Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PEM Lectures dirigées > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Initial naloxone dose for young/opioid naive children

A

0.1mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Initial naloxone dose for adolescent/at risk of withdrawal

A

0.04mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Maximal therapeutic dose acetaminophen

A

Children - 90mg/kg/d
Adults - 4g/d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Toxic dose acetaminophen

A

150mg/kg in < 24hrs
10g in < 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the toxic metyabolite of acetaminophen that causes hepatotoxicity?

A

NAPQI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What produc detoxifies NAPQI?

A

glutathione

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does NAC work?

A

= glutathione precursor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the stages of acetaminophen toxicity?

A

Stage 1 - 0.5-24hrs post-ingestion. Asymptomatic or GI symptoms, possible ALOC and elevated anion gap acidosis

Stage 2- 24-72 hours. Hepatotoxic signs with RUQ pain, possible AKI but improvement of GI symptoms

Stage 3 - 72-96hrs. Fulminant hepatitis with return of GI symptoms, possible encephalopathy, metyabolic acidosis, AKI, coagulopathy, possible multisystem dysfunction and death

Stage 4 - 4d-2wks. Recuperation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If patient comes in with ingestion > 8hrs ago or unknown time, how do you manage?

A

Start NAC immediately and refer to nomogram once results available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the criteria for being able to use the nomogram?

A

Single ingestion or over < 8hrs
bloodwork done 4-24hrs post-ingestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are indications for use of NAC?

A

APAP > 66
Abnormal transaminases (do at least 2 checks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When can NAC treatment be stopped?

A

If APAP dose not toxic based on nomogram
At end of treatment if acetaminophen negative and normal transaminases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are secondary effects of NAC?

A

elevated INR
flushing
urticaria
angioedema
dyspnea/hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the therapeutic dose of activated charcoal?

A

1g/kg, max 50g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you consider more than one dose of activated charcoal?

A

large quantity of ingested pills, especially if salicylate
ingestion of substance that slows gastric emptyin
extended release pill
enterosoluble pill
blood concentration of substance continues to increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are contraindications to use of charcoal?

A

lithium, heavy metals, alcohols
inadequate protection of airways
intestinal occlusion
ingestion of corrosive substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What substances warrant repeated charcoal doses?

A

theophylline, caffeine, phenobarbital, carbamazepine, dapsone, quinine, amatotoxine (mushrooms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the doses for repeated activated charcoal?

A

1g/kg q4h or 0.5g/kg q2h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What bloodwork should be done if not able to get history in comatose/ALC patients?

A

CBC, uric acid, Cr, lytes, transaminases, gas, serum osmolality, EtOH, ECG, APAP/ASA dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the calculation for anion gap?

A

Na - (Cl + HCO3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the substances that cause elevated anion gap metabolic acidosis

A

Methanol
Uremia
Diabetic ketoacidosis (DKA)

Paraldehyde, phenformin;
Iron, isoniazid
Lactic (ie, carbon monoxide [CO], cyanide)
Ethylene glycol
Salicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you calculate osmolality?

A

2Na + Glucose + BUN (2 salts and a sugar bun)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a normal osmolar gap value?

A

< 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What toxins cause elevated osmolar gap?

A

Ketones
Alcohols**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What anti-arhythmic medication should be avoided in cases of toxic OD?

A

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the electrolyte-channel associated with enlarged QRS?

A

Sodium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the electrolyte-channel assoiciated with prolonged QTc?

A

Potassium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

In what toxidromes should beta-blockers be avoided?

A

sympathomimetic, anticholinergic, serotoninergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What drug should be dosed + consider administration of its antidote in tachycardia?

A

digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What substances are sodium channel blockers?

A

quinine
procainamide
TCA
lidocaine
phenytoine
local anesthetics
cocaine
chloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you treat widened QRS caused by sodium channel blockers?

A

Sodium carbonate 1-2mmol/kg IV in 1-2 mins
Repeat until QRS < 100 or until BP stabilized and ECG normal

OR

Try NaCl 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What substances cause long QTc/torsades de pointe by Potassium cannel blockers?

A

sotalol etc
macrolides
psychotropic meds
methadone
domperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you treat long QTc/torsades de pointe caused by Potassium cannel blockers?

A

Magnesium sulfate 1-2g IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the symptoms of anticholinergic toxidromes?

A

DRY
Delirium/agitation/hallucinations
Mydriasis
Hypertension
Tachycardia
Tachympia
Possible urinary retention
Hyperthermia
Redness
Hyperreflexia/trembling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the symptoms of Cholinergic toxidromes? (Muscarinic)

A

WET

  • delirium/depression
  • Myosis
  • Salivation + tearing
  • Hypotension
  • Bradycardia
    Bronchospasm
    Increased GI motility
    Incontinence
    Vomiting/cramps/diarrhea
    Diaphoresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Cholinergic (nicotinic) toxidrome?

A

WET
mydriasis
hypertension
tachycardia
fasciculations
weakness
hyper then hyporeflexia + paresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Sympathomimetic toxidrome

A

delirium/agitation
mydriasis
hypertension
tachycardia
tachypnea
no GI/Urinary symptoms
hyperthermia
diaphoresis
hyperreflexia
trembling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Opioid toxidrome

A

confusion/somnolence
myosis
hypotension
bradycardia
bradypnea
hypothermia
hyporeflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Serotoninergic toxidrome

A

delirium/agitation
mydriasis
hypertension
tachycardia
tachypnea
increased GI peristalsis
hyperthermia
diaphoresis
clonus
hypertonia
hyperreflexia
tremors
bruxism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Examples of methanol-containing toxins

A

fondue liquid
anti-freeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Lab findings in methanol + ethylene glycol poisoning

A

starts with elevated osmolar gap
then elevated anion gap
metabolic acidosis (methanol = elevated formic acid, ethylene glycol = oxalic acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Antidotes to methanol + ethylene glycol poisoning

A

Fomepizole
Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How much methanol can cause significant intoxication

A

0.25ml/kg
4-10 mL can cause permanent blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the clinical symptoms of methanol poisoning?

A

GI symptoms - nausea, vomiting, anorexia, abdo pain, pancreatitis
neurologic symptoms - depression, headache, compa, convulsions, cerebral edema, possible basal ganglia effects
Visual disturbance - “snowstorm”, central scotoma, papilledema
Tachycardia, hypotension
Tachypnea initially followed by respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are examples of ethylene glycol containing toxins?

A

antifreeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Toxic quantity of ethylene glycol

A

0.2ml/kg
1-1.5ml/kg = lethal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Clinical symptoms of ethylene glycol poisoning

A

GI - nausea, vomiting, ado pain
Neuro - depression, seizure, cerebral edema, coma, polyradiculopathy, IC hemorrhage
Renal - AKI, oxaluria, hypocalcemia, tetany
Leucocytosis, hyperglycemia
tachycardia
QTc prolongation
CHF
tachypnea then resp failure
pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What labs need to be done for toxic alcohol poisoning?

A

Concentration 1.5-2hrs post ingestion then repeat q 4-8hrs
CBC, Electrolytes inc Ca, BUN. Cr, glycemia, hepatic enzymes, lipase, troponin, CK
EtOH, serum osmolality, gas, lactate

ethylene glycol - UA looking for calcium oxalate crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Products containing isopropanol

A

rubbing alcohol, solvants, some antifreeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Lab changes in isopropanol poisoning

A

elevated Ketones
Elevated osmolar gap
NO metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Clinical symptoms of isopropanol poisoning

A

Fruity breath (acetone)
CNS depression
nausea, vomiting, abdo pain
hemorrhagic gastritis
acute pancreatitis (rare)
Severe - coma, hypotension, hypothermia, arhythmias, AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Labs to do for suspected isopropanol poisoning

A

CBC, Lytes, BUN, Cr, glucose
Hepatic enzymes, lipase
concentration of isopropanol and acetone (metabolizes to acetone)
other alcohols
ketones
blood gas
serum osmolality
UA - ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Treatment for isopropanol poisoning

A

symptomatic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Indications for use of Fomepizole

A

Methanol > 6mmol/L
Ethylene glycol > 3mmol/L
Metabolic acidosis with osmolar gap > 10 without clear reason
false hyperlactatemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Dose of fomepizole

A

15mg/kg IV over 30 mins
12 hrs later give 10mg/kg iV over 30 mins - repeat q12h x 4 doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When can fomepizole be stopped?

A

resolution of metabolic acidosis
methanol < 6 mmol/L or ethylene glycol < 3 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What adjunct treatments can be given in methanol poisoning?

A

leucovorin (folic acid) 1mg/kg/dose IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What adjunct treatment can be given for ethylene glycol poisoning?

A

Pyridoxine 50mg q6h + thiamine 100mg IV q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are indications for hemodialysis in methanol poisoning?

A

visual symptoms
coma
seizures
methanol > 15-22
pH < 7.15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are indications for hemodialysis in ethylene glycol poisoning?

A

AKI
EG > 8
pH < 7.15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is a possible systemic toxic effect of OD of local anesthetics?

A

Methemoglobinemia - topical and oral use of benzocaine

CNS - tinnitus, dizziness, lingual/peribuvval numbness, visual changes, hearing changes, confusion, tremor, seizures, coma

CV (higher concentrations) - shock, vascular collapse, sodium channel block

62
Q

What local anesthetic is most cardiotoxic?

A

Bupivacaine

63
Q

What is the antidote for local anesthetic OD?

A

Intralipids

64
Q

What medications have anticholinergic effects?

A

atropine
scopolamine
glycopyrrolate
TCAs
antihistamines
antipsychotics
antispasmodics
antiparkinsoniens (benztropine)
muscle relaxants
anticonvulsants - carbamazepine
belladonna plant

65
Q

What labs need to be done for anticholinergic ingestion?

A

Cardiac monitoring
CK - if agitation, convulsion, compa
Lytes, BUN, Cr
UA - myoglobinuria if suspected rhabdomyolysis

66
Q

What is the antidote for anticholinergics?

A

Physostigmine
- only if pure anticholinergic ingestion, severe and refractory to other treatments
Dose 0.02mg/kg (max 0.5mg) IV max rate 1mg/min
Can repeat q 10-30 mins - max 2mg cumulative dose

67
Q

What is a contraindication to physostigmine use?

A

evidence of sodium channel block

68
Q

Symptoms of TCA overdose

A

Antihistamine - Sedation
Anti-muscarinic - agitation, hallucinations, delirium, tachycardia, hyperthermia, mydriasis, dryness, ileus, urinary retention
Alpha adrenergic - hypotension, reflex tachycardia
Diaphoresis, tachycardia
Serotonin syndrome
Sodium channel blocker - large QRS, brugada, seizures
Potassium channel blocker - QTc prolongation
GABA antagonists

69
Q

What is the best prognostic parameter to prognosticate risk of arrhythmia and seizure in TCA intox?

A

ECG - R wave in aVR > 3mm

70
Q

Treatment of TCA overdose

A

Consider if in cardiogenic shock. If yes, will respond well to NaHCO3 administration
If large QRS give 1-2mmol/kg IV of NaHCO3 boluses
- goal = pH 7.45-7.55

71
Q

What medications are “one pill killers”?

A
  • benzocaine – methemoglobinemia and seizures
    • β-blockers – bradycardia, hypotension, seizures
    • calcium channel blockers - bradycardia, hypotension
    • camphor – seizures, CNS depressant
  • chloroquine – seizures, arrhythmia
  • clonidine – bradycardia, CNS depression
  • diphenoxylate/lomotil – CNS and respiratory depression
  • hypoglycemics (sulfonylureas) – hypoglycemia
  • Lindane – seizures, CNS depression
  • methyl salicylate (oil of wintergreen) – seizures, CVS collapse
  • phenothiazines – seizures, arrhythmia
  • quinidine – seizures, arrhythmia
  • theophylline – seizures, arrhythmia
  • TCAs – Seizures, CVS collapse, hypotension
72
Q

What medication does oleander ingestion mimic?

A

digoxin

73
Q

What are the signs of oleander toxicity?

A

vomiting, diarrhea, abdominal pain, weakness, confusion, hyperkalemia, and bradyarrhythmias, especially high grade atrioventricular block

74
Q

What are the signs of hemlock toxicity?

A

spontaneous vomiting within 1 hour. Salivation, headache, fever, mental confusion, and muscular
weakness may follow, and the child may deteriorate to convulsions, coma, and death from respiratory failure.

75
Q

what is the toxidrome of jimsonweed toxicity?

A

anticholinergic

76
Q

Antidotes for the following med classes:
Acetaminophen
Antichoninergic
Anticholinesterase
Organophosphates
Benzos
Beta blockers
Calcium channel blockers
Digitalis
Fluoride
Iron
Isoniazid
Methanol/ethylene glycol
Methemoglobinemia
Opoioids
Sulfonylureas
TCAs
Warfarin

A

Acetaminophen - NAC
Antichoninergic - Physostigmine
Anticholinesterase - atropine
Organophosphates - pralidoxime
Benzos - flumazenil
Beta blockers - glucagon
Calcium channel blockers - CaCl or CaGluconate + insulin/glucose
Digitalis - digibind
Fluoride - calcium gluconate
Iron - deferoxamine
Isoniazid - pyridoxine
Methanol/ethylene glycol - fomepizoe, ethanol, folate, thiamine
Methemoglobinemia
Opioids - naloxone
Sulfonylureas - octreotide
TCAs - sodium bicarb
Warfarin - vit K

77
Q
A
78
Q

Possible side effect of repeated doses of succinylcholine

A

*bradycardia
Hypotension
Arrhythmia
MI
Prolonged paralysis
Hyperkalemia and ventricular arrhythmias in patients in catabolism or with muscular trauma

79
Q

Stages of ethylene glycol poisoning

A

Stage 1 CNS – profound metabolic acidosis, tachycardia, mild HTN, leukocytosis, nausea/vomiting, convulsions + coma, hypocalcemia

Stage 2 Coma + cardiopulmonary failure – result of acidosis

Stage 3 Renal failure – ATN requiring dialysis

80
Q

What are the final toxic products in the metabolism of ethylene glycol?

A

Glycoaldehyde, glycolic acid, oxalate

81
Q

What chemicals should not be immediately irrigated?

A

Dry lime
Elemental metals
Phenol

82
Q

Side effects of physostigmine

A

seizures
asystole
cholinergic crisis

83
Q

3 antidotes for methanol

A

ethanol
folate
fomepizole

84
Q

Meds that are dangerous to toddlers in 1-2 doses

A

benzocaine
betablockers
calcium antagonists/calcium channel blockers
camphor (eg. vicks vapo rub)
chloroquine
clonidine
lomotil
glyburide
lindane
methyl salicylate
opioids
chlorpromazine
quinidine
quinine
theophylline
TCAs

85
Q

5 stages of iron toxicity

A

Stage 1 (0-6h) - GI symptoms, if severe can have GI bleeding
Stage 2 (6-24h) - latent, no GI sx, lethargy, tachycardia, metabolic acidosis
Stage 3 (24-72h) - shock, GI hemorrhage, coagulopathy, worsening metabolic acidosis, convulsion, coma
Stage 4 (2-3d) - hepatic failure
Stage 5 (long term) - intestinal stenosis, scarring, pyloric stenosis

86
Q

Indications for deferoxamine

A

ingestion > 40mg/kg of elemental iron with GI symptoms or lethargy
Iron > 90 micromol/L OR
iron > 63micromol/L with CV symptoms or metabolic acidosis

87
Q

Starting dose of deferoxamine

A

15mg/kg/hr

88
Q

When can deferoxamine treatment be stopped?

A

decontamination is done
no more symptoms
no more lactic acidosis

89
Q

side effects of deferoxamine

A

urticaria or erythema
hypotension
ARDS
RED/PINK URINE

90
Q

TCA clinical findings in OD

A

sedation or agitation
hallucinations/delirium
tachycardia
hyperthermia
mydriasis
dry mouth/skin
ileus
urinary retension
hypotension
QRS prolongation, brugada
seizures
QTc prolongation

90
Q

Most accurate way to predict arrhythmogenic and convulsive risk in TCA overdose

A

ECG shows R in aVR > 3mm

91
Q

Labs in TCA OD

A

lytes, BUN, creatinine, hepatic enzymes, CK
lactate, gas
Urinalysis for myoglobinuria

92
Q

Signs of mild to moderate bupropion toxicity

A

tachycardia and hypertension
agitation
dizziness
tremors
paresthesias
lethargy
confusion
seizures

93
Q

Signs of severe bupropion toxicity

A

hyperthermia
hypotension
QRS prolongation
QTc prolongation
ventricula arrhythmias
status epilepticus
coma

94
Q

How long does patient with toxic ingestion of bupropion need to have ECG monitoring?

A

18-20 hours post ingestion if asymptomatic or minimum 12h post end of symptoms

95
Q

Symptoms of IMAO toxicity

A

hyperthermia
nausea/vomiting/diarrhea
mydriasis
ocular clonus
redness
diaphoresis
headache
delirium
neuromuscular symptoms
hypertension initially followed by hypotension
possible MI

96
Q

which SSRI is at risk of causing late-presenting torsades de pointes/

A

citalopram

97
Q

How long does ECG monitoring need to continue for citalopram or escitalopram ingestion?

A

24hrs minimum

98
Q

How long does clinical monitoring need to continue for SSRI ingestion?

A

18-20 hours post ingestion if asymptomatic or minimum 12h post end of symptoms

99
Q

Mirtazipine toxicity clinical signs

A

tachycardia
dizziness
altered LOC
hypothermia
dry mouth
constipation
elevated transaminases
QRS prolongation

100
Q

Trazodone toxicity clinical signs

A

lethargy
dizziness
myoclonus
ataxia
seizures
nausea/vomiting
respiratory depression
hypotension
bradycardia
mydriasis
priapism
hyponatremia
hypokalemia

101
Q

Venlafaxine + Duloxetine toxicity

A

seizures
altered LOC
nausea/vomiting
tachycardia
hypotension
diaphoresis
hyperthermia
QRS and QTc prolongation
hyponatremia
rhabdomyolysis
transaminitis

102
Q

Clinical presentation of neuroleptic malignant syndrome

A

hyperthermia
rigidity (cogwheel)
altered LOC
autonomic instability - tachycardia, diaphoresis, hypersalivation, incontinence, irregular respiration, arrhythmia, hyper or hypotension
leucocytosis
rhabdomyolysis
myoglobinuria
AKI

102
Q

Risk factors for neuroleptic malignant syndrome

A

recent initiation of antipsychotic medication or dose increase
young age
male
dehydration
co-treatment with lithium
combination of multiple agent
rapid dose increases

103
Q

Betablocker toxicity

A

decreased contractility
bradycardia
confusion
altered LOC/coma
nausea/vomiting
bronchospasm
hyperkalemia
pulmonary edema
HypOglycemia

104
Q

Which betablocker can cause torsades de pointe?

A

sotalol

105
Q

Calcium channel blocker toxicity

A

vasodilation of arteries
decreased contractility
bradycardia
confusion
altered LOC/coma
nausea/vomiting
pulmonary edema
HypERglycemia

106
Q

Indications for pralidoxime use in cholinergic toxicity

A

presence of nicotinic signs or CNS signs with only an organophosphate or mixed with carbamate insecticide

107
Q

Acute digoxin intoxication

A

nausea + vomiting*
hyperkalemia (marker of severity in acute ingestion)
bradycardia, AV block, VT/VF
lethargy
comfusion
weaknessA

108
Q

Chronic digoxin intoxication

A

predominant neuro symtoms - delirium, comfusion, somnolence, hallucinations, photophobia, blurred vision, scotoma, chromatopsy (seeing yellow haloes)
GI symtpoms
Electrolyte abnormalities secondary to chronic renal insufficiency
bradycardia
slow AF
AV block
bigeminy/trigeminy
VT

109
Q

Pathognomonic arrhythmia for chronic digoxin intoxication

A

Bidirectional ventricular tachycardia

110
Q

When should digoxin levels be drawn

A

6hrs post ingestion

111
Q

What is the antidote for digoxin intoxication?

A

Digoxin-specific antibody antigen-binding fragments (DSFab)

112
Q

Indications for use of Digoxin-specific antibody antigen-binding fragments (DSFab)

A

symptomatic and progressive bradyarrhythmia
2nd or 3rd degree AV block resistant to atropine
tachycardia or Vfib
Digoxin level > 12.8 6hrs+ post ingestion
Potassium > or equal to 5

113
Q

What dose of iron is toxic?

A

> 30mg/kg of elemental iron or iron > 32micromol/L 4h post-ingestion

114
Q

Examples of oral hypoglycemic agents that increase insulin release

A

sulfonylureas - eg. glipizide, glyburide, chlorpropamide
Gliptines - sitagliptine, saxagliptin
GLP-1 analogs - exenatide
meglitinides - nateglinide, repaglinide

115
Q

Up to when can symptoms of sulfonylurea toxicity appear

A

up to 24hrs post

116
Q

Effects of oral hypoglycemics with increased insulin release - toxicity

A

hypoglycemia**
Neuro sx - seizure, delirium, coma
tremor
sweating
tachycardia
hypokalemia
hypomagnesemia
hypophosphatemia
mild hypothermia

117
Q

Effects of metformin OD

A

unlikely to cause hypoglycemia
mild-moderate: nausea, vomiting, abdo pain, myalgia
Severe: severe lactic acidosis, cNS depression, hypothermia, tahypnea, hypotension, AKI

118
Q

Toxic dose of metformin for children

A

> 1.7g

119
Q

Which oral hypoglycemic can cause QTc prolongation?

A

sitagliptin

120
Q

What is the antidote for oral hypoglycemics?

A

Octreotide

121
Q

When is octreotide administration indicated

A

recidivant hypoglycemia induced by a sulfonylurea or no IV access

122
Q

When can octreotide treatment cease?

A

absence of hypoglycemia x 24h after last dose of octreotide including an 8hr period of fasting

123
Q

Dose of dextrose to give to correct hypoglycemia caused by oral hypoglycemics

A

0.5g/kg followed by a perfusion of 0.5g/kg/h

124
Q

Dose of glucagon for hypoglycemia

A

20-30mcg/kg IM

125
Q

Risk associated with intox by hypoglycemic agents in a patient already on beta blockers or co-ingested with beta-blocker

A

may not present adrenergic manifestations of hypoglycemia

126
Q

Causes of methemoglobinemia

A

Local anesthetics (Eg. benzocaine, lidocaine)
Nitrates and Nitrites
Antimicrobials (eg. chloroquine, dapsone)
bromates
chlorates
metoclopramide
nitrous oxide
nitroglycerin
napthelene

127
Q

What age group is most at risk for methemoglobinemia in pediatrics?

A

< 36 months

128
Q

Risk factors for developing methemoglobinemia

A

anemia
malnutrition
renal insufficiency
sepsis
acidosis
G6PD deficiency

129
Q

In which patients should methemoglobinemia be considered?

A

cyanosis that does not fit with clinical picture and does not respond to O2 administration

130
Q

Antidote for methemoglobinemia

A

methylene blue 1% 1-2mg/kg in 5 min IV repeated 30-60 mins later if needed

131
Q

When can methylene blue treatment be stopped?

A

max dose 7mg/kg
no more symptoms

132
Q

Secondary effects of methylene blue

A

blue/green coloured urine, stool and skin
nausea, vomiting, headache, abdo pain, vertigo, hypotension, dyspnea
superficial thrombophlebitis

133
Q

Lithium toxicity (acute)

A

GI predominant - nausea, vomiting, diarrhea
CNS (late signs)
ECG - flattened or inverted T waves, QTc prolongation, bradycardia

134
Q

Lithium toxicity (chronic)

A

Nervous predominant - tremor, hyperreflexia, clonus, fasciculations, nystagmus, ataxia, dysarthria, seizures somnolence, confusion, coma

135
Q

what is SILENT?

A

syndrome of irreversible lithium-effectuated neurotoxicity

136
Q

Treatment of lithium toxicity

A

hydration at 1.5-2x maintenance
regular monitoring of electrolytes and renal function
hemodialysis - consider

137
Q

Salicylate toxic dose

A

150-200mg/kg

138
Q

Examples of salicylate-containing products

A

ASA
Methyl salicylate (tea tree essential oil + wintergreen)
pepto-bismol

139
Q

3 stages of salicylate toxicity

A

1 - hyperventilation
diaphoresis
vomiting
tinnitus
hypoacusis

respiratory alkalosis
hypokalemia
alkaline urine with high K+

2 - hyperglycemia
volume contraction
deterioration

elevated anion gap
hypokalemia
acid urine

3 - hyperthermia
pulmonary edema
possible hepatotoxicity
hypoglycemia
confusion/coma
seizures
CV collapse

acid urine
acidosis (blood)

Also: SIADH (hyponatremia) or dehydration (hypernatremia), ketonuria
more rarely: rhabdomyolysis, GI hemorrhage

140
Q

How often to monitor salicylate levels?

A

q2hrs

141
Q

how often to measure urine pH in salicylate toxicity?

A

q1h

142
Q

Treatment of salicylate toxicity

A

charcoal decontamination
administer dextrose
Urine alkalanization - pH 7.5-8, plasma alkalanization (ifpH < 7.4) using sodium bicarbonate (2-3ml/kg/hr max 150-200ml/hr)
prevent hypokalemia
consider hemodialysis

143
Q

Why do we do urine/plasma alkalanization in salicylate toxicity?

A

higher pH = salicylates more ionized = decreased absorption in the renal tubules = increased excretion

144
Q

Serotonin syndrome

A

myoclonia, tremor and hyperreflexia (predominant sxs)
clonus
hyperthermia
ocular clonus
rigidity

145
Q

Medications that are NOT SSRI/SNRI that can cause serotonin syndrome

A

methylene blue
linezolid
bupropion
cocaine
dextromethorphan
fentanyl
tramadol
trazodone
LSD
amphetamines
MDM
buspirone
lithium
mirtazapine

146
Q

Major differentiating factor between NMS vs serotonin syndrome

A

Serotonin syndrome = faster onset, more tremor, myoclonia and hyperreflexia

NMS = slower/delayed onset, rigidity and bradykinesia more prominent

147
Q

antidote to serotonin syndrome

A

cyproheptadine 1-2mg PO or NG q 1-4h until end of symptoms or max 12mg/24h
indicated for severe SS

148
Q

Secondary effects of cyproheptadine

A

mydriasis
urinary retention

149
Q

Amanita toxicity

A

Phallotoxin acts first, causing nausea, vomiting, abdominal pain, and diarrhea. Fever, tachycardia, and hyperglycemia may also occur during this stage. The other toxin, amatoxin, causes renal tubular and hepatic necrosis.

PEM Lectures dirigées (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions