Toxicology

Question 1

what are the characteristics of sympathomimentics

Answer 1

agitation, dilated pupils, diaphoresis, tachycardia, fever, hypertension.

Caused by amphetamines, MDMA, bath salts, cocaine

Question 2

What are toxic alcohols?

Answer 2

Ethylene Glycol and Methanol- create toxic metabolites when broken down by ADH and produce an anion gap acidosis that can be fatal.

Question 3

what are the signs/symptoms of ethylene glycol ingestion and how do you treat it?

Answer 3

can be deadly in one dose, toxic byproducts result in lactic acidosis with anion gap acidosis and osmolar gap. As the EG gets metabolized, the osmolar gap will normalize and the lactate and chemistry will become more abnormal.

Symptoms include hypotension, AKI hypocalcemia, coma.

Diagnosis is clinical and serum assays can be sent but usually take too long.

Treat with IV fomepizole which competes with toxic alcohols by occupying the enzyme alcohol dehydrogenase so that it is not broken down into the toxic metabolites.
Ethanol was used as a treatment prior to 1998.
Hemodialysis might be needed in severe cases of acidemia or AKI.
Pyridoxine and thiamine are adjunctive with minimal added benefit.

Question 4

what are the symptoms of isopropyl alcohol ingestion and how do you treat it?

Answer 4

It is NOT a toxic alcohol since it does not produce toxic metabolites or metabolic acidemia. It can cause an increased osmolar gap but without acidosis. It causes severe gastric irritation in addition to symptoms similar to alcohol intoxication. Massive ingestions can have hypotension and CNS depression

The isopropyl alcohol can be removed by hemofiltration for patients who are severely hypotensive, though supportive care is an option too. Cannot use fomepizole for these patients since you don’t need to prevent the toxic metabolites