Toxicology Flashcards

1
Q

First action when handling an expected ingestion

A

-ABCs
—-Vomiting, not breathing, check a pH
-SpO2/EtCO2
—When a pulse ox can steer you wrong - carbon monoxide poisoning
—-EtCO2 is a better measure, if they are not breathing, EtCO2 will increase
-EKG
-CNS - blood glucose, seizure
- Toxidromes - clues to certain ingestion
- Imaging
-Alter toxin pharmacokinetics - slow absorbsion, block the drug or increase rate of elimination

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2
Q

Options of treatment when someone ingests something

A

-Activated charcoal
—Latches onto substances and helps it out of the body and does not allow it to go into the cells or organs

-Gastric lavage - not very useful

-Whole Bowel Irrigation
—Need to drink a gallon of Go Lytely
—Usually do this if you have swallowed packages of drugs that are wrapped
—Also good for long acting drugs like Lithium

-Hemodialysis
—Poisonous alcohol
—Tricyclics

Labs

EKG

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3
Q

Symptoms of cholinergic drugs

A

i.e. Donepizil
SLUDGE

Salivation
Lacrimation
Urination
Diarrhea
Gastro
Emesis

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4
Q

Symptoms of anticholinergic drugs

A

Benadryl, Atropine, Benztropine

Blind as a bat
Mad as a hatter
Dry as a bone - Can’t pee
Red as a beet
Tachycardia

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5
Q

EKG changes in different toxic ingestions
Brady arrhythmias?
Tachyarrhythmias?
Long QTc?
Wide QRS?
ST elevations?
Osborn wave?

A

Bradyarrhythmias
-Digoxin, CCB, beta blockers, clonidine

Tachyarrhythmias
-Stimulants, TCAs, cholinergics

Long QTC
-Antipsychotics, SSRI, TCA, antifungals, Zofran

Wide QRS
-TCA, benadryl, cocaine, lidocaine

ST elevations
- cocaine, amphetamines

Osborn wave (notched right after the S before the T)
-hypothermia

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6
Q

Tylenol OD: Time of onset, pathophys

A

Rapidly absorbed within 4 hours of taking it
—Should therefore obtain tylenol level at 4, 8, 12 hours

Upper limit of normal is 4g in 24 hours
—Tylenol level of 150

Breaks down into toxic metabolite NAPQI
Normally there is enough glutathione to break it down and metabolize it appropriately in the liver but in overdose, it runs out of glutathione

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7
Q

Tylenol OD: medications for treatment

A

N-Acetylcysteine (Mucomyst)
-Oral every 4 hours or IV loading dose and then 2 additional doses
-Will definitely need antiemetics
-NAC replaces glutathione to help break down NAPQI
-Might help reverse liver failure

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8
Q

Features of digoxin overdose and treatment

A

Digoxin decrease the rate of depolarization and conduction through the SA and AV nodes

Digoxin toxicity causes lethargy, confusion, weakness, abd pain, n/v

Obtain Digoxin level 6 hours after last dose

Likely will see hyperK and Salvador Dali wave on EKG

Treat with Activated Charcoal and Digiband - Dig Fab

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9
Q

Features of toxic alcohol poisoning

A

Visual disturbances, GI bleed, pancreatitis, vomiting

Will see increase in osmolal gap and metabolic acidosis

Give ethanol or fomepizole and plenty of IVF

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10
Q

What are most overdoses treated with?

A

Supportive care

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11
Q

Salicylate intoxication: Symptoms and treatment

A

Aspirin overdose

Symptoms do not usually start for several hours after ingestions

Symptoms:
N/v
Tinnitus, dizziness, headache
Dehydration
Hyperthermia
Apnea, cyanosis, metabolic acidosis
Elevated LFTs

Treatment:
Activated charcoal
Sodium bicarb IV to correct severe acidosis

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12
Q

Organophosphate (Insecticide) Poisoning: Symptoms and Treatment

A

Symptoms:
N/V/D
Excessive salivation
Headache
Blurred Vision and miosis
Bradycardia
Mental confusion

Management:
If external - wash skin thoroughly
If internal - activated charcoal

Should keep atropine close by because of bradycardia

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13
Q

Treatment of a patient with serotonin syndrome

A

Dantrolene Sodium

Klonopin to treat rigors and agitation

Cooling blankets to control temp

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14
Q

Symptoms and Treatment of beta-blocker OD

A

Symptoms:
Hypotension
Sinus bradycardia
Delirium
Bronchospasm

Treatment:
Charcoal if appropriate - if recent
Glucagon - if more than 4 hours ago
Atropine, as needed
Stabilization of airway

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15
Q

Symptoms and treatment of ethylene glycol overdose

A

Symptoms:
First stage (30 mins - 12 hours)
—Loss of coordination
—Headache
—Slurred Speech
—N/V

Second stage (12-24 hours)
—Irregular heartbeat
—Shallow breathing
—Changes in blood pressure

Third stage (24-72 hours)
—Kidney failure

Treatment:
Fomepizole (Antizol)
Ethanol if fomepizole is not available

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