Toxic ingestion

Question 1

Antifreeze and fluorescein

Answer 1

Antifreeze contains fluorescein to help identify radiator leaks.

This is also useful clinically! You can make the diagnosis of ethylene glycol poisoning with a Wood’s lamp on the urine.

Question 2

Methanol can be a byproduct of ___

Answer 2

Methanol can be a byproduct of moonshine

So, home-made moonshine drinkers may present with methanol poisoning: AG metabolic acidosis with osmolar gap and/or gradual blindness.

Question 3

Acetominophen toxicity

Answer 3

• Acute fulminant hepatitis
• Toxic dosage: More than 2g/day chronically or more than 3g acutely
• Dx: Acetominophen level at 4h and 16h of ingestion, compare to nomogram. If you are thinking transplant, calculate a MELD-Na.
• Tx: If above nomogram line, give NAC. If below, observe. If liver failure, transplant.

Question 4

Salicylate toxicity

Answer 4

• Aspirin toxicity, typically
• Early symptoms: Tinnitus, N/V, vertigo, primary respiratory alkalosis (due to effects on medullary respiratory controller)
• Late disease: Anion gap metabolic acidosis, obtundation/coma, may have hyperpyrexia (very high fever, >106 F)
• Dx: Salicylate level
• Tx: Alkalinization of urine to facilitate elimination + pharmacologic diuresis.

Question 5

When you suspected carbon monoxide, you should also suspect . . .

Answer 5

. . . cyanide

Both are products of smoke inhalation, and they tend to go together.

Question 6

Two scenarios where you want to suspect cyanide toxicity

Answer 6

1. Nitroprusside administration > 24 hours or even less for someone with impaired kidney function
2. Smoke exposure, along with carbon monoxide

Question 7

“Cherry red skin” or “Cherry red blood” on ABG

Answer 7

Indicates cyanide

Question 8

Diagnosis and Tx of cyanide toxicity

Answer 8

• Dx: Clinical
• Tx: Thiosulfate OR amoylnitrate
  
  • Most of the time, thiosulfate will be right answer, and if you have to choose between them it certainly is.
  • Amyolnitrate can precipitate methemoglobinemia, which can exacerbate carbon monoxide poisoning. So amoylnitrate should NEVER be used to treat suspected cyanide poisoning if the cyanide poisoning was caused by smoke. For nitrporusside cases, it is fine.

Question 9

The Alcohol Tox Table

Answer 9

• RF = renal failure

Question 10

Organophosphate toxicity

Answer 10

• Etiology: Contact w/ pesticides or stigmine overdose
• Symptoms: (SLUDGE)
  
  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • GI upset
  • Emesis
• Dx: Clinical
• Tx: Atropine + pralidoxime.
  
  • Atropine blocks muscarinics, pralidoxime helps displace organophosphates.