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Emergency > Toxicology > Flashcards

Toxicology Flashcards

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1
Q

Toxic dose of aspirin

A

200-300 mg/kg

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2
Q

Salicylate toxicity acid-base

A

Respiratory alkalosis + anion gap metabolic acidosis

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3
Q

Hemodialysis indication in salicylate toxicity

A

Level >100 mg/dL in acute overdose and >50 mg/dL in chronic overdose
Coma
Rising levels despite alkalinization
Kidney failure
Pulmonary edema
Altered MS
Clinical deterioration

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4
Q

What is the antidote for malignant hyperthermia

A

Dantrolene

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5
Q

Triad of serotonin syndrome

A

Autonomic instability (tachycardia, diarrhea, shivering, mydriasis, diaphoresis)
AMS
Increased neuromuscular activity (clonus, hyperreflexia, tremor, seizures)

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6
Q

Which opioid cause mydriasis in overdose?

A

Meperidine

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7
Q

What is the toxic metabolite of methanol?

A

Formic acid

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8
Q

What is the toxic metabolite of isopropanol?

A

Acetone

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9
Q

Acid base of isopropanol intox?

A

Elevated osmolar gap, ketosis without acidosis

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10
Q

Triad of opiate toxidrome?

A

CNS depression
Respiratory depression
Pinpoint pupils

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11
Q

Expected finding in ethanol ingestion (pediatrics)?

A

Hypoglycemia

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12
Q

Treatment of ethylene glycol poisoning?

A

Fomepizole

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13
Q

Isoniazid toxicity acid-base and antidote?

A

Anion gap metabolic acidosis
Pyridoxine (B6)

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14
Q

Coma +anion gap metabolic acidosis + increased lactate, seen in which toxicity?

A

Cyanide

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15
Q

Cyanide treatment?

A

Hydroxocobalamin
Cyanide kit (nitrites and sodium thiosulfates)

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16
Q

What is the difference between BB and CBB?

A

Both present as bradycardia, hypotension
Betablockers = HYPOglycemia
Calcium channel blockers = HYPERglycemia

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17
Q

Treatment of BB toxicity?

A

Glucagon
HIGH dose insulin 1 unit/kg

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18
Q

Treatment of anticholinergic

A

Supportive
Physostigmine for agitation (CI in TCA)

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19
Q

Physostigmine complications and CI?

A

Complications: dysrhythmias and seizures (only give of normal QRS)
CI: TCA

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20
Q

Serum pH goal in TCA tox, and how to maintain

A

7.5-7.55
Sodium bicarb 150 mEq in 1L D5W

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21
Q

What to avoid in malignant hyperthermia patients?

A

Depolarizing muscle relaxants (succ, suxamethonium, and decamethonium)
Volatile anesthetics: halothane, sevo, des, iso, enflurane

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22
Q

Most common ECG finding in digoxin tox

A

MOST COMMON is PVC
Other findings: Atrial tach with AV block, bidirectional v.tach, slow a.fib

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23
Q

Initial dose in digoxin tox in unknown ingestion?

A

10 vials

24
Q

Poor prognosis in digoxin tox?

A

Hyperkalemia

25
Q

Haloperidol and methadone can cause what ECG changes?

A

QTC prolongation

26
Q

Indications for hyperbaric oxygen therapy due to CO poising?

A

Evidence of end-organ damage
LOC, coma, seizures
Confusion, focal findings, or cognitive deficits
MI, life-threatening dysrhythmia
Persistent symptoms after tx. With 1 atm O2
COHb lvel >25% (15% in pregnant)

27
Q

What to avoid when taking metronidazole or TCA?

A

Metro - > Ethanol: Results in disulfiram-like reaction
TCA -> diary

28
Q

Digoxin is seen in which plants?

A

Fox glove
Oleander
Lilly of the valley

29
Q

Digoxin-specific antibody dosing?

A

If unknown or cardiac arrest: 10 vials (5 in peds)
Known amount: (?mg X 0.8) / 0.5
Known serum: [(serum level ng/mL x weight in kg) / 100]

30
Q

Indication for dialysis in ASA tox

A

Serum >100 mg/dL in acute and >60 in chronic
Rapidly rising salicylate level
Altered MS (cerebral edema)
Kidney or liver failure
Pulmonary edema
Severe acid/base abnormality
Worsening clinical

31
Q

How much will administration of 50 mL of sodium bicarbonate change serum pH?

A

For every 50 mL of sodium bicarbonate administered, serum pH increases by 0.1

32
Q

What is the chelation therapy in lead and when to start in children?

A

Dimercaprol
If asymptomatic start equal to or above 70 microg/dL

33
Q

Patient presents with pain out of proportion after exposure to material:
What is it?
What electrolyte imbalance is seen?
How to treat?

A

Hydrofluoric acid
HYPOcalcemia and HYPOmagnesemia, and HYPERkalemia
Calcium gluconate

34
Q

Blood smear reveals: microcytic anemia with basophilic stippling, what is the diagnosis

A

Lead poising

35
Q

Valproic acid tox present with what in the blood and what is the antidote?

A

Elevated serum ammonia level, hypernatremia, hypocalcemia, metabolic acidosis
L-carnitine

36
Q

What ECG finding necessitates starting sodium bicarbonate infusion in TCA overdose?

A

QRS interval >100 ms

37
Q

Oxymetazoline can present with similar toxicity to what?

A

Clonidine
Result in bradycardia, hypotension, and miosis

38
Q

Jimsonweed which toxidrome?

A

Anticholinergic

39
Q

Iron tox antidote

A

Deferoxamine

40
Q

Organophosphate (cholinergic tox) antidote

A

Atropine
Pralidoxime

41
Q

Methanol tox produces what compund

A

Formic acid

42
Q

How to calculate anion gap?

A

Sodium (Na) - [Calcium (Cl) + HCo3]

43
Q

What is CI in cocaine (sympathomimetic) patients?
Ex: methamphetamine, MDMA (ecstasy), ephedrine, bath salts

A

Metoprolol

44
Q

How do MDMA patients present?

A

Hyperthermia, dehydration, and HYPOnatremic

45
Q

Patients takes MDMA and dextromethorphan will present with what toxidrome?

A

Serotonin syndrome

46
Q

PCP present with what physical finding?

A

Nystagmus

47
Q

What is the endpoint for atropine treatment?

A

Resolution of bronchorrhea

48
Q

Toxic metabolite of ethylene glycol?

A

Oxalic acid

49
Q

Non-ionizing radiation?

A

Microwave

50
Q

Indication of emergent hemodialysis following acute ethylene glycol overdose?

A

Glycolic acid level > 8 mmol/L

51
Q

What 2 co-factors adjuncts should be given in acute ethylene glycol overdose?

A

Thiamine and pyridoxine

52
Q

How to distinguish between naloxone and clonidine?

A

Clonidine present with bradycardia and hypotension, though initially presenting with hypertension

53
Q

Indications for deferoxamine chelation therapy?

A

Iron level > 500 mcg/dL
Shock
Acidosis
AMS
Severe refractory GI symptoms

54
Q

Hemodialysis in lithium toxicity?

A

Lithium concentration > 5 mEq/L
Lithium concentration > 4 mEq/L AND IMPAIRED KIDNEY FUNCTION
Presence of seizure, AMS, dangerous dysrhythmias
Elevated lithium concentration in symptomatic patients with CI to aggressive hydration (ex: HF)

55
Q

What toxic alcohol does no produce lactic acidosis?

A

Isopropanol

Emergency (3 decks)

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