Toxicology Flashcards
Medication classes that cause methemoglobinemia
nitrates
local anesthetics
dapsone
quinine
sulfonamides
3 exam findings in NMS
cogwheeling, lead pipe rigidity, hyperthermia, decreased LOC, autonomic instability
5 drug classes/drugs that can cause serotonin syndrome
SSRI
SNRI
TCA
MAOI
Amphetamines
methadone
tramadol
Lithium
sumatriptan
linezolid
Management for NMS
Cooling
stop offending agent
benzos for agitation
Muscle relaxant - dantrolene
Dopamine agonist - bromocriptine
consider intubation/paralysis - non depolarizing agent
monitor for rhabdo
criteria for diagnosis serotonin syndrome
Hunter criteria - any of the following in exposure to known serotonergic agent
- spont clonus
- indiculible clonus AND agitation or diaphoresis
- ocular clonus AND agitation or diaphoresis
- tremor and hyper-reflexia
- hypertonic with temp >38 and ocular clonus or inducible clonus
Treatment serotonin syndrome
Cooling
Hydration
benzos for agitation
cyproheptadine
Treatment sympathomimetic toxicity
cooling
IV benzos - agitations, tachycardia, hypertension
refractory HTN ok to use BB labetolol
avoic succ
wide complex tachy - bicarb (sodium channel blocker)
Calculate anion gap
NA - (HCO3 + Cl)
Causes AG metabolic acidosis
Methanol
Uremia
DKA
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol, Ethanol
Salicylates
Cyanide, CO
Calculate osmolar gap
2Na + Glucose + Urea (+1.25xEtOH)
causes elevated osmolar gap
EtOH
Methanol
Ethylene glycol
isopropyl alcohol
propylene glycol
mannitol
glucose
Hyper TG
multiple myeloma
Name 4 drugs that are dialyzable
- Isopropanolol
- Valproic acid
- Salicylates
- Theophylline
- Uremia
- Methanol
- Barbituates
- Lithium
- Ethylene Glycol
- Nadolol
- Atenolol
- Sotalol
Toxic dose acetaminophen in adults and children
adults - >7.5-10 g
Children - 150 mg/kg
Name of tylenol overdose nomogram
Rumack-Matthew Nomogram
$ reasons you cannot use tylenol overdose nomogram
unknown time of ingestion
chronic/staggered ingestion
ingestion <4 hrs
delayed release tabs
coingestions with delay through gut
health conditions causing impaired liver function
Indications to start NAC without using nomogram
acute ingestion >8 hrs
acute ingestion and AST elevated
Late presenter (>24 hrs)
Massive ingestion
uncertain timing
Treatment Methanol poisoning
Fomepizole / Alcohol
Dialysis
(folic acid + bicarb infusion)
presentation + sources mathanol poisoning
Drunk
Altered LOC
*Visual complaints - snow storm
Parkinsonism
Moonshine
Minshield washer fluid
antifreeze
glass cleaner
Ethylene glycol treatment
fomepizole / EtOH
Thiamine
Pyridoxine
Mg
sodium bicarb
dialysis
