Tox 2 Flashcards
What are the secondary effects of salicylate ingestion?
Respiratory alkalosis
Metabolic acidosis
Impaired glucose metabolism
Water and electrolyte loss
What is tell tale sign of ASA toxicity?
tinnitus
Patient presents with N/V, tinnitus, hyperventilation, fever, disorientation and eventual coma. What question should you ask?
Have you taken any NSAIDS?
What nomogram do you use for ASA OD?
What other lab should you get?
Done Nomogram. Blood levels are drawn at 6 hours post ingestion.
APAP level.
How do you treat an NSAID OD?
Alkalinization of urine with bicarb. (Acid + base = ionized = hydrophilic = kidney excretion)
Patient arrives with lethargy, bradycardia, hypotension, N/V, cherry red skin, and admits to drinking nail polish remover, taking Nitroprusside and eating 100 peach pits in the last few days. What is his most likely dx?
cyanide toxicity
What is the MOA of cyanide?
Forces organism to convert to anaerobic metabolism - LA build p and decreased O2 metabolism.
Which toxic substance is associated with the smell of bitter almonds?
cyanide
What are the 5 likely persons to get cyanide poisoning?
Industry or lab worker who suddenly collapses
Fire victim with coma and acidosis
Suicide attempter with acidosis and unexplained coma
Ingestion of nail polish remover
ICU patient on NTP and with AMS and acidemia
What are the 3 things in the Lilly Cyanide Antidote kit?
Why?
- Amyl nitrate pearls - metHB
- Sodium Nitrate IV- metHB
- Sodium Thiosulfate - sulfur donor for rhodanse to form thiocyanate which is less toxic
Nitrates form metHB, which cyanide cannot bind to.
Digoxin is a _______ inotrope and ________ chronotrope.
Positive inotrope
Negative chronotrope
How does a patient present with Dig OD?
N/V
AMS
sinus and AV block, bradycardia
EYES - visual disturbances, yellow/green haze and halovision
How do you treat Dig OD?
Digibind - sheep derived IgG antibodies that are infused into the blood stream to inactivate Dig
Patient arrives with bradycardia and hypotension, N/V, AMS. She thinks she may have taken too much of CCB. What should you do for her and what should you not do?
Do NOT give Ca - no sinus node effect or effect on vasodilation
DO - monitor ABCs, vital signs, EKG for 6 hours, possible give Glucagon if patient was on Verapamil or Diltiazem to increase inotropy/chronotropy
A new mother calls and says that her child just ate a silica gel packet from her purse. What should you tell her?
They are harmless.
What is the hallmark characteristic of a brown recluse?
- Light brown spider with VIOLEN shaped marking on its back, very shy
Why is a brown recluse spider poisonous?
Venom is a potent vasoconstrictor, similar to NE.
How do you treat a brown recluse bite?
Wound care, tetanus
Dapsone within first 24h may reduce lesion size
No antivenom or excusion.
How does a brown recluse bite appear?
What other skin condition may look similar?
- Painful bite, bulls eye lesion over 12h, necrosis over 1-3d + systemic sx of fever, chills, malaise, DIC
- Community acquired MRSA
Pregnant mother arrives to ED and says 2 y/o just ate her prenatal iron supplements and is now vomiting. You find out that the child’s serum iron level is 501 mcg/dl. How do you treat this iron OD?
ABCs, get abdominal x-ray to see if pills are still in stomach
Deferoxamine. 10 mg/kg/hr- follow until urine color has returned back to normal color
Pregnant mother arrives to ED and says 2 y/o just ate her prenatal iron supplements and is now vomiting. You find out that the child’s serum iron level is 200mcg/dl. How do you treat this iron OD?
ABCs, get abdominal x-ray to see if pills are still in stomach
What are the 4 stages of iron OD?
Immediate - corrosive, emesis, bloody diarrhea
Latent - improve over 12h
Relapse - acidosis, abrupt coma, shock, Sz, coagulopathy, hepatic failure, death
Late - scarring, strictures, GI obstruction
Toxicity is likely if serum level Fe is >______ mcg/dl.
You should use Deferoxamine if serum Fe is >______ mcg/dl.
What is the color of the patients urine when taking Deferoxamine?
Toxicity >450
Deferoxamine if >500
Orange - pink
Could you use HD or charcoal for iron OD?
NO
Mother calls and said her child just ate 15 Flintstone vitamins. What is your biggest concern here?
the iron in the vitamins
What are the water soluble vitamins? Are these dangerous in overdose?
B & C
No, you will just pee them out
What are the fat-soluble vitamins? Are these dangerous in OD?
ADEK
Yes - they accumulate over time, typically with chronic overuse
What are Nephro Caps?
Multivitamins with water soluble vitamins - people on dialysis take them.
What is the likely symptom of someone who eats a bunch of holly or mistletoe?
Gastroenteritis, nontoxic
What are the Pit Vipers? What is an obvious characteristic?How is their venom poisonous?
Diamond Back Copperhead Cotton mouth Rattle Snake (most poisonous) - Triangular shaped head - Neurotoxic and coagulopathic
What is the name of the group of snakes that strangle their prey? How do they look different? Which snakes do this?
- Elapidae
- Round head
- Coral snake, cobras, kraits, mambas
What are the effects of the elapidae bites?
Delayed, neurotoxic
Overall treatment of snake bites entails..
Keep pt calm, get to hospital ASAP Remove constricting clothing, jewelry Immobilize bitten area below level of heart Tetanus if indicated Broad spectrum Abx
If your patient is bitten by an exotic snake and you want to ask about antivenom or anything, who do you call?
Arizona Poison Control
American Association of Zoological Parks and Aquariams
What is the antivenom for the Crotalidae snakes?
Polyvalent - horse IgG (monitor for allergic rxn)
What is the antivenom for the Coral snakes?
Monovalent
