Toxicology

Question 1

History

Answer 1

History
Risk Assessment •  Agent(s) •  Dose ingested mg/kg •  Time •  Co-ingesOons •  Clinical feature and progression •  PaOent’s factors ( weight, comorbidity&
allergy)

Question 2

Risk assessment

Answer 2

Toxic dose of paracetamol in children more than 200 mg/kg or more than 10 g /d

** use pediatric dose until age 12 or wt > 50 kg

Question 3

ExaminaOon

Answer 3

ExaminaOon
•  Level of consciences •  Vital signs •  Head to Toe (e.g pupils, smell, skin, GI,
reflexes) •  Toxidromes

Question 4

AnOcholinergic Toxidromes

Answer 4

increased body temperature

mydriasis (dilated pupils)

dry skin, dry mouth

flushed skin

delirium
Decrease Peristalsis + urinary retention

Question 5

Approach

Answer 5

Approach
•  Airway, Breathing and CirculaOon
•  Detect and Correct - Seizure - Hypoglycemia - Hyper/Hypothermia
•  Emergency anOdotes administraOon

Management Principles
•  SupporOve care •  DecontaminaOon •  Administer AnOdote •  Enhance eliminaOon - AlkalizaOon of urine (Salicylate) - Dialysis (EXTRIP guidelines)

Question 6

Hypotension

Answer 6

Hypotension
•  Fluid boluses - 20ml/kg Normal Saline
•  Vasopressors - nor-epinephrine - epinephrine
•  High dose insulin and glucose

Question 7

Seizure

Answer 7

Seizure
Very Common •  Benzodiazepine •  Phenobarbital •  Pyridoxine (Vit B6)
•  Not phenytoin

Question 8

AcOvated charcoal

Answer 8

AcOvated	charcoal		
•  Dose	0.5-1g/kg		max	50	g		
•  10:1	Charcoal:	toxins		
•  With	in	1-2	hours	of	ingesOon		
•  It	prevents	absorpOon	of	toxins		
Don’t	give	acOvated	charcoal		
CHEMICAL	Or	high	risk	for	seizure/	altered	LOC		 CausOcs	 Hydrocarbons	 Electrolytes	(e.g	K	&	Ca)	 Metals		 Iron	 Cyanide	 Alcohol	 Lithium

Question 9

DecontaminaOon

Answer 9

AcOvated charcoal
Gastric lavage

WBI# whole bowel irrigation
Syrup of ipecac

Question 10

IndicaOons for Defuroxamine

In iron toxicity

Answer 10

IndicaOons for Defuroxamine
•  Metabolic acidosis •  RepeOOve vomiOng •  Hypotension •  Signs of shock •  Considered for concentraOon above 90μmol/l

Question 11

Management of paracetamol

Answer 11

Supportive ABCDE
Charcol
AnOdote: Start 21 H IV NAC protocol:
– 150 mg/kg over 1 H
– 50 mg/kg over 4 H
– 100 mg/kg over 16 H •  Repeat APAP, LFTs, INR, and creaOnine before
the end of the infusion •  Psychiatry assessment

indicators of prognosis?
•  Dose ingested
•  Time to NAC (Time is LIVER) ما نعطي قبل اربع ساعات
•  Presence of detectable APAP at the Ome of
raise of transaminases