Toxicology Flashcards
Toxicology from these resources: AAP PREP:EM course
If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning
salicylate poisoning
classic blood gas abnml with salicylate poisoning
metabolic acidosis + respiratory alkalosis
key difference in presentation between ethylene glycol and methanol poisonings
ethylene glycol: results in oxalic crystals in the urine and hurts the kidneys
methanol: results in formic acid and causes blindness
toxic alcohol resulting in blindness
methanol
toxic alcohol resulting in renal failure
ethylene glycol
radiopaque toxins (5)
COINS
1. chloral hydrate
2. opiate packets
3. iron and Hg, As, Li, Ca
4. neuroleptics
5. SR/enteric coated meds
also solvents like CCl4
poisonings that activated charcoal won’t work for (3)
ions/metals
acids/bases
alcohols
this common household object can be 17% EtOH
mouthwash
toxin that smells like rotten eggs
hydrogen sulfide
toxin that smells like almonds
cyanide
toxin that smells like garlic
arsenic
Morning Glory poisoning symptoms
hallucinations, mydriasis, perspiration, bronchorrhea, salivation, hyper or hypothermia, diarrhea
Treatment to reduce thyroid uptake of radioactive iodine?
Potassium iodine
Fish associated with scombroid poisoning?
tuna, mackerel, bonito, mahi-mahi, bluefish, sardines, anchovies
Fish associated with cigautera poisoning?
barracuda, snapper, grouper, amberjack, moray eels, triggerfish, parrotfish
bidirectional v tach is pathognomic for what toxicity?
digoxin toxicity
digoxin toxicity causes what characteristic, unique EKG abnormality?
bidirectional v tach
what is unique about digoxin toxicity related hyperkalemia?
do NOT give calcium - it can cause a “stone heart” from excessive intracellular calcium and cardiac tetany
what is the treatment for digoxin toxicity?
atropine
digiFab
mag, potassium
consider PHYT, lidocaine
first lab abnml in radiation poisoning
leukopenia
treatment for cesium radiation poisoning
prussian blue
EKG findings in TCA OD
sinus tach, prolonged PR, QRS, and QT intervals
Symptoms of scorpion sting
local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis
envenomation associated with metallic taste
rattlesnake
systemic symptoms of brown recluse spider bite
fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure
fish that cause scombroid
tuna, mackerel, and bonito
fish that cause ciguatera
barracuda, grouper, and snapper
what do you need to avoid when treating a patient with ciguatera poisoning?
opioids - may interact with toxin and cause hypotension
toxic dose of acetaminophen?
150mg/kg in adults
200-250mg/kg in kids
toxicity of ethelyne glycol vs methanol?
ethylene glycol: metabolized into oxalic acid, will crystals in urine and possible ARF
methanol: metabolized into formic acid, injures the eyes
normal serum osmolality
285-295
treatment of organophosphate poisoning
atropine if wet/killer Bs
pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)
Coral snake vs king snake?
red on black, venom lack;
red on yellow, kill a fellow.
ricin poisoning
inhalational: sudden onset of fever, chest tightness, cough, dyspnea, nausea, and arthralgias, progressing to cyanosis, pulmonary edema and respiratory failure
Tularemia: symptoms and treatment
fever, malaise, pneumonia
tx: streptomycin, doxy, cipro
aerosolized toxin that smells of “newly mown hay”? symptoms?
phosgene - ocular and nasal irritation, resp symptoms, pulmonary edema
inhalational anthrax - presentation
initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.
inhalational anthrax ppx
cipro or doxy
staph enterotoxin b symptoms
sudden onset of fever, chills, headache, myalgias and nonproductive cough
pneumonic plague symptoms
The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.
The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.
pneumonic plague
toxin with sudden onset of fever, chills, headache, myalgias and nonproductive cough
staph enterotoxin b
initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.
inhalational anthrax
treatment of plague
ppx?
tx: doxy or streptomycin or cipro
ppx: doxycycline or cipro
what is hydrogen sulfide
mustard gas
causes superficial skin burns, eye irritation, and resp tract irritation
ingestions where multidose activated charcoal may be helpful?
phenobarbital, carbamazepine, theophylline, and dapsone
carbamezepine toxicity
can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures
has some anticholinergic properties
false positive for TCAs on UDS
symptoms and management of hydrofluoric acid burns?
used in glass etching, metal cleaning, and electronics manufacturing
hypocalcemia, hypomag, and hyperkalemia
treat with topical, intra-arterial, IV calcium gluconate
Symptoms of lithium toxicity
coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction.
Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.
Amanita phalloides ingestion
white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure
ectasy/MDMA intoxication
hyponatremia, concentrated urine, altered mental status
may see serotonin syndrome
toxic alcohol resulting in large ketosis
isopropyl alcohol
toxins causing miosis
COPS cholinergics/clonidine opiates phenothiazines sedatives
toxins causing mydriasis
AAAs antihistamines anticholinergics atropine sympathomimetics
toxins causing hypoglycemia
HOBBIES hypoglycemics oral hypoglycemics beta blockers insulin ethanol salicylates
nerve agents
sarin and venom x (VX)
act as organophosphates
