Toxicology

Question 1

Top 2012 Toxic Exposures

Answer 1

1. Analgesics
2. Cosmetics, Personal Products
3. Household Cleaning Solution
4. Sedatives, Hypnotics, Antipsychotics
5. Foreign Bodies
6. Topical Preparations
7. Cardiovascular Drugs
8. Antihistamines
9. Pesticides

Question 2

Hypothermia

Answer 2

Opiates, sedatives, and alcohol ingestions.

Question 3

Hyperthermia

Answer 3

Salicylates, anticholinergics, and amphetamines.

Question 4

Tachycardia

Answer 4

Anticholinergics, antihistamines, sympathomimetics, and tricyclic antidepressants.

Question 5

Bradycardia

Answer 5

Beta-blockers, calcium channel blockers, and clonidine ingestions.

Question 6

Tachypnea

Answer 6

Direct pulmonary insult or noncardiogenic pulmonary edema or as a compensatory mechanism in the setting of metabolic acidosis.

Question 7

Respiratory Depression

Answer 7

Clonidine, opiates, or sedative-hypnotic ingestion.

- Especially in young children.

Question 8

Hypotension

Answer 8

Tricyclic antidepressants, beta-blockers, calcium channel blockers.

Question 9

Salicylates

Answer 9

Stimulates the respiratory center in the brainstem, limiting ATP production, causing accumulation of pyretic and lactic acid resulting in mixed respiratory alkalosis with compensatory metabolic acidosis.

S/S: GI upset, vomiting, hyperexia, dysarthria, seizures, respiratory depression, coma, cerebral edema, hyperglycemia, hyperkalemia, metabolic acidosis, coagulopathy.

Tx: Check salicylate levels every 2 hours, monitor electrolytes, gastric lavage up to 4 hours after ingestion.

• Activated charcoal.
• Hemodialysis, if indicated.

Question 10

Anticholinergics

Answer 10

Atropine, Belladonna, Alkaloids, Mushrooms, Scopolamine, TCAs.

“Mad as a hatter, red as a beet, blind as a bat, hot as a hare, dry as a bone.”
- Depressed mental state, confusion, psychosis, fever, agitation, seizures, coma, normal DTRs.

S/S: Irritability, dry skin, flushing.

Tx: Antidote is physostigmine.
- Activated charcoal if < 8 hours since ingestion.

Question 11

Acetaminophen

Answer 11

Can cause liver failure and loss of liver function.

S/S: Anorexia, pallor, vomiting, diaphoresis, or no symptoms!

Tx: Based on timing of ingestion and Tylenol serum levels.
- IV N-Acetylcysteine (NAC)

Question 12

Benzodiazepines

Answer 12

Half life can be long or short, cause coma, confusion, agitation, bradycardia, hypotension, respiratory depression.

S/S: Depressed mental status, CNS depression, normal pupils, hyporeflexia.

Tx: Charcoal if within 1 hour, supportive care, respiratory support, IV fluids.

Question 13

Opioids/Narcotics

Answer 13

Confusion, lethargy, euphoria, somnolence, seizures, ataxia.

S/S: Pupillary constriction, normal DTRs or hyporeflexia, lethargy.

Question 14

Calcium Channel Blockers

Answer 14

Seizures, coma, dysarthria, lethargy, hypotension, peripheral vasodilation, apnea, pulmonary edema, hyperglycemia, mild hyperkalemia, flushing, cyanosis.

S/S: May develop hours after ingestion.

Tx: EKG, cardiac monitoring, respiratory support, gastric lavage.
- Antidote is calcium salts and IV calcium chloride.

Question 15

Clonidine (Patch or Tablet)

Answer 15

CNS depression, coma, lethargy, profound hypotension.
- Small ingestions can cause significant toxicity.

S/S: Lethargy, hypotension, bradycardia, respiratory depression.

Tx: Activated charcoal, whole bowel irrigation for clonidine patch ingestion, supportive care.
- Can last up to 24 hours.

Question 16

Hypoglycemics

Answer 16

Cause severe delayed hypoglycemia with possibility of seizures, status epilepticus.
- Metformin causes metabolic acidosis.

S/S: Fatigue, dizziness, confusion, tachycardia, cardiac compromise, diaphoresis.

Tx: Hourly glucose checks, hypertonic 10% glucose solution, octreotide.