoxicating than ethanol
b. Found in rubbing alcohol, industrial solvents, window cleaners, antiseptic and disinfectants
c. Metabolized to acetone (a ketone)
i. No acidic metabolites so does not cause anion gap acidosis
d. S/S
i. CNS depression, Fruity breath odor, Ketosis without metabolic acidosis
ii. Lactic acidosis
iii. Mild metabolic acidosis
iv. Anion gap (slight from dehydration, lactic metabolism)
v. Slight osmole gap (20-30)
vi. Acetone in urine
vii. Gastritis
viii. *Falsely elevated creatinine (d/t acetone interference)
ix. Stupor
x. Seizures
e. Treatment
i. Supportive
ii. Airway eval and management
iii. IV crystalloid for hypotension
iv. Consider hemodialysis (rare)
v. No charcoal
- Methanol
*Found in windshield washing fluids and paint thinners
Metabolized to:
i. Formate
- Causes acidosis and blindness
ii. Lactate
- Causes acidosis
Primary effects:
i. Brain injury
- AMS, Sz, coma
ii. Eye injury
- Visual disturbances (“snow”)
iii. Liver injury
iv. Kidney injury
- Acute renal failure with myoglobinuria
v. Heart injury
Lab abnormalities:
i. Osmole gap starts high and declines normal gap does not rule out toxicity
ii. Anion gap acidosis starts low and rises
iii. Level > 20mg/dL is toxic
iv. Level > 40mg/dL is very serious
v. Rarely use formate level (metabolite)
Toxic ingestion:
i. 60-200ml fatal dose for most adults
ii. As little as 10ml may cause blindness
S/S:
i. Visual disturbances (blindness)
ii. Metabolic acidosis
iii. Osmol gap (40+)
g. Methanol Treatment
Treatment:
i. Ethanol
- Blocks formation of nephrotoxic metabolites of methanol in the liver
- Reach and maintain level of 100mg/dl ethanol in blood
ii. Hemodialysis
iii. Fomepizole
- Inhibitor of alcohol dehydrogenase
- Easier to use clinically than ethanol
- Does not cause CNS depression or hypoglycemia
- Requires less monitoring than ethanol
iv. Folic acid or Folinic acid
- Enhances metabolism of formic acid (toxic metabolite of methanol)
v. Thiamine (vitamin B1) and pyridoxine (vitamin B6)
Calculation of level
- Osmolar gap multiply by 3.2 for a rough estimate of methanol level mg/dL
- Fatal oral dose calculated to be 30-240ml
- Ethylene Glycol
Primary effects
i. Kidney damage
ii. Metabolic acidosis
S/S
i. “inebriation”
- AMS, ataxia, nystagmus, slurred speech
ii. High anion gap metabolic acidosis (starts low and rises)
iii. Osmol gap (starts high and falls). *may hide a gap in a normal level
iv. Oxalate crystals in urine
v. Crystals may also precipitate in heart, brain, or spinal cord
vi. May have pulmonary edema with hypoxia requiring mechanical ventilation
vii. Hypocalcemia with tetany
viii. Late toxicity
- bilat facial paralysis
- diminished hearing
- dysphagia
c. Ethylene Glycol Treatment
c. Treatment
i. Ethanol
1. Blocks formation of nephrotoxic metabolites of ethylene glycol in the liver
2. Reach and maintain level of 100mg/dl ethanol in blood
ii. Hemodialysis
iii. Fomepizole
1. Inhibits alcohol dehydrogenase
2. Advantages over ethanol
a. Does not cause CNS depression or hypoglycemia
b. Requires less monitoring
iv. Thiamine, Pyridoxine, Folic acid
- *Calculation of level**
i. Osmolar gap multiply by 6.2 for a rough estimate of ethylene glycol level mg/dL
ii. Approximate lethal dose is 1-1.5ml/kg
iii. False positive level can be caused by high triglycerides, lactate, etc. - *level should be confirmed by gas chromatography (GC)
7.4 Identify the toxicity and symptoms of exposure to cleaning substances.
7.4 Identify the toxicity and symptoms of exposure to cleaning substances.
- Bleaches
a. Mixed with acid = chlorine gas
b. Mixed with ammonia = chloramine gas
c. Treatment
i. Remove from exposure
ii. Humidified O2
iii. Observe for upper airway obstruction (intubate if needed)
iv. Endoscopy for any s/s gastric/intestinal corrosive injury
v. Cxr and abd films to eval for perforation
vi. Dilute with water/milk
- Disinfectants (i.e. iodine, phenol, pine oil)
- Disinfectants (i.e. iodine, phenol, pine oil)
- Soaps, Detergents, and Laundry Products
a. MOA
i. Irritants of skin, eyes, mucosa
b. Anionic and nonionic detergents are fairly benign
i. Mildly irritating
c. Cationic or phosphate containing products should be watched closely
d. Cationic (i.e. quaternary ammonium compounds)
i. May be caustic and cause corrosive burns
j. Hematemesis, dysphagia, abd pain, hypotension, CNS depression, sz, coma
e. Automatic dishwasher detergents (more concerning with industrial products) are corrosive (alkaline)
f. Phosphate containing products
i. Cause hypocalcemia and hypomagnesemia
g. Consult GI if concern for corrosive injury
h. Inhalation can result in vocal cord and pharyngeal edema
i. May have lactic acidosis from propylene glycol
j. Hypoxia/ARDS, mucosal burns, lactic acid and metabolic acidosis
k. Some AMS noted (be aware of airway!)
l. Treatment (Soaps, Detergents, and Laundry Products)
i. Observe any pt who vomited for at least 6 hrs
ii. Treat hypocalcemia after phosphate containing products with IV calcium
iii. Treat methemoglobinemia with methylene blue
iv. Dilute with water/milk
v. Antiemetic (do not induce vomiting)
vi. Consider gentle lavage
vii. NO charcoal
viii. Oral aluminum hydroxide can potentially bind phosphate in the GI tract
7.5 Identify the toxicity and symptoms of exposure to foreign bodies.
7.5 Identify the toxicity and symptoms of exposure to foreign bodies.
- Button Batteries
a. Contain caustic metal salts that can cause corrosive injury
b. Diagnosis
i. Find location with radiograph
ii. If in esophagus immediate endoscopy for removal
iii. If in stomach or further along in GI tract repeat radiograph in 7-10 d if not visualized in stool
- Coins
a. Xray if dysphagia present
- Holiday Hazards
a. Bubble lights. If swallowed or absorbed through the skin, the liquid (methylene chloride) becomes carbon monoxide
b. Holly & mistletoe berries, poinsettia: GI upset
c. Christmas tree preservatives: GI upset
- Magnets
a. More than one magnet may cause perforation
- Glow Sticks
a. Irritation/burning. Rinse/dilute.
- Feces
p. Watch for s/s bacterial infection
7.6-7.7 Identify the toxicity and symptoms of exposure to hydrocarbons.
- Types of hydrocarbons
a. Aliphatic (lighter fluid, kerosene, gasoline, furniture polish)
- Poorly absorbed from GI tract.
- Risk of aspirationb. Aromatic and Halogenated (DDT, Freon, benzene, toluene, purines)
- Capable of serious systemic toxicity such as coma, sz, cardiac arrhythmias
c. Terpenes. (Ex pine oil, turpentine).
- CNS depression, aspiration
Hydrocarbon Exposure
- Ingestion
a. Abrupt N/V; hemorrhagic gastroenteritis; some compounds are absorbed and cause systemic toxicity. - Inhalation
a. May cause intoxication/hypoxia
b. *sensitization of myocardium to catecholamines can cause cardiac dysrhythmias - Pulmonary aspiration
a. Aspiration risk greatest with low viscosity and low surface tension
- Ex: petroleum naptha, gasoline, turpentine
b. Immediate onset coughing/choking
- Progresses (minutes to hours) to chemical pneumonitis - Dermal exposure
a. Local burns, irritation, or corneal injury - Injection
a. Local inflammation, pain, necrosis
b. *tracking may occur
c. Any hand/finger injury with high pressure injection of hydrocarbon warrants a hand consult - Systemic toxicity
a. Variable but often includes AMS, ataxia, lethargy, headache
b. Syncope, coma, respiratory arrest, cardiac arrhythmias
c. Hepatic and renal injury
- Treatment for Hydrocarbons
a. no steroids or antibiotics for pneumonitis
b. Hand or plastic consult for injections into fingertip or hand
c. Treat systemic toxicity per specific hydrocarbon
i. Acetylcysteine for carbon tetrachloride
ii. Methylene blue for methemoglobin formers
iii. Chelation therapy for leaded gasoline
d. Antidotes for pesticides
e. Gastric decon and charcoal discouraged (unless concern for systemic toxicity)
7.8 Identify the toxicity and symptoms of exposure to tobacco products.
- Nicotine
a. Contained in tobacco products and pesticides
b. 2mg = GI upset
c. 40-60mg = fatal dose if absorbed quickly
d. s/s onset 30-90 mine. S/S
i. N/V/D/ abd pain
ii. Salivation/diaphoresis
iii. Agitation then lethargy
iv. High BP, HR, RR then Low BP, HR, RR
v. CNS depression, fasciculations, seizures, paralysisf. Treatment
i. Atropine for cholinergic s/s (bronchorrhea and cardiac depression)
ii. Benzos for seizures
iii. Antidote
- Mecamylamine (Inversine)
- - Only oral form
7.9 Identify the toxicity and symptoms of exposure to other products.
7.9 Identify the toxicity and symptoms of exposure to other products.
- Adhesives, Glues, and Epoxy
a. Generally nontoxic
- Fertilizers and Plant Food
a. n/v/d
i. methemoglobinemia d/t presence of nitrites
ii. anhydrous ammonia can cause corrosive injury
iii. ECG abnormalities, hyperkalemia, metabolic acidosis, & acute renal failure with some fertilizers that contain metals and electrolytes
- Fire Extinguishers
a. Some contain methylene chloride which cause CO
b. Tetrachloroethylene is anesthetic agent that causes CNS/resp depression; sz hepatic failure
c. Others may cause resp irritation/pneumonitis
- Hydrogen Peroxide
a. Gastric distension, perforation, gas emboli
- Lacrimators (i.e. Capsaicin)
a. Ocular, dermal, resp irritation
- Moth Repellants
a. Napthlene causes methemoglobinemia
- Paint and Paint Strippers
a. Paint generally nontoxic
b. Paint stripper may contain methylene chloride (CO); methanol
- Personal Care Products
a. Cosmetics
i. Generally nontoxic
b. Dental Care
i. Concern for Fluoride
c. Hair Care
i. Dyes; straighteners may be caustic/corrosive
d. Mouthwashes
i. Concern for alcohol, fluoride
e. Nail Care
i. Concern for acetone. CNS depression, sz
f. Perfumes, Colognes, and After Shaves
i. Concern for alcohol
g. Powders (i.e. talc, other)
i. Pneumonitis/pulmonary edema
h. Suntan and Sunscreen
i. GI upset
ii. Some products may contain aspirin
i. Diaper rash cream
i. n/v/d from zinc oxide
