Tox

Question 1

primary treatment for toxic alcohol poisoning

Answer 1

1. Inhibition of alcohol dehydrogenase through either fomepizole or ethanol
2. this prevents the development of toxic acid metabolites

Question 2

salicylates primary treatment goals

Answer 2

Alkalinize and dialyze

1. Treat dehydration (Make euvolemic, Do not cause forced diuresis)
2. Correct potassium depletion

Question 3

Primary treatment for digoxin overdose

Answer 3

digoxin-specific antibody fragments (digoxin-Fab)

Question 4

first-line treatment for cyanide poisoning

Answer 4

Hydroxocobalamin

Question 5

treatment pathway for salicylate toxicity

Answer 5

1.Support ABCs
2. Alkalinize the serum/urine (1-2 mEq/kg sodium bicarb. IV bolus followed by sodium bicarb. infusion (3 amps into 1L D5W) @ 1.5-2 X maintenance rate) goal serum pH ~7.5; goal urine pH >7.5
3. Salicylate overdose + IV sodium bicarbonate therapy = potential hypokalemia. Avoid hypokalemia because it prevents alkalization of the urine, prolonged elimination of salicylate (goal K+ 4.0 to 4.5 mEq/L)
4. Monitor Ca++ levels (ionized/total); IV NaHCO3– can cause hypocalcemia
5. Consider glucose supplementation if altered mental status (Serum glucose may be normal but CNS levels may be low d/t effects of salicylates)
6. CCP transport for emergent hemodialysis

Question 6

Goals of management in toxic alcohol poisoning

Answer 6

1. Block the toxic metabolites with fomepizole or ethanol
2. Correct pH to 7.2 with bicarb
3. Eliminate toxic metabolites with dialysis (especially methanol)
4. Add adjuncts 5g folate for methanol
5. Thiamine and B6 for Ethyl-Alcohols

Question 7

Treating TCA overdose

Answer 7

1. administer sodium bicarbonate for QRS > 100-120
   2.Bicarbonate is administered at 1-2 meq/kg IVP. This dose may be repeated q5 minutes, until the QRS interval narrows and the hypotension resolves.
2. After 3 rounds of bicarb, start a bicarbonate drip (3 amps in 1L D5W) at a rate of 250 cc/hr. continued 12-24 hours after the EKG has normalized

Question 8

Beta Blocker OD treatment

Answer 8

1. IV Calcium (Increase contractility)
2. Glucagon
3. High Dose Insulin-Euglycemia Therapy (HIE) Heart prefers glucose over free fatty acid when stressed, this increases CO by mainly SV. Effects can work up to 10Units per hour (this is high dose)
4. Catecholamines and Pressors (These receptors are mainly blocked but you try anyway to maintain hemodynamics) Goal MAP is 65 mm Hg
5. Lipid Emulsion Therapy, this will absorb fat soluble drugs as it’s a big Lipid Sink (If the drug is not lipophilic this won’t work), also activates ion channels even if they are not overdosing on a lipophilic drug (might have some effect).

Question 9

Calcium Channel blocker OD treatment

Answer 9

Same as Beta without glucagon