Toxicology Flashcards
Anion Gap
Na - (Cl +HCO3)
Should be less than 12 +/-4
Anion Gap Metabolic Acidosis Reasons
MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis
Propylene Glycol
Ingestion, iron, isoniazid
Ethylene Glycol
Salicylates
Acetylsalicylic Acid Overdose
Toxic Dose: >150 mg/kg
S&S: HA, vertigo, tinnitus, mental confusion, sweating, thirst, hyperventilation, N/V, drowsiness.
More Severe: Acid-base disturbances, electrolyte disturbances, agitation, coma, pulmonary edema,
Tx: Charcoal, alkaline diuresis, dialysis
Acetaminophen Overdose Stages
Toxic Dose: >150 mg/kg
Stage 1: First 24hrs, anorexia, N/V, malaise, pallor, diaphoresis
Stage 2: 24-72 hrs, RUQ pain, increases liver enzymes, serum bilirubin, prothrombin increase after 36 hrs
Stage 3: 72-96 hrs, peak liver function abnormalities, stage 1 symptoms return with jaundice. Death usually occurs due to fulminant hepatic necrosis
Stage 4: 4 days to 2 weeks after poisoning, patients are asymptomatic and liver functions return to base levels
Acetaminophen OD Tx
- Charcoal if administered within a few hours
- After 4 hours after ingestion levels are toxic OR if liver function tests reveals impairment then N-acetylcysteine(NAC) should be administered IV/PO 150/140 mg/kg
- NAC is most beneficial if used within 8 hours, almost useless after 24 hours
Anticholinergic OD
- Antihistamines, antipsychotics, TCAs, plants
- Block the action of ACH at muscarinic receptors
- Bi carb if QRS is getting wide
BB and CCB Overdose
First line treatments are fluids and norepi/epi along with Insulin
Pacing, more insulin, and lipid emulsion if the previous treatments didn’t work
Glucagon can also be used in 3-5 mg boluses.
Digitalis Overdose
The problem is hyperkalemia amongst other cardiac/noncardiac manifestations.
Hyperkalemia is managed as appropriate unless a direct result of digitalis.
Digoxin antibody fragments can be administered to bind with digoxin and be excreted through the urine.
TCA/Sodium Channel Overdose
Similar to an anticholinergic but has key cardiac changes: Right Axis Deviation, RBBB, wide complex tachycardias, terminal R wave greater than 3mm in aVR.
Tx: Bicarb if QRS is > 100 ms, hypertonic saline can be used in place of bicarb if there are ph concerns
Organophosphate Poisoning
SLUDGE
Atropine, 2PAM, Benzos for seizures
Toxic Alcohols
Ethylene Glycol 1 mg/kg
Methanol: 0.5 mg/kg
Give Fomepizole(Antizol) or ethanol drip
What are pit vipers
Rattlesnakes, Copperheads, water moccasins(cottonmouths)
Pit viper Venom
Hemotoxic
Elapidae Venom
Neurotoxin
How to treat serum sickness
Antihistamines and steroids
