Toxic ingestion Flashcards

1
Q

severity of caustic esophageal injury depends upon

A

the ingested substance corrosive properties, amount and concentration, alkali ingestion

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2
Q

alkali ingestion can cause

A

liqufactive necrosis in the esophagus that spreads within seconds to minutes to the mediastinum

this can happen for 3-4 days

slow healing of the esophageal mucosa can take up to 1-3 months

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3
Q

presentation of caustic esophageal ingestion

A

dysphagia, odynophasia, retrosternal pain, vomiting, and occasional hematemsis

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4
Q

management of alkali ingestion

A

CXR and ABD XR to look for perforation

Needs EGD in 1st 24 hrs in HDS pts to look and grade esophageal involvement

more severe grades can lead to perforation, mediastinitis, or severe strictures

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5
Q

long term side effects of alkali ingestion

A

15-20 years heed to have routine screening for esophageal cancer,
esophageal strictures

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6
Q

role for NG tube after caustic ingestion

A

no as it can lead to perforation

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7
Q

role for ingestion of weak acid after alkali ingestion?

A

no because damage is instantaneously

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8
Q

Toluene solvent inhalation pathophysiology

A

early on causes a high anion gap metabolic acidosis but byproduct (hippuric acid) gets excreted by kidneys with sodium and K resulting in non anion gap metabolic acidosis and hypokalemia and hypophosphatemia and low level rhabdomyolysis and distal (type 1) RTA.

Results in muscle weakness from low K`

also see cognitive impairment.

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9
Q

Toluene solvent inhalation treatment

A

supportive care with IVFs and repletion of electrolytes

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10
Q

Tricyclic antidepressant (TCA) overdose can manifest with

A

respiratory depression, hypotension, tachycardia, sedation, seizures and coma and death

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11
Q

Anticholinergic toxicity with diphenhydramine and amitriptyline is

A

hyperthermia, flushing, mydriasis, delirium and urinary retention

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12
Q

sertraline overdose leads to

A

serotonin syndrome (hyperreflexia, seizures, fever, autonomic instability and AMS)

doesn’t affect heart commonly

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13
Q

Lorazepam overdose causes

A

delirium sedation, respiratory depression and may need intubation

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14
Q

what to look for in TCA overdose?

How to treat the finding? how to monitor that goal?

A

wide complex tachycardia with QRS>100 msec which indicates potential cardiac toxicity. PR interval can increase but doesn’t correlate with cardiac toxicity.

Tx with IV sodium bicarb even in absence of acidosis as it predicts higher arrhythmia risk which can be fatal

Sodium bicarbonate goal is pH of 7.45-755 until QRS complex duration normalizes

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15
Q

why should you never give flumazenil if someone has overdosed on benzo or TCA?

A

it can lower seizure threshold.

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16
Q

salicylate ingestion causes

A

respiratory alkalosis (stimulates central respiratory center) and uncouples oxidative phosphorylation (to create increased anion gap metabolic acidosis (due to increased lactate)

17
Q

clinical features of mild salicylate intoxication:

A

mild cases: tinnitis, fever, vertigo, nausea, vomting and diarrhea

18
Q

clinical features of SEVERE salicylate intoxication:

A

hyperthermia, noncardiogenic pulmonary edema, AMS

19
Q

acid base disturbance seen with salicylate intoxication:

A

respiratory alkalosis with or without increased anion gap metabolic acidosis

20
Q

lab changes in salicylate intoxication:

A

elevated PT, low serum uric acid level and mildly elevated LFTs

21
Q

why do we see lower serum uric acid level in salicylate intoxication?

A

decreased tubular reabsorption of uric acid

22
Q

salicylate causes increased PT time

A

stops synthesis of some vitamin K dependent coagulation factors

23
Q

diagnosis of salicylate intoxication

A

elevated plasma salicylate level

24
Q

treatment of salicylate ingestion

A
supportive care (oxygen)
try to avoid intubation because aspirin acts on respiratory center in medulla and can cause increased minute ventilation

Alkalinization of the urine with IV bicarb traps the ionic form of salicyclate acid in tubular fluid and allows for renal excretion.

Alkalinization is not a contraindicated despite the presence of alkalemia from respiratory alkalosis.

25
Q

when do we do hemodialysis for pts who have salicylate intoxication?

A

do hemodialysis with pts

  • altered mental status
  • pulmonary edema
  • renal insufficiency
  • salicylate level >100mg/dl