Tox Flashcards
ethylene glycol
(antifreeze)
toxidrome: metabolizes to glycolic / oxalic acids -> renal failure
antidote: fomepizole or ethanol, HD + mag/ca/pyridoxine (B6)
hydrofluoric acid
calcium, mag
isoniazid
pyridoxine (B6)
methanol
windshield washer / moonshine
toxidrome: metabolizes to formic acid (can cause blindness)
antidote: fomepizole or ethanol, HD; folic acid
TCA
sodium bicarb
beta blocker
glucagon, calcium, insulin, intralipids
CCB
calcium, glucagon, insulin, intralipids
heavy metals
BAL, then EDTA
iron
toxidrome:
stage 1: GI sxs (0-6hrs)
stage 2: quiescent phase (6-24hrs) labs worsen
stage 3: shock, metabolic acidosis, organ failure (24-72hrs)
stage 4: liver failure (48-96hrs)
stage 5: gastric strictures (2-8 weeks)
tx: deferoxamine (level b/w 350-500), whole bowel irrigation
cyanide
hydroxycobalamin, sodium nitrate, amyl nitrate, sodium thiosulfate
wernicke vs korsakoff
wernickes: ophthalmoplegia, gait disturbance, AMS
korsakoffs: confabulation, amnesia, apathy/lack of insight
isopropanol
metabolized to acetone
-no acidosis
-fruity odor
acetaminophen
NAPQI is toxic metabolite -> depletes glutathione
toxic dose = 150mg/kg (7-10g in adult)
stage 1: N/V (0-24h)
stage 2: RUQ pain, transaminitis, INR inc (24-48hr)
stage 3: encephalopathy, jaundice, organ failure (72-96h)
transplant if: pH <7.3, Cr >3, INR >3, encephalopathy
NSAIDS
HD for massive poisonings
salicylates
aspirin, wintergreen, pepto bismol
uncouples oxidative phosphorylation
toxidrome:
acute: hyperthermia, tinnitus, N/V
chronic: confusion, dehydration
-mixed resp alkalosis with metabolic acidosis
antidote: HD for acute >100, chronic >60
anticholinergics
red as a beet, dry as a bone, blind as a bat (large pupils/mydriasis)
jimson weed, antihistamines
antidote: supportive care w/ benzos, physostigmine (careful)
TCA
amitriptyline, desipramine
-tachy, seizure, acidosis, QRS widening (Na channel blockage), hypotension
antidote: sodium bicarb (want serum pH 7.45-7.55), benzos
MAOI
isocarboxazid, phenelzine, selegiline, and tranylcypromine
hypertension -> hypotension
think serotonin syndrome too
aminoglycosides
ototoxicity, nephrotoxicity, prolonged neuromuscular blockade
cephalosporins
crystalluria, prolonged bleeding time
chloamphenicol
grey baby syndrome
dapsone
methemoglobinemia, hemolysis if G6PD
ethambutol
optic neuritis, peripheral neuropathy