Toxic ingestion Flashcards
severity of caustic esophageal injury depends upon
the ingested substance corrosive properties, amount and concentration, alkali ingestion
alkali ingestion can cause
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
presentation of caustic esophageal ingestion
dysphagia, odynophasia, retrosternal pain, vomiting, and occasional hematemsis
management of alkali ingestion
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
long term side effects of alkali ingestion
15-20 years heed to have routine screening for esophageal cancer,
esophageal strictures
role for NG tube after caustic ingestion
no as it can lead to perforation
role for ingestion of weak acid after alkali ingestion?
no because damage is instantaneously
Toluene solvent inhalation pathophysiology
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.
Toluene solvent inhalation treatment
supportive care with IVFs and repletion of electrolytes
Tricyclic antidepressant (TCA) overdose can manifest with
respiratory depression, hypotension, tachycardia, sedation, seizures and coma and death
Anticholinergic toxicity with diphenhydramine and amitriptyline is
hyperthermia, flushing, mydriasis, delirium and urinary retention
sertraline overdose leads to
serotonin syndrome (hyperreflexia, seizures, fever, autonomic instability and AMS)
doesn’t affect heart commonly
Lorazepam overdose causes
delirium sedation, respiratory depression and may need intubation
what to look for in TCA overdose?
How to treat the finding? how to monitor that goal?
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
why should you never give flumazenil if someone has overdosed on benzo or TCA?
it can lower seizure threshold.