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DipIMC > Toxiciology > Flashcards

Toxiciology Flashcards

1
Q

What are the features of salicylate poisoning? (6)

A
  1. Increased RR
  2. Tinnitus
  3. Deafness
  4. Sweating
  5. Vasodilation
  6. Acid base disturbance
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2
Q

What metabolic disturbance do adults presenting with salicylate poisoning predominates?

A

Reps alkalosis > metabolic acidoses

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3
Q

What metabolic disturbance do children presenting with salicylate poisoning predominates?

A

Metabolic acidosis > resp alkalosis

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4
Q

What is mild salicylate poisoning and how should it be managed?

A
  1. < 300mg/L
  2. Asymp and normal VBG then home at 6 hours
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5
Q

What is moderate salicylate poisoning and how should it be managed?

A
  1. 300-700mg/L
  2. Urinary alkalization - PH 7.5-8.5 using sodium bicarbonate
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6
Q

What is severe salicylate poisoning?

A

1, CNS features, acidosis or > 700mg/L
2. Consider HD and I+V

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7
Q

What is the pathophysiology of paracetamol poisoning?

A

Metabolite of paracetamol (NAPQI) binds glutathione in the liver and causes hepatic necrosis when glutathione stores are depleted.

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8
Q

What are the features of TCA OD in conscious patients? (7)

A

Anti-cholinergic toxidrome

  1. Tachycardia
  2. Dry skin
  3. Dry mouth
  4. Dilated pupils
  5. Urinary retention
  6. Ataxia
  7. Jerky limb movements
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9
Q

What signs do unconscious patients developed following TCA OD? (7)

A
  1. Divergent squint
  2. Hypertonia
  3. Hyper-reflexia
  4. Myoclonus
  5. Upgoing plantars

If comatose - areflexia and muscle facciditiy

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10
Q

What ECG changes will be seen in TCA OD and which is the most sensitive?

A
  1. Increased QRS (most sensitive)
  2. Increased PR
  3. Tachy
  4. P waves can be lost in T - looks like VT
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11
Q

What is the tx for TCA overdose? (5)

A
  1. If under 1 hour activated charcoal
  2. 50-100ml 8.4% bicarbonate
  3. Aim PH 7.5-7.55 (excessive is fatal) and normal QRS
  4. Avoid routine use anti-arrhythmics
  5. Severe consider glucagon or intralipid
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12
Q

What is the antidote to benzo OD?

A

Flumazenil

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13
Q

How long does flumezanil last?

A

1 hour

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14
Q

What are the risks of using flumazenil and when is it particularly high risk?

A

Can lead to convulsions and arrhythmias

With concurrent TCA OD - can lead to arrest

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15
Q

What signs/symptoms feature in haloperidol + chlorpromazine (and related drugs)?

A

Oculogyric crisis
Muscle spasms - torticollis/opisthonus

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16
Q

What ECG changes will you see in haloeridol/chlorpromazine/similar drugs in OD? (2)

A
  1. Increased QRS
  2. Arrhythmias
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17
Q

What is the treatment for haloperiol/chlorpromazine OD? (3)

A
  1. Proycylidine
  2. Diazepam
  3. Bicarbonate if QRS >120ms
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18
Q

What are the features of lithium toxicity? (6)

A
  1. n/v
  2. diarrhoea
  3. ataxia
  4. confusion
  5. increased tone
  6. clonus
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19
Q

What is the treatment for lithium toxicity?

A

Supportive
Dialysis

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20
Q

What are the effects of sulfanylurea overdose?

A
  1. Low glucose
  2. Low potassium
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21
Q

What is the treatment for sulfanylurea overdose?

A

Octreotide

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22
Q

What are the features of unique to propanolol OD? (2)

A
  1. Bronchospasm in asthmatics
  2. Hypoglycaemia in children
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23
Q

What does sotalol OD cause in particular?

A

Torsades des pointes

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24
Q

What are the treatments of beta blocker OD without severe hypotension?

A
  1. Consider activated charcoal
  2. Atropine may work (pacing probably not)
  3. Glucagon 5-10mg IV (anticipate vomiting)
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25
Q

In severe beta-blocker OD with low BP what are 3 treatment options?

A
  1. High dose Insulin Euglycaemic Therapy (HIET)
  2. Intralipid
  3. Ionotropes/vasopressors
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26
Q

What are the features of CCB OD? (6)

A
  1. Bradycardia
  2. AV block
  3. Profound vasolidation
  4. Metabolic acidosis
  5. Hyperkalaemia
  6. Hyperglycaemia
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27
Q

What is the treatment for CCB OD? (3)

A
  1. Consider activated charcoal
  2. Atropine +/- pacing
  3. Calcium chloride 10% over 10 mins and consider repeating up to x 4
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28
Q

What are the treatment options for severe CCB OD? (4)

A
  1. Glucagon
  2. Intralipid
  3. HIET
  4. Vasopressors/ionotropes
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29
Q

What are the features of digoxin toxicity? (4)

A
  1. Xanthopisa- yellow flashes/discolouration
  2. Hyperkalaemia
  3. Brady, increased PR/QRS
  4. Arrhythmias
30
Q

What is the treatment for digoxin toxicity? (3)

A
  1. Digiblind/Digifab
  2. Insulin/dex for increased K+ (rapid decrease with Digibind)
  3. Atropine/pacing
31
Q

What are the biochemical changes in acute methanol poisoning? (3)

A
  1. Acidosis
  2. Hypergylcaemia
  3. Raised amylase
32
Q

What are survivors of methanol poisoning at risk of? (2)

A
  1. Blindness
  2. Parkinsonian features
33
Q

What is the treatment for methanol poisoning? (4)

A

Ethanol
Fomepizole
Folinic acid
Bicarbonate if acidotic

34
Q

What are the early (<12 hours) features of ethylene glycol poisoning?

A

Appear drunk, no smell alcohol

35
Q

What are the late features of ethylene glycol poisoning? (6)

A
  1. CCF
  2. Acidosis
  3. Tachy/arrhythmias
  4. Hypocalcaemia (can be profound)
  5. Acute tubular necrosis
  6. CN palsies`
36
Q

What are the treatment options for ethylene glycol poisoning? (5)

A
  1. Fomepizole
  2. Ethanol
  3. Sodium bicarbonate for acidosis
  4. Calcium chloride only if seizures or QTc >500 as can lead to calcium oxolate stones
  5. HD + I+V
37
Q

What can occur in petrol ingestion?

A

Can be fine but aspiration lead to severe pneumonitis requiring steroids + resp support

38
Q

What is the pathophysiology of organophosphate poisoning?

A

Inhibit cholinesterases which leads to build up of acetylcholine at nerve endings (cholinergic affect)

39
Q

What are the features of organophosphate poisoning (cholinergic toxidrome)? (8)

A

S- alivation
L - acrimation
U - rination
D - efecation
G - I upset
E - mesis
M - iosis
M - muscle twitching

Bradycardia, paralysis and resp failure

40
Q

What is the treatment for organophosphate poisoning and what is its mechanism

A

Atropine - blocks affect of acetylcholine at muscarinic receptors
Eases smooth muscle constriction and dries up secretions

41
Q

What is the atropine dose in organophosphate poisoning?

A

2mg IV adult
0.02mg/kg children
Every 5 mins double dose until atropinisation

42
Q

What is the mechanism of pralidoxime?

A

Reactivate acetylcholinesterase inhibited by organophosphates allowing metabolisation of acetylcholine.

43
Q

What can lead to cyanide poisoning? (3)

A
  1. Polyurethane burning
  2. Fruit kernels
  3. Finger polish remover
44
Q

What are the features of cyanide poisoning? (4)

A
  1. Metabolic acidosis
  2. Seizures
  3. Pulmonary oedema
  4. Arrhythmias
45
Q

What is the initial management of cyanide poisoning? (2)

A
  1. Remove clothes
  2. Wash exposed skinW
46
Q

What is the antidote for severe cyanide poisoning and what is the risk of giving it?

A
  1. Dicobalt edetate - Kelocyanor
  2. If no cyanide can be fatal
47
Q

What are the treatments for mild cyanide poisoning? (2)

A
  1. Sodium thiosulphate
  2. Sodium nitrate
48
Q

What is the best treatment for inhaled cyanide poisoning?

A

5g hyroxycobalamin IV (Cyanokit)

49
Q

What is the max dose of lidocaine?

A

3mg/kg
max 200mg

50
Q

What is the maximum dose of lidocaine with adrenaline?

A

7mg/kg
max 500mg

51
Q

What is the maximum dose of bupivicaine?

A

2mg/kg
150mg

52
Q

What is the management of LA toxicity including dose?

A

Intralipid

1.1.5mg/kg bolus and 15mg/kg/hr infusion
5 mins no response:
2. 2nd bolus and increase infusion to 30mg/kg/hr
3.Continue to 3rd and 4th bolus which is maximum

In arrest may need 1 hour for intralipid to take effect

53
Q

How are hydrofluric burns managed? (4)

A
  1. Irrigate normal saline ++
  2. Calcium gluconate gel
  3. Tx low Ca2+
  4. In arrest - 60ml x 10% calcium chloride
54
Q

What drugs can cause methaemoglobinaemia?(7)

A

benzene derivatives
chloroquine
dapsone
prilocaine
metoclopramide
nitrites (nitroglycerin, NO, sodium nitroprusside)
sulphonamides

55
Q

What are the features of methaemoglobinaemia?

A

1.cyanosis
2. symptoms and signs of decreased oxygen delivery e.g. chest pain, dyspnea, altered metal state, end organ damage
3. SpO2 reading 85-90%
4. blood samples typically have a chocolate brown hue
5. Normal PaO2

56
Q

What is the treatment for methaemoglobinaemia?

A

Methylene blue

57
Q

What is the triad of symptoms in serotonin syndrome?

A
  1. Change in mental staus
  2. Autonomic hyperactivity
  3. Neuromuscular manifestations
58
Q

What are the 3 major and 5 minor symptoms suggestive of neuroleptic malignant syndrome?

A

Major
1. Fever
2. Rigidity
3. Elevated CK

Minor
1. Tachycardia
2. Abnormal arterial pressure
3. Altered consciousness
4. Diaphoresis
5. Leucocytosis

59
Q

Describe an anticholinergic toxidrome (8)

A
  1. Altered mental status, confusion, restlessness, seizures, coma

Symptoms resulting from peripheral muscarinic receptor blockade:
2. Impaired sweat gland function
3. Dry mouth
4. Dry axillae
5. Mydriasis
6. Tachycardia
7. Flushing
8. Urinary retention

60
Q

In cases of serotonin syndrome where other management options have failed, what is the treatment?

A

Cryoheptadine

61
Q

What are the tx options for NMS? (2)

A
  1. Bromocriptine (first line)
  2. Dantrolene
62
Q

What are the commonly used drugs in ED that might cause methaemaglobinaemia? (4)

A
  1. Metoclopramide
  2. Nitrites (including ‘poppers’ and GTN)
  3. Local anaesthetics
  4. Abx including dapsone
63
Q

What level of methaemagobinaemia should be treated? (2)

A
  1. > 30% methaemaglobin
  2. Any evidence of tissue hypoxia
64
Q

If initial management of beta blocker OD with low BP doesn’t success (i.e. glucagon) what does toxbase suggest as second line?

65
Q

How is the toxicity of something calculated?

A

From the Lethal Dose 50 (LD50) = concentration required to kill 50% of exposed individuals

66
Q

How do cholinergic drugs act?

A

Class of medication that increase/mimic activity of acetylcholine and lead to parasympathetic activity increase

67
Q

Name anticholingergic medication? (7)

A
  1. Tricyclic antidepressants (amitryptyline)
  2. oxybutynin
  3. olanzepine
  4. quetiapine
  5. clozapine
  6. chlorpromazine
  7. prochlorperazine
68
Q

What type of toxidrome does Sarin gas cause?

A

Cholinergic

69
Q

Over what level does acute radiation syndrome?

A

> 0.5 Sv (Sievert)

70
Q

What are the paeds ‘one pill killers?’ (8)

A
  1. Beta blockers
  2. Calcium channel blockers
  3. Opiates
  4. Amphetamines
  5. Theophylline
  6. Sulfonyureas
  7. TCAs
  8. Chloroquines

DipIMC (15 decks)

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