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Residency > Tox > Flashcards

Tox Flashcards

1
Q

dosing of opiod overdose

A

naloxone (narcan)
starit with 0.04mg for adults and 0.1mg/kg kids

if no increase in RR in 2-3min –> increased to 0.5mg –> 2mg –> 4mg –> 10mg –> 15mg

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2
Q

management of sympathomimetic overdoses

A

benzos 1st line

antipsychotics if pts still agitated

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3
Q

difference betweeen sympathomimetic toxidrome vs antimuscarinic

A

sympathomimetics has sweating

antimuscarinic has dry mucosal membranes

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4
Q

sources of antimuscarininc toxidromes

A

Quetiapine, TCAs carbamazepine, jimson weed, oxybutinin, diphenhydramine

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5
Q

clinical features of antimuscarinic toxidrome

A 
(mad hatter, dry as a bone, etc...)
AMS
mydriasis 
urinary retention
ileus 
tachy
anhidrosis (dry)
mumbling speech
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6
Q

antidotal therapy for antimuscarinic toxidrom

A

physostigmine (mod-sev) 0.5-2mg IV (not to exceed 1mg/min)

tx: agitation (benzo)
wide complex tachy (Na bicarb)
cool blankets, IVF

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7
Q

contraindications to physostigmine

A 
bradycardia
av block 
severe asthma
allergy to it or salicylate 
mechanical obstruction GU orGI
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8
Q

muscarinic toxidrome

A

pilocarpine, mushrooms, organophosphates

DUMBELLS (diarrhea, urination, miosis, brady, bornchorrhea, emesis, lacrimation, sweating

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9
Q

tx of muscarinic toxidrome

A

atropine given until bronchorrhea resolves
start 0.5-2mg Q5min

pralidoxime

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10
Q

sedative overdose management

A

supportive care
Flumazenil for benzo toxicity
phenobarb elimination enhance with urinar alk (Na bicarb infusion) and/or hemodialysis

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11
Q

which syndrome has lead pipe rigidity

A

NMS
vs
Serotonin syndrome has hyperreflexitivity

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12
Q

presentation of serotnonin syndrome

A 
clonus 
hyperreflexia 
lower extremity rigidity 
diarrhea
shivering 
tremor 
diaphoresis
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13
Q

tx of serotonin syndrome

A

benzos 1st line
cyproheptadine in refractory cases

dantrolene for rigidity

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14
Q

NMS

A

90% in 1st week of new med

AMS, hyperthermia, tachy, lead pipe rigidity, bradykinesia, rhabdo

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15
Q

tx of NMS

A

benzos
bromocriptine in refractor cases

dantrolene for rigidity

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16
Q

indications for emergency dialysis

A 
acidosis
electrolytes 
intoxications 
overload 
uremia
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17
Q

dialyzable drugs

A

salicyclates
toxic alcohols
lithium
INH

metformin
theophylline
atenolol

topiramate
acyclovir
phenorbabital

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18
Q

Common indications for charcoal

A 
cyanide 
cyclic antidepressants 
CCBs
colchicine 
mushrooms
cocaine 
aspirin
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19
Q

contraindications to using charcoal

A

iron
lithium
arsenic

methanol
ethanol
ethylene glycol

strong acids or bases

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20
Q

almond odor

A

cyanide poisoning - burning nitrites, pesticides, nitroprusside

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21
Q

carrot smells

A

water hemlock - cicutoxin water vegetation

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22
Q

garlic breath

A

organophosphates
arsenic
selenium

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23
Q

mothballs scent

A

camphor - topical pain cream

naphthalene - insecticide

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24
Q

wintegreen

A

methyl salicylate

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25
Q

rotten egg scent

A

sulfur dioxide

hydroge sulfide

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26
Q

mc toxin ingested in US

A

acetaminophen

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27
Q

when does acetaminophen toxicity develop in an acute single ingestion

A

> 150mg/kg

up to 200mg/kg in kids <8yrs old

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28
Q

levels obtained prior to 4hrs

A

<100mcg/ml between 2-4hrs = (-) 100%
<100cg/ml between 1-2hrs = (-) 97%

> 300mcg/ml at any time = tx needed

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29
Q

NAC

A

72hr course if PO

21hr if IV

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30
Q

presentation of salicylates overdose

A
  • tachy
  • resp alk due to tachpnea
  • n/v/gastritis
  • met acid
  • ketoacidosis
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31
Q

management of salicylate overdose

A
  • IVF w/ LR
  • urinary alkalinization is key
  • Goal serum pH 7.45-7.55 with urine pH >7.5
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32
Q

how to achieve urinary alkalinization

A

bolus na bicar 1-2mEq/kg prn target pH followed by infusion

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33
Q

how to prepare nabicarb infusion

A

add 3ampules of na bicarb and 40mEq K+Cl to 1L of D5W

infuse at 150-250ml/hr

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34
Q

hemodialysis indications for salicylate overdose

A
  • renal failure
  • worsening acidosis or rising levels despite aggressive tx
  • AMS
  • level >100mg/dL
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35
Q

end organ toxicity of acute salicylate toxicity <150mg/kg (mild)

A

tinnitus
hearing loss
dizziness
n/v

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36
Q

end organ toxicity of acute salicylate toxicity 150-300mg/kg (mod)

A 
tachypnea 
hyperpyrexia
diaphoresis 
ataxia
anxiety
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37
Q

end organ toxicity of acute salicylate toxicity >300mg/kg (severe)

A 
AMS
seizures 
acute lung injury 
renal failure 
cardiac arrhythmias
shock
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38
Q

clinical features of NSAIDs overdose

A 
>400mg/kg 
gastritis 
met acidosis 
ams 
tachy
seziures 
AKI
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39
Q

tx of NSAID overdose

A

supportive
LR>NS
sucralfate for gastritis

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40
Q

opiod overdoses associated with seizures

A

tramadol
propoxyphene
meperidine

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41
Q

opiods associated with cardiotoxicity including QT prolongation

A

methadone**
loperamide
propxyphene

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42
Q

amides vs esters

A

amids = lidocaine, bupivacine, prilocaine

esters = tetracaine, benzocaine, cocaine

(amides = 2 i’s and esters = 1 i in their name)

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43
Q

toxic dose of lido w/ and w/o epi

A

with epi = 7mg/kg, 1% 10mg/ml, 2% 20mg/ml, max 500mg

w/o epi = 5mg/kg, max 300mg 1% 10mg/ml, 2% 20mg/ml

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44
Q

toxic dose of bupivicaine w/ and w/o epi

A

w/ epi = 3-5mg/kg (max 225)

0.5% sol = 5mg/ml

w/o epi = 1.5-3mg/kg (max 175mg)

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45
Q

management of QRS widening

A

boluses of sodium bicar 1-2mEq/kg q5min

until QRS interval responds or pH ?7.55

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46
Q

management of QT prolongation

A

mag sulfate 50mg/kg x1 empirically

K needs to be >4.5

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47
Q

causes of methemoglobinemia

A

benzocaine, dapsone, nitrites, metoclpraide

nitrobenzne, aniline dyes, trinitrotoluene

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48
Q

chocolate blood on venipuncture think

A

methomglobinemia

measure via co-oximetry to confirm dx

tx - methylene blue 1-2mg/kg reduces Methb to hemoglobin (renders pulse ox meaningless for a few min

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49
Q

when is methylene blue contraindicated

A

G6pd def

if methylene blue is unavailable treat with blood transfusion

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50
Q

acute toxicity of warfarin can lead to

A
  • elevated INR above range
  • calciphylaxis in pts w/ ESRD leading to thrombi formation
  • skin necrosis within first 10 days typically in obese middle aged women w/ protein C def
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51
Q

tx of warfarin toxicity

A

INR <5 w/ no sig bleed = hold next dose or lower daily dose

INR 5-9 w/ no sig bleed = hold next 1-2 doses and consider vit K

INR >9 w/ no sig bleed = hold coumadin and give vit K

Serious bleed at any INR = hold coumadin give vit K and FFP or&raquo_space; PCC (better)

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52
Q

reversal agent for dabigatran

A

idarucizamab and also hemodiaysis can help eliminate dabigatran

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53
Q

alteplase reversal agent

A

amiocproic acid

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54
Q

enoxaprin and unfractionated heparin reversal agent

A

protamine sulfate

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55
Q

toxicity signs for CCBs

A 
bradycardia
hyperglycemia
ileus 
bowel infarction 
hypotension
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56
Q

management of CCBs toxicity

A

IVF
Ca gluconate 1-2g IV
NE and EPi

high dose insuline(esp for verapamil and dilt)
bolus insulin 1unit/kg and then start infusion 1u/lg/hr

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57
Q

Beta blocker toxicity presentation

A

bradycardia
hypotension
QRS widening and/or QT prolongation (propanol, sotalol)

hypoglycemia, seizures

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58
Q

tx of beta blocker toxicity

A

glucagon traditionally (ADR n/v)

now IVF, and manage hypotension with pressors

Na bicarb for QRS >120ms, 1-2 mEq/kg q5min until its narrowed or pH >7.55

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59
Q

clonidine toxicity presentation

A

CNS depression
hypotension
bradicardia
MIosis

seizures, hypothermia (less common)

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60
Q

management of clonidine toxicity

A

supportive
IVF for BP

naloxone for CNS depression (may need high doses)

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61
Q

Digoxin toxicity presentation

A

bradydysrhythmias (acute)
tachydysrhythmias (chronic)

Hyper K >5 (50% mortality if no tx), >5.5 (100% mortality if no tx)

Visual disturbances (perceived flashes of light, abnormal colored vision)

Gi symptoms, weakness

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62
Q

Digoxin toxicity EKG

A

bidirectional v tach and paroxysmal atrial tachy with block

scooped/scagging ST segment (salvador dali mustache)

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63
Q

tx of digoxin toxicity

A 
supportive 
digoxin Fab fragments if: 
K >5
dig level >15 any time 
dig level >10 ( >5hrs post ingest) 
progressive bradydysrhthmias 
severe ventricular dysrhythmias 
ingestion >4mg kid 
ingestion >10 adult
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64
Q

what can falsely elevated dig levels

A

digoxin Fab so once given dig levels dont mean anything but a free digoxin concentration can be used if available

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65
Q

classes of antidysrhythmics

A

Simply Block the Proper Channel

I = Sodium 
II = beta adrenergic 
III = Potassium 
IV = Calcium
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66
Q

chronic amiodarone toxicity may include

A

thyroid dysfunction
pneumonitis
corneal microdeposits
skin discoloration

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67
Q

ACE inhibitors ADR and notes

A

hyperkalemia
hypotension
cough
angioedema

transient Cr bump
monitor in pts with renal issues

68
Q

Losartan (angiotensin II receptor blocker) ADR and notes

A

hyperkalemia
hypotension
cough

monitor in renal pts

69
Q

loop diuretics ADR and notes

A

ototoxicity (high doses)
hypokalemia
hypomag

monitor electrolytes and orthostatics

70
Q

thiazide diuretics ADR and notes

A

hypokalemia
hypo Na

volume depletion
monitor electrolytes and orthostatics

71
Q

spironolactone (K sparing) ADR and notes

A

hyper K

gynecomastia

72
Q

amiodarone ADR and notes

A

QT prolongation
hepatotoxicity

pulm fibrosis
thyroid toxicity

Hypotension w/ rapid infusion

73
Q

diltiazem and verapamil (nondihydropyridine CCB) ADR and notes

A

hypotension
AV block (esp when combined with beta blockers)
bradycaria

CYP3A5 substrates

74
Q

amlodipine (dihydropyridine CCB) ADR and notes

A

hypotension

edema

75
Q

uses for metoprolol vs esmolol

A

metoprolol (Afib)

esmolol (short acting aortic dissection

76
Q

what pts should you avoid using clopidogrel on

A

active bleeding

pts with stroke hx or TIA

77
Q

heparin dose adjustments

A

not necessary in renal dysfunction

Ok during pregnancy

78
Q

enoxaprin dose adjustments

A

dose reduction in renal dysfunction pts

Ok during pregnancy

79
Q

presentation of phenobarbital toxicity

A

CNS depression
resp depression (occasionally)
hypotension
bradycardia

80
Q

management of phenobarbital toxicity

A

supportive

urinary alkalinization (bicar bolus and infusion)

hemodialysis

81
Q

phenytoin toxicity presentation

typically chronic due to zero order elimination

A

cerebellar signs (ataxia, nystagmus and dysmetria)

IV - cardiotoxic/seziures

elimination can be enhanced by hemodialysis

82
Q

carbamazepine toxicity presentation

A

CNS depression
cerebellar signs

seizures, cardiotoxc (QRS widening and QT prolongation)
antimuscarininc toxicity

83
Q

management of carbamazepine toxicity

A

cardiotoxic w/ Na bicarb and/or mag

seizures w/ benzos

physostigmine for antimuscarininc

consider hemodialysis for levels near 40mcg/ml

84
Q

topiramate toxicity presentation

A

CNS depression
cerebellar signs

normal gap acidosis
hypo K
hyper Cl

seizures

85
Q

management of topiramate toxicity

A

replace K w/ potassiu phosphate or K acetate

benzos for seizures

hemodialysis

86
Q

valproic acid toxicity presentation

A 
CNS depression 
QT prolongation 
elevated AST and ALT 
Pancreatitis 
Bone marrow suppression

hypotension
hyper ammonemia
less common seizures

87
Q

management of valproic acid toxicity

A

if soon after overdose -> charcoal

  • L carnitine indicated in AMS pts and w/ elevated levels
  • -> dose 50-100mg/kg followed by 25-50mg/kg q6hrs until VPA level <100

naloxone for CNS dep
hemodialysis - >500mcg/ml

88
Q

TCA toxicity

A
  • QRS widening from Na channel poisoning
  • QT prolongation due to K efflux blockade

tachy or brady (severe)
hypotension

sedation, antimuscarinic tox, seizures, serotonergic tox

89
Q

management of TCA toxicity

A

QRS widening w/ Nabicarb 1-2mE1/kg q5min until QRS interval resolved or pH >7.55

90
Q

management of refractory hypotension w/ TCA toxicity

A

NE or Epi

Dopamine is contraindicated (can exacerbate hypotension)

91
Q

SSRI toxicity

A

tachycardia
GI symptoms (mc)
CNS depression

QRS widening and/or QT prolongation (citalopram)

hyperreflexia

92
Q

bupropion toxicity

A

can take >24hrs
seizures

tachy, CNS depression
QRS wid and/or QT pro

93
Q

management of bupropion toxicity

A

Gi decontamination with single dose activated charcoal or whole bowel irrigation

94
Q

lithium toxicity

A

GI signs predominate

Neuro signs
serum level correlates w/toxicity

95
Q

management of lithium toxicity

A

whole bowel irrigation
aggressive fluid resuscitation w/ NS

hemodialysis if concomitant renal insufficiency

96
Q

normal lithum level

A

0.6-1.2

97
Q

ADR of clozapine

A

agranulocytosis
weight gain

hyperglycemia
myopathy

98
Q

EKG finding of atypical antipyschotics

A

QT prolongation (although rare)

99
Q

ADHD stimulant toxicity

A

tachy, HTN, diaphoresis
mydriasis, agitation

seizures

tx - supportive, benzos for szs

100
Q

sulfonylureas toxicity and management

A

hypoglycemia >12hrs later

GI decontamination
supp dextrose + octreotide - preferred antidote (safer than glucagon) dose = 1mcg/kg IV/SQ 16hrs prn

101
Q

metformin toxicity and management

A

sig lactic acidosis in pts w/ risk factors: ckd or chronic liver dz

tx - supp hemodialysis if: rising lactate levels, renal insuff w/ hyper K

102
Q

ondansetron (zofran) ADR

A

qt prolongation at doses >32mg

103
Q

prochlorperazine ADR

A

sedation
antimuscarinic toxicity

miosis, rhabdo
cardiotoxicity

104
Q

management of prochlorperazine

A

tx cardiac and antimuscarinic tox as usual

lipid emulsion in massive overdose

105
Q

metoclopramide toxicity

A

CNS depression
QT prolongation
methemoglobinemia

extrapyramidal signs

tx like the rest

106
Q

what is the risk of allergic rxn to 1st and 2nd gen cephalosporins in PCN allergic pts

A

1% and the risk for 3rd and 4th gen cephalosporins = negligible

107
Q

fluoroquinolones ADR

A

QT prolongation

associated with tendinopathy (esp in elders)

108
Q

macrolides (azithro) ADR

A

QT prolongation

large doses cause sensorineural hearing loss

CYP 4500 3A4 inhibition

chronic use = hepatitis

109
Q

tetracyclines (doxy) ADR

A

pill esophagitis
photosensitivity
occasionally nephrotoxic
hepatotoxic

110
Q

ADR of vanc

A

red man syndrome

111
Q

INH toxicity

A

CNS depression
seizures

metabolic acidosis
hepatitis

112
Q

antidote for INH

A

pyridoxine dose should be equivalent to ingested

113
Q

Antimalaria toxicity

A

GI symptoms, tinnitus
CNS depression, seizures,
dysrhythmias, rnela fialure

QRS wide, QT prol, hypotension

114
Q

acyclovir toxicity

A

AMS
seizures
nephrotoxicity

115
Q

nucleoside reverse transcriptase inhibitors ADR

A

lactic acidemia

zidovudine - hematologic toxicity

pancreatitis

116
Q

dextromthorpan ADR

A

dissociation

large ingestion -> serotonin toxicity - AMS, tachy, hyperthermia, clonus, hyperreflexia, diarrhea

117
Q

management of dextromethorphan toxicity

A

supp care
benzos
cyproheptadine

dantrolene for rigidity

118
Q

antihistamine toxicity

A

sedation, (antimuscarinic) AMS, tachy
anhidrosis, mydriasis

ileus, urine retention

rhabdo and cardiotoxicity

119
Q

management of anthistamine toxicity

A

cardio tox like usual
szs w/ benzos

antimuscarinic w/ physostigmine

consider lipid emulsion in massive overdose

120
Q

signs of alcohol withdrawal

A

tremor, restlessness
hallucinations (visual>auditory)

seizures
DTs (48-96hrs)

121
Q

management of alcohol withdrawal

A

diazepam and chlordiazepoxide (long acting)

benzos (ineffective in malnourished pts) and failure mcc underdosing

122
Q

methanol toxicity (wiper fluid, carburetor cleaner, etc)

A

mild inebriation
elevated methanol level

wide gap acidosis
ocular signs -> lesions in putamen

hyperglycemia and pancreatitis (less common)

123
Q

ethylene glycol toxicity (antifreeze)

A

mild-mod inebriation
wide gap acidosis
AKI w/ hypo Ca

CN palsies (less common)

124
Q

management of ethylene glycol toxicity

A

if early - fomepizole is sufficient

if late - hemodialysis

125
Q

isopropyl alcohol toxicity (rubbing alcohol)

A

significant inebriation
gastritis

ketosis but NO acidosis

Hypotension
CNS depression

126
Q

chronic stimulant use is associated with

A

vasculitis
cardiomyopathy
pulm HTN

valvular injury

127
Q

when should flumazenil be avoided

A

in pts who have ingested a proconvulsant xenobiotic aka: TCA, tramdol or buprpion

128
Q

how can phenobarbital elimination be enhanced

A

hemodialysis and urinary alkalinization

129
Q

carbon monoxide toxicity

A

greater affinity for Ox than Hgb (pulse ox - false nml)
“flu w/o the fevere”

HA, N, confusion
dyspnea, chest discomfort
rhabdo

dysrhthmias, MI, Sz, Coma,

130
Q

dx and tx of CO toxicity

A

measuring COHb via co-oximetry

tx - 100% oxygen reduces half life of COHb

131
Q

CN toxicity

A

rapid unconsciousness
seizures
acidosis

cardio tox
arterialization (bright red blood)

132
Q

tx of CN toxicity

A

supp care
antidotal therapy with amyl nitrite and sodium nitrite (avoid in smoke inhalation)

sodium thiosulfate IV

hydroxocobalamin IV (HTN and skin discoloration are temporary ADR)

133
Q

hydrogen sulfur toxicity (flammable colorless gas)

A

smells like rotten eggs but high levels olfactory paralysis

irritation of skin and mucus membranes

ha, vomiting, szs, coma
cardiovascular instability

134
Q

tx of hydrogen sulfur toxicity

A

supp

nitrites (weak evidence)

135
Q

insecticide toxicity

A 
DUMBELS 
defecation 
urination 
miosis 
bradycardia 
bronchospasm
bronchorrhea 
emesis 
lacrimation 
salivation
136
Q

iron toxicity

A 
sign toxic >60mg/kg 
GI phase (first 6hrs) 
- vomiting and/or diarrhea
Latent phase 
- look better but developing tox at cellular level
Shock + Acidosis phase
137
Q

management of iron toxicity

A

consider whole bowel irrigation

deferoxamine indicated for pts with signs and symptoms + serum level >450mcg/dL

  • dose 15mg/kg until iron level therapeutic or sym resolved
    • ADR hypotension give Fluids and may predispose pts to yersinia infections
138
Q

lead toxicity

A

abd pain, anemia, acute liver injury, encephalopathy

chronic - anorexia, weight loss, constipation, HTN, anemia, nephrotoxic, CNS issues

139
Q

dx and tx of lead toxicity

A

dx - whole blood lead level

tx - supp, chelation therapy if indicated, dimercaprol, CaEDTA, and succimer

whole bowel irrigation (for large acute ingestion)

140
Q

arsenic toxicity

A

gastroenteritis that may be hemorrhagic
hypotension, tachycardia

metabolic acidosis, AMS, rhab

neuropathy, pancytopenia

chronic: BMS, peripheral neuropathy, pvd, portal HTN, skin disorders

141
Q

common skin finding for arsenic poisoning

A

spots of hyperkeratosis and hyperpigmentation on the palms and soles seen in chronic arsenic poisoning

142
Q

dx and tx of arsenic toxicity

A

dx - 24hr urine arsenic levle

tx - supp, chelation therapy if indicated w/ dimercaprol, unithiol, succimer

whole bowel irrigation (large acute ingestions)

143
Q

hydrofluoric acid toxicity

rust remover, glass etching supplies

A

local mucus membrane irritation
bronchospasm
corneal injuries

hypo Ca, Mg
hyper K
QT prolongation

144
Q

management of hydrofluoric acid toxicity

A 
decontamination, supp 
supplemental Ca - topical Ca for burns 
or
Ca gluconate 
10% solution 0.2-0.4mL/kg IV for systemic toxicity
145
Q

caustic toxicity (toilet bowel cleaner, bleaches, car batteries, gun bluing agents)

A

alkalis cause liquefactive necrosis
acids cause coagulative necrosis

mucus membrane and skin irritation, pneumonitis

146
Q

management of caustic injuries

A

DONT INDUCE EMESIS
endo for pts w/ resp distr, hematemesis, stridor, vomiting, drooling

GI decontamination except for zinc Cl and cationic detergents

147
Q

hydrocarbon toxicity (essential oils, gas, lighter fluids, solvents)

A

bronchospasm, pneumonitis
(avoid albuterol see below)
skin damage, GI injury, CNS effects (lead to leukoencephalopathy)

Sensitize myocardium

148
Q

antimuscarinic plants

A

jimson weed

atropa belladonna

149
Q

nicotinic plants

A

poison hemlock
tobacco

mydriasis, tachy, weakness, HTN, szs, sweating

150
Q

water hemlock

A

causes status epilepticus by antagonizing GABA receptors

may require high doses of benzos

151
Q

castor bean toxicity

A

disrupts protein synthesis inhibiting 28S subunit of the ribosome producing significant GI symptoms and multi organ failure

tx - spp care, fluid resus

152
Q

death cap mushroom (amanita phalloides)

A

cause of 95% mushroom deaths

stage 1 - GI phase (6-12hrs)

stage 2- liver damage, elevated transaminases and bili, coagulopathy, hepatic encephalopathy (2-3days)

stage 3- liver and renal failure (death in 3-7days)

153
Q

management of death cap mushroom toxicity

A

activated charcoal if presentation is 1-2hrs
spp care with fluid and electrolyte resus

NAC (IV)
PCN (high dose IV)
OTC raw milk

154
Q

stone fish

A

dyspnea, spasticity
hypotension, tachycardia
vomiting, abd cramping

tx - spp care, local wound care, HOT water immersion (45C) 30-60min and anti-venom

155
Q

stingrays envenomation presentation

A

sig pain and concomitant trauma

vomiting, syncope
seizure, hypotension
heart failure

156
Q

tx of stingray envenomation or injury

A

spp care, local wound care

HOT water immersion (30-60min)

infection in 13% of cases so prophylactic abx should be given

157
Q

cnidaria (jelly fish, portuguese man o war, anemones)

presentation

A

pain, papular lesions
local tissue injury

vomiting seizures
hypotension
cardiovascular collapse
death

158
Q

management of cnidaria injury

A

spp care

inactive nematocyts w/ vinegar for 30 min (**except for American Sea nettle, mauve stinger and lions mane jellyfish)

control pain w/ parenteral narcotics and hot water immersion 45C (30-60min)

159
Q

scombroid presentation

A

develops when histidine gets decomposed by bacteria to histamine

causing flushing and gastroenteritis (within min)

160
Q

fish that are associated with scombroid

A

TUNA
mackerel
mahi mahi

albacore, bonito, skipjack, blue fish

161
Q

management of scombroid poisoning

A

H1 and H2 antagonists

albuterol and occasionally epi for the tx of bronchospasm

162
Q

Ciguatera toxin fish species

A

GROUPER
sea bass

barracuda
parrot fish
sturgeon

163
Q

presentation of ciguatera toxin following large consumption

A

2-6hrs later:
temperature reversal

HA, diaphoresis
brady hypotension

vomiting, abd cram, profuse diarrhea

sensation of loose teeth

164
Q

management of ciguatera toxin

A

spp care

gabapentin

165
Q

tetrodotoxin (TTX)

species
pathyophys
tx

A

blue ringed octopus
pufferfish

TTX blocks Na channels -> paresthesia, weakness, dysphagia, hypotension, brady and

flaccid paralysis (6-24hrs)

tx - spp care, neostigmine (possibly)

Residency (19 decks)

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