Tox

Question 1

What agents ⬆︎risk for Methemoglobinemia - 3

Answer 1

1. Nitrities
2. Local/topical anesthetics
3. Dapsone

Pulse Ox Saturation will be low and PaO2 will “seem” to be normal

Question 2

How does the pulse ox read for methemoglobinemia? ; why?

Answer 2

reads low (< 85%) but this does NOT actually represent the oxygen levels - it’s like this because of low affinity of methemoglobin for O2

The actual saturation is actually even lower even though PaO2 may read normal!

Dark chocolate colored blood

Question 3

Dark chocolate colored blood = ______ ; MOA for tx?

Answer 3

Methemoglobinemia ; Methyelene Blue accepts an electron from NADPH which converts –> LeukoMethylene blue. LM reduces Methomoglobin back to Hgb

Question 4

Houses built before what year at ⬆︎risk for lead poisoning?

Answer 4

1978

false positives occur so be sure to confirm with venous blood draw!

Question 5

What are the Lead chelating agents?-2 ; At what lead level do you use them?

Answer 5

1. Dimercaptosuccinic acid (45-69)
2. Dimercaprol with EDTA ( ≥70 or acute encephalopathy)

Be sure to confirm lead levels with venous lead level before starting tx

Question 6

Antidote for Cyanide toxicity - 3

Answer 6

1. Hydroxocobalamin
2. Sodium Thiosulfate
3. Nitrites (incudes methmeglobinemia)

empircally treat smoke inhalation pts!

Question 7

What is the MOA for Sodium Bicarbonate in TCA OD

Answer 7

⬆︎extracellular sodium and ⬆︎pH to alleviate cardio-depressent action on sodium channels

Question 8

cp for Arsenic toxicity - 3

Answer 8

3 P’s

1. Painful Polyneuropathy
2. Pigmentation abnormalities
3. Pancytopenia

RF: pressure treated wood, pesticides

Question 9

What’s the most serious consequences of methanol intoxication? - 2

Answer 9

1. VISION LOSS
2. Coma

Question 10

What is the most reliable sign of opioid intoxication

Answer 10

Respiratory Depression

Question 11

cp for Carbon Monoxide poisoning?-3 ; Dx?

Answer 11

1. Pinkish skin hue
2. GI distress
3. HA

Dx = Carboxyhemoglobin levels

This can present very similarly to Cyanide (also pinkish skin with bitter almond breath) and Methemoglobin (bluish skin) poisoning so be careful!

Question 12

Victims of smoke inhalation injury should be empircally treated for what chemical intoxication? ; What are the treatments?-3

Answer 12

Cyanide toxicity ;

1. HydroxyCobalamin
2. Sodium Thiosulfate
3. Nitrites (induces methemoglobinemia)

empircally treat smoke inhalation pts!

Question 13

cp for lead toxicity - 2

Answer 13

1. GI distress
2. Neuro distress ( stocking glove neuropathy, memory ⬇︎)

Remember that lead toxicity impairs heme synthesis –> microcytic Sideroblastic Anemia

Question 14

Toxicity of which compound causes Bitter Almond Breath?

Answer 14

Cyanide toxicity

will also have pink skin like carbon monoxide toxicity