Toxicology

Question 1

3 cardinal features of serotonin syndrome

Answer 1

1. Autonomic stimulation - hyperthermia, tachycardia
2. Mental status changes- restlessness, agitation
3. Neuromuscular excitation - hyper reflexia, myoclonus

Question 2

Different agents causing serotonin syndrome

Answer 2

1. SSRIs- fluoxetine, paroxetine, sertraline, citalopram
2. Monoamine oxidase inhibitors- moclobemide,
3. SNRIs- venlafaxine
4. Analgesics - tramadol , pethidine, fentanyl, methadone
5. lithium
6. Recreational drugs- ecstasy, MDMA, methamphetamine
7. Herbal preparation - St John wort
8. Tryptophan

Question 3

Antidote for serotonin syndrome

Answer 3

Cryptohepdatine 8mg PO/ NGT

Question 4

Multiple dose charcoal - agent responsive:

Answer 4

1. Antimalarials (quinine), aminophylline (theophylline),
2. Barbiturates ( phenobarbital),
3. Carbamazepine
4. Dapsone

Question 5

Agents don’t bind to charcoal

Answer 5

1. Pesticides
2. Heavy metals - lead
3. Acids/ alkali/ alcohol - ethylene glycol
4. Iron
5. Lithium
6. Solvents

Question 6

Ingestions for hemodialysis

Answer 6

1. Phenobarbital
2. Lithium
3. Acidosis
4. Salicylates
5. Metformin
6. Alcohols
7. Theophylline
8. Valproic acid

Question 7

Determine pts envenomed

Answer 7

1. History/ symptoms- collapse, N&V, bleeding, weakness , bleeding from site
2. Signs- vitals- hypotension, lymphadenopathy, symmetrical flaccid paralysis (ocular, small muscle of face & bulbar function affected 1st) , mental status
3. Coagulation profile - INR, APTT, fibrinogen, D dimer, FBE, CK, renal function, urinanalysis (blood/ myoglobin), LDH