Toxicology Flashcards
What’s in a coma cocktail?
O2, narcan, D50 and thiamine
Preferred gastic decontamination method if presenting in ED after one hr? Won’t be effective for lithium, iron, ETOH, potassium
activated charcoal
First line treatment of seizures that is longer acting.
diazepam
When is induced emesis with ipicac most useful as treatment for overdose?
within first few minutes
What is the antidote for acetaminophen?
Acetylcysteine
What is the antidote for anticholinergics?
Physostigmine
What is the antidote for benzos?
Flumazenil
What is the antidote for cyanide?
Na nitrite and Na thiosulfate
Given with contrast dye to prevent allergic rxn?
mucomyst (acetylcystine)
What is the antidote for methanol/polyethylene gylcol?
ethanol
What is the antidote for narcotics?
narcan
Presentation includes this saying: Blind as a bat (dilated pupils), Red as a beet (vasodilation), Hot as a hare (hyperthermia), Dry as a bone (dry skin), Mad as a hatter (hallucinations/agitation). The bowel and bladder lose their tone (ileus, urinary retention).And the heart runs alone (tachycardia)
anticholinergic overdose
Most common cause of change in Osm
ETOH
Saturates the glutathione detoxification system. Accumulates in liver and causes delayed hepatotoxicity
24-72 hours post ingestion
acetaminophen overdose
What is the toxic overdose of acetaminophin?
> 140 mg/kg
How long should you give acetylcysteine therapy in a tyelonol overdose?
140mg/kg orally of a 10%-20% solution. Follow-up with a 70mg/kg dose every 4 hours for 18 doses
or until the Tylenol level is O (zero)
Biggest concern with cocaine and amphetamine overdoses
vasospasm (MI)
Can be used to treat DBP > 120 in cocaine/amphetamine overdose
nitroprusside
Why should you not acidify urine with cocaine/amphetamine overdose?
can result in myogloburia and acute renal failure
Should never be used with tricyclic overdose, asthma, or
mechanical bowel or bladder obstruction
physostigmine
Name the vitamin K dependent clotting factors
II, VII, IX, X
When are peak effects of coumadin seen?
after 1-2 days
Crampy abdominal pain, vomiting, profuse watery diarrhea, burning mucosa, conjunctivitis, tremor and seizures. A garlic odor may be on patient?s breath. Periorbital edema after 1-2 days
acute arsenic ingestion
Treatment of acute arsenic poisoning
GI decontamination with GI lavage
and charcoal; Administer dimercaperaol(BAL) 3-5mg/kgdose q4h for 5 days
Treatment of chronic exposure to arsenic poisoning
penicillamine 100mg/kg/d (max 1
Gm) orally divided qid (May not reverse neurological damage)
What is treatment of CO poisoning?
100% FiO2 for 4 hours
Acute ingestion of an overdose is often associated with
HYPERkalemia. ECG shows toxic effects of 3rd degree AV block, bradycardia, ventricular ectopy, or paroxysmal atrial
tachycardia with AV block
digitalis toxicity
Used to treat hyperkalemia associated with digitalis toxicity if > 7 with care to avoid CaCl which would kill the patient. Although generally you won’t need to treat because it will decrease with reversal
use the glucose + insulin therapy
Used to treat ventricular ectopy from digitalis toxicity
lidocaine
What is the antidote for a digoxin overdose?
Digibind (digitalis specific Fab fragment antibodies)
Severe gastroenteritis followed by delayed hepatic and
renal failure in 48-72 hours. Onset of symptoms is 6-24 hours post ingestion. Treatment is supportive only and hospitalize all with baseline renal and hepatic functions
Amatoxin (Amanita Genus) mushrooms
Symptoms are: salivation, miosis, bradycardia, diarrhea. Onset of symptoms is 30 min-1 hour post ingestion. Treatment is supportive and Atropine for severe
cholinergic symptoms
Muscarine (Inocybe or Clitocybe) mushrooms
Symptoms are hallucinations (used by several NA tribes). Onset is 15-30 minutes post ingestion. MOST COMMONLY seen mushroom poisoning
(intentional). Treatment is supportive
Psilocybin (Psilocybe genus) mushrooms
Symptoms are anticholinergic: mydriasis, tachycardia,
hyperpyrexia, delerium. Onset is 30 min to 2 hours post ingestion. Treatment is supportive and physostigmine for severe sx
Ibotenic acid and muscimol (Amanita muscaria) mushrooms
Symptoms are severe gastroenteritis with occasional
hemolysis, hepatic and renal failure. Onset of symptoms is 6-12 hours post ingestion. Treatment is supportive and IV pyridoxine may prevent the hepatic/renal failure
Monomethylhydrazine (Gyromitra) mushrooms
should be considered in any patient who is unconscious from unknown cause
opiate overdose
How do you differentiate clonidine overdose from opiate overdose?
Clonidine overdose may appear identical to opiate
overdoes, but they do NOT respond to naloxone
Symptoms include miosis, excessive salivation,
bronchospasms, hyperactive bowel sounds, lethargy, muscle fasiculations, and seizures (DUMBELS). Death is from respiratory distress
organophosphate overdose
What is the treatment of organophosphate overdose besides aggressive airway management?
Atropine IV in LARGE doses and Pralidoxime (2-PAM Chloride)
Symptoms range from severe, paranoid, bizarre
violent behavior to quiet stupor. Treatment aimed at limiting seizures and violence using diazepam or haloperidol. Monitor and prevent rhabdomyolysis
PCP overdose
What are the three C’s of TCA overdose?
Cardiac abnormalities, convulsions and coma
What are the treatment options of ventricular arrhythmias and conduction defects from TCA overdose?
NaHCO3 (50-100 mEq IV), Lidocaine 1-2mg/kg, or Phenytoin 15-18mg/kg may be effective
What are treatment options of hypotension due to TCA overdose?
NaHCO3 (50-100 mEq IV) and crystalloid (0.9% NaCl)
