Tox 2 Flashcards
CCB symptoms
vasodilation and HoTN***
decreased perfusion = CNS and pulmonary manifestations
severe CCB OD sxs
complete heart block
depressed myocardial contractility
vasodilation = CV collapse
non DHP OD
sinus Brady
av block
HoTN
I.e. verapamil, diltizem
DHP OD
TACHYCARDIA
peripheral vasodilation
HoTN
pulm manifestations CCB toxicity
due to decreased perfusion
can be seen if given execss crystalloid
CNS symptoms CCB toxicity
seizure
delirium
coma
secondary to hypo perfusion
EKG findings CCB toxicity
sinus bradycardia
AV block
lab findings CCB toxicity
hyperglycemia
lactic acidosis
CI of oral activated charcoal
> 2 hrs
AMS, vomiting
list of pharm tx CCB toxicity
- atropine
- Ca salts
- IV crystalloid
- pressers
- cardiac pacing
IV cyrstalloid CCB toxicity
HoTN management
over resuscitation = produce or worsen pulmonary edema
pacing CCB toxicity
indicated if HoTN and severe Brady (< 30 bpm)
digoxin tx for?
AF and symptomatic CHF
digoxin MOA
inhibitor of Na-K ATPase
toxicity = increased intracellular Na, Ca, extracellular K
digoxin Ca accumulation
augments inotrophy
results in PVC and dysrhythmia
digoxin cardiac glycoside
increased vagal tone = reduction in conduction thru SA and AV nodes
manifestations of gen digoxin toxicity
Syncope, dysrhythmia
GI distress, dizzy, HA, weak, confusion/AMS
**Bradycardia
acute digoxin toxicity sxs
neuro manifestations
yellow green halo in vision (xanthopsia)
hyperkalemia***
chronic digoxin toxicity sxs
renal function/decreased body mass
GI symptoms
Neuro (weakness, fatigue, confusion, delirium)
how is digoxin toxicity diagnosed?
EKG
T wave flattening/inversion
scooped ST segment
dig level increase = 6 hrs after ingestion
antidote of digoxin toxicity
Dig-Fab/Digibind
binds to digoxin in plasma, removes from tissues
given if HyperK presents
Lithium toxicity with what drug?
TZDs
also in renal insufficiency
succinylcholine and vecuronium prolonged effect
ADR of Lithium toxicity
fine postural hand tremor fatigue polyuria (loss of ability to concentrate urine) hypothyroid development of ataxia/dysarthria
Lithium toxicity tx
hemodialysis
IVF
ABCD
hemodialysis indications Lithium toxicity
impaired renal function
seizure activity
dysrhythmia
lithium level >4.0 mEq
Carbon Monoxide
Patho
Colorless, odorless gas
Combines with HgB to form COHgB which has greater affinity for O2 than tissues
Decreased oxygen delivery to tissue
Carbon Monoxide
Sources of Exposure
Smoke, car exhaust, hibachi grill, kerosene heater, methylene chloride
CO S/S based on saturation
<5%
none/mild HA
CO S/S based on saturation
10%
Slight HA, dyspnea on vigorous exercise
CO S/S based on saturation 20%
Throbbing HA, dyspnea with moderate exertion
CO S/S based on saturation 30%
Severe HA, irritability, fatigue, dim vision
CO S/S based on saturation 40-50%
tachycardia , confusion, lethargy, syncope,
CO S/S based on saturation 50-70%
Coma, death
CO S/S based on saturation >70%
Rapidly fatal
CO poison key Clinical features
Tachycardia, pallor skin (early), cherry red skin (late)
CO
Tx
Humidified oxygen
+/- HBO
Salicylate Toxicity
Clinical Features
Agitation, altered, diaphoretic, tinnitus, n/v, tachycardia and hyperventilation, fever
Salicylate Toxicity
Toxic Effects
- Central respiratory stimulation (respiratory alkalosis and secondary metabolic acidosis)
- Uncoupling of oxidative phosphorylation
- Interference with lipid and carbohydrate metabolism
- Acid Base abnormalities
- Decreased PCO2 and respiratory alkalosis
- Anion gap metabolic acidosis (lactic acidosis and ketoacidosis
Salicylate Toxicity labs
BMP (anion gap) ABG Glucose Cr Salicylate normal (NML 15-30)
Salicylate Toxicity tx
Activated charcoal
Correction of fluid and electrolytes
IV sodium bicarbonate
Hemodialysis
Intubation is dangerous in these patients (removes ability to compensate for acidosis)
acute Salicylate Toxicity
Single ingestion >300 mg/kg
Hemodialysis: >100 mg/dL
chronic Salicylate Toxicity
Non specific symptoms (confusion, dehydration and metabolic acidosis)
Hemodialysis: >60 mg/dL
Isopropranolol Clinical Features
CNS depression
Hemorrhagic gastritis
Pulmonary edema, hypoglycemia
Severe HoTN
IsopropranololTx
ABCs
IV hydration
Hemodialysis
Methanol source
Windshield fluid, antifreeze, moonshine
Methanol Symptoms
12-18 hrs later
Visual change/blurring Scotomata Snow storm blindness Seizure Respiratory failure
Ethylene Glycol
Clinical Features
Flank pain
Hematuria
Oliguria seizure
Respiratory failure
tx
Methanol and Ethylene Glycol
Supportive
4-MP fomepizole
IV ETOH
Sodium bicarbonate and hemodialysis
Anion Gap Metabolic Acidosis
Na - (Cl + HCO3)
NML: 8-12 mEq/L
If elevated, MUDPILES
MUDPILES
etiologies of anion gap metabolic acidosis
M methanol U uremia D DKA P paraldehyde I INH, Iron, Isopropyl alcohol L Lactic Acidosis E ethylene glycol S salicylates
Osmol Gap
Used to evaluate unexplained anion gap
MC 2/2: methanol, ethylene glycol, isopropanol
