Toxicology Flashcards
what are radio-opaque drugs
COINS choral hydrate Opiods packets Iron and other heavy metals Neuroleptics if earlyalc Sustained release tablets - bezoar formed
what ingestion will cause tachycardia
anticholinergics
ethanol
sympathomimetics
what ingestion will cause bradycardia
opiods
bet blockers
Ca channel block
what ingestion will cause QRS widening?
TCA
what ingestion will cause prolonged QT
neuroleptics
TCA
organophosphates, carbamates (neostigmine..) and alzheimer drugs are part of what group
cholinergics
what is DUMBELLS?
cholinergic toxidromes symptoms: Diaphoresis Urination Miosis Bronchorrhea/bradicardia Emesis Lacrimation Lethargy Salivation
how do you manage a cholinergic poisoning
eg. organophosphates
1. 100% O2
2. early intub
3. Remove clothing and irrigate skin
4. Atropine + Pralidoxine
what is a common anticholinergic that teens will try to abuse
Jimson weed
what are common anticholinergics
TCA are weakly antichol
antihistamine
atropine or cyclopentolate eye drops
neuroleptics
how do you manage a anticholinergic poisoning?
Lorazepam for agitation
bring down T
consider activated charcoal if < 1 hr
Physostigmine if central and periph toxicity EXCEPT if TCA
what are sympathomimetic drugs?
cocaine
amphetamine
PCP
MDMA
what are sympathomimetic features
diaphoresis HTN Sez agitation - drug dep inc HR inc temp Psychosis
how can Dx MDMA use?
ecstacy
can do urine test
opiod toxidrome
miosis brady low BP hypopnea coma
when does Charcoal PHAIL
PHAILS Potassium Hydrocarbons Alcohols Iron Lithium Solvents
What are the drugs where one can be enough to kill
cardiovascular drugs (eg, β-blockers and calcium-channel antagonists) antidepressants antipsychotics anticonvulsants antiarrhythmic agents salicylates oral hypoglycemics opioids
what does an organophosphate injestion look like
organophosphate inhibit cholinesterase enz and cause Colinergic syndrome DUMBBELS Diarrhea Urination Miosis Bronchorrhea Bradycardia Emesis Lacrimation Salivation
how do you manage a organophosphate OD?
remove clothing and wash skin
Atropine-competitive inhibitor of Ach at muscarinic level
Pralidoxine to help remove the organo -in first 18 hrs
What makes you think your patient tooks ecstacy?
HTN- can be and emergency Hyperthermia Hyponatremia from drinking too much H2O Serotonin syndrome Cardiac ischemia Hepatotoxicity
how do you manage ecstacy ingestion
Activated charcoal if it has been < 1 hours
Lorazepam for HTN and agitation
fluid restrict for hyponatremia
cool mist and fans
Antidote for Iron
deferoximine
Antidote for carbon monoxide?
Oxygen
antidote for pesticide
atropine
antidote for nifedipine?
glucose and insulin
antidote foramitriptyline?
Na bicarbonate
antidote for methanol
fomepizole
antidote for Glyburide
glucose or octreotide
how do you manage a hydrocarbon ingestion
Stat CXR and repeat in 4-6 hours
oxygen
+/- bronchodilator
can DC if well 4-6 hrs
what metabolic abnormality could you see with metformin
lactic acidosis
what drugs can cause hypoglycemia?
Glyburide
beta blockers
ethanol
ASA
what is the toxic dose of Tylenol
150 mg/kg
what are complications of tylenol OD?
Anion gap metabolic acidosis
acute tubular necrosis
fulminant liver failure
when does the hepatotoxicity of Tylenol OD start?
24-72 hours - stage II
when do most deaths occur in Tylenol OD
stage III -72-96 hours
what is the nomogram used for Tylenol OD
Rumack-Mathew
best outcome if started within 8hours
what might make you think your patient took an ASA OD?
HIGH temps
CNS:confusion, hallucination, Sz, cerebral edema
RESP: tachypnea, pulmonary edema - resp alkalosis
can see AG metabolic acidosis if develop pulmonary or cerebral edema
LYTES: Low glucose,Low potassium
PARADOXICAL aciduria
N/V/GI bleed
Tinnitus and hearing loss
Hyperglycemia regressing to hypoglycemia
Diaphoresis
? renal failure
how do you manage an ASA ingestion?
- ABC
- Charcoal up to 6 HRS!!! bc of bezoar formation
- Alkalinize urine -aim for 7-7.5 wth bicarbonate
- K IV
May need dialysis or ECMO if CNS inolvement
what makes you think your patient ingested IRON
- N/V/D
- poor perfusion and metabolic acidosis
- GI bleed
- Coagulopathy - 12-24
- resp failure - 12-24
- ARDS - 2-3
- Liver failure - d2-3
- GI stricture - Wk 3-4
how do you manage IRON OD
Whole bowel irrigation if tablest seen o AXR or if < 6 hrs - textbook only
fluid resc
deferoxamine early bc once in cell, chelation is useless
what is the only alcohol that does not cause metabolic acidosis
isopropyl alcohol
ketosis without acidosis
if patient ingested windshield fluid, what are they most at risk of developing?
Methanol
retinal injury and blindness
what electrolyte abnormalities might you see post ethylene glycol ingestion?
metabolic acidosis
hypocalcemia causing prolonged QTc and calcium oxalate crystals
clinical presentation of Ethylene Glycol ingestion
inebriation but odorless
cardiac decompensation andprolonged QTc
Renal failure
cerebral hearniation
how do you manage ethylene glycol ingestion
Na bicarb to correct acidosis
Fomepizole
may need dialysis
cofactor therapy -folic acid and leucovorinm
How do you manage a TCA OD
- charcoal
- may needintubation
- Na bicarb if QRS >100
- Norepinephrine for low BP
physostigmine is contraindicated
a pt is brought in with dizziness, nausea and HA.The est of the family has similar symptoms. Normal pulse oxymetry and normal PO2. What BW will help Dx and how do you manage
Carboxyhemoglobin level > 25%
start 100% O2
if > 25% - need hyperbaric treatment
a patient states that they tried bath salts. WHat might we find?
hallucinations suicidality Seizures GI symptoms inc HR
