Tox Flashcards
For what substances is activated charcoal not effective?
PHIAL Pesticides Hydrocarbons Iron/metals Alcohols Lithium
What are the indications for hyperbaric treatment in CO poisoning?
- COHb >25% (15% in pregnancy)
- neuro deficits or AMS
- syncope
- myocardial ischemia
- CV instability or arrhythmias
- severe acidosis (pH < 7.1)
What does hydrogen fluoride exposure cause?
Hypocalcemia, hypomag, dysrhythmias
Tx: calcium chloride
Used for glass etching, rust removal
What medications cause methemoglobinemia?
Nitrates
Dapsone
Benzocaine spray
Phenazopyridine
What are the indications for digibind in digoxin toxicity?
K >5
Ventricular dysrhythmia
Bradycardia refractory to atropine
Dig level >10 in adults, >4 in peds
What are the symptoms of MAOI toxicity?
Hypertensive emergency, dysrhythmias, DIC
How much is typically a toxic dose of Tylenol?
150 mg/kg
When is methylene blue indicated for methemoglobinemia?
When patient is symptomatic or MetHb > 20%
When is cyanide poisoning seen?
House fires, exposure to nitroprusside, metal polish, certain insecticides
What are the sx and lab findings in methanol ingestion?
Intoxication, renal failure, blindness
Lactic acidosis w/ elevated AG
Tx: HD, fomepizole, folinic acid
What are the sx and lab findings in ethylene glycol ingestion?
HypoCa, renal failure, urine contains calcium oxalate crystals, acidosis and elevated AG
Tx: ethanol, fomepizole, HD, thiamine and pyridoxine
What are the sx and lab findings in isopropyl alcohol ingestion?
Intoxication, hemorrhagic gastritis, hypotension, elevated AG + ketosis without acidosis
Tx: supportive care
What is the lethal dose of aspirin?
500 mg/kg
Severe toxicity at > 300 mg/kg
What is considered a massive overdose of ibuprofen?
450 mg/kg (clinically significant is 100 mg/kg)
What are the sx of dextromethorphan toxicity?
Similar to PCP - visual hallucinations, rotary nystagmus, tachycardia, mydriasis, hyperthermia, resp despression, rhabdo
Can cause serotonin syndrome if co-ingested w/ SSRI
What is the fatal dose of iron?
60 mg/kg
What are indications for deferoxamine after iron ingestion?
- iron level > 500 mcg/dL (or >350 in a symptomatic patient)
- intractable vomiting/diarrhea
- anion gap metabolic acidosis
- severe AMS
- shock
At what blood lead level is dimercaprol indicated?
70, should follow dimercaprol w/ CaNa2EDTA
What is the treatment for beta blocker toxicity?
- activated charcoal (if within 1-2 hours)
- calcium gluconate or chloride
- glucagon (increase cardiac contractility)
- high-dose insulin (1-10 U/kg/hr)
Atropine does not work!
What are the sx and tx of valproic acid toxicity?
Sx: n/v, sedation, resp depression, elevated ammonia
Tx: L-carnitine
What are the components of salicylate toxicity treatment?
1) aggressive IVF
2) activated charcoal (if within a few hours of ingestion)
3) bicarb gtt for alkalinization of urine - bolus 1-2 amps + infusion of 3 amps in 1L D5W running at 2-3x maintenance (goal urine pH > 7.5)
4) correct hypokalemia
5) dialysis if needed
What are indications for dialysis in salicylate toxicity?
- clinical deterioration or failure to improve in spite of other treatment
- failure to sufficiently alkalinize urine or serum
- renal insufficiency or failure
- severe acid-base disturbance
- AMS
- acute lung injury
- strongly consider in any pt w/ serum salicylate > 100
What are the symptoms of TCA toxicity?
Sedation, antimuscarinic effects (similar to atropine - tachycardia, hyperthermia, delirium, dry mouth, urinary retention), slurred speech, clonus/hyperreflexia, seizure, cardiotoxicity
What EKG changes are seen in TCA toxicity?
Prolonged PR, widened QRS, terminal R wave in aVR, QT prolongation, Brugada pattern
