tox Flashcards
what toxins can vs can’t cross placenta
cadmium can’t
lead, mercury, PCBs, insecticides all can
what shouldn’t you use activated charcoal for
CALM cyanide alcohol/alkaline/kerosene lithium heavy metals
also antidotes, except for NAC
activated charcoal dosing
0.5-1 g/kg
adult range: 25-100 g
how much acetaminophen = overdose
140 mg/kg
if known to have ingested more than this, can give NAC right away
when to take acetaminophen level
4-10 hrs post ingestion
most important predictor of outcome
wintergreen odor
salicylates
can salicylate toxicity cause fever
yes
management of ibuprofen ingestion
supportive
cutoffs for BAC in ethanol toxicity
- 1% = mild
- 2% = moderate (slurred speech, ataxia)
- 3% = severe (stupor, confusion)
- 4% - coma, resp depression
what to monitor for in ethanol toxicity
hypoglycemia
electrolyte abnormalities
other toxidromes
metabolic acidosis, abdominal pain, high AG, vision issues
methanol ingestion
management of methanol ingestion
ethanol?
4-MP?
sodium bicarb
drunk with no odor of alcohol and large anion gap
ethylene glycol toxicity
calcium oxalate crystals in urine 2/2 ingestion
ethylene glycol
muscarinic effects
salivation, lacrimation, diarrhea, wheezing, bradycardia
give atropine
nicotinic effects
neuromuscular - weakness, paralysis, fasciculations
give pralidoxime
management of TCA toxicity
activated charcoal
EKG monitoring
sodium bicarb if widening QRS
TCA and allergy testing
interfere with histamine response - results not valid
GI irritation, choking, resp symptoms, infiltrates on CXR
hydrocarbon (gasoline, kerosene, lighter fluid) ingestion
can cause ARDS
mgmt of hydrocarbon ingestion
obs for 6 hrs if asymptomatic
resp support if symptomatic
sudden flu like symptoms, afebrile, other family members affected
carbon monoxide poisoning
CO poisoning management
100% oxygen (O2 sat reading inaccurate)
carboxyhemoglobin levels
smell of almonds, flu like symptoms and respiratory distress without responding to O2
cyanide poisoning
management of cyanide poisoning
hydroxocobalamin
sodium thiosulfate, nitrate
coughing, crying, drooling, chest pain, trouble swallowing
caustic substance ingestion
DO NOT DO GASTRIC LAVAGE
what part of GI tract do alkali substances injure
esophagus
what part of GI tract do acidic substances injure
stomach
mechanism of alkali toxicity
direct contact with skin and mucosa cuasing necrosis
min lead level to cause cognitive deficit
10 mcg/dL
what to do for lead 5-14 mcg/dL
report and confirm in 3 months, screen for iron, development
what to do for lead 15-44 mcg/dL
report and confirm in 4 weeks, consider XR for pt with pica
what to do for lead 45-70
confirm in 48 hours, chelation with succimer as outpt, admit if GI or CNS sx
what to do for lead 70+
confirm immediately, admit, dimercaprol and edetate calcium disodium
how much iron is toxic ingestion
40 mg/kg elemental iron
multisystem effects of iron ingestino
metabolic acidosis
coagulopathy
cardiovascular collapse
when to check iron level
4 hrs post ingestion
indications for iron chelation
severe symptoms
AG acidosis
iron > 500 mcg/dL
many pills seen on AXR
activated charcoal for iron?
not indicated (poor absorption)
when is deferoxamine therapy done?
urine no longer pink
early teeth eruption, dark pigmentation of skin, acneiform rash, low birthweight
prenatal PCB exposure
Pigmentation Cutting teeth Birthweight low
vesicles starting in face and extremities in same stage of dvlpmt, leaves scars
small pox
pruritic papule –> central black painless eschar
cutaneous anthrax
coin in esophagus on CXR
face forward on PA film
coin in trachea on CXR
face forward on lateral film
how long for coin to pass through GI tract
4-6 days
coin in prox esophagus –>
endoscopy
coin in mid-lower esphagus –>
observe if asymptomatic
