Toxicology Flashcards
List the symptoms of a cholinergic toxidrome.
DUMBBELSS (leaky syndrome/ SLUDGE)
diarrhea, urination, mitosis, bradycardia, bronchosecretions, emesis, lacrimation, salivation, sweating
List the symptoms of an anticholinergic toxidrome.
hyperthermia, dry skin, mydriasis (dilated), delirium, hallucinations, tachycardia, urinary retention (large bladder), seizure
hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat
Antidote for cholinergic toxidrome?
atropine +2-PAM
likely causes include organophosphates, mushrooms, sarin gas
What is the antidote for anticholinergic syndrome?
physostigmine
caused by the anti’s and atropine (anti
List the symptoms of a sympathomimetic toxidrome.
hyperthermia, diaphoresis, mydriasis (dilated), tachycardia, hypertension, seizure, agitation, may have active bowel sounds
List the symptoms of a opioid toxidrome.
mitosis (constricted), hypoventaliation (decreased rate and effort), coma, bradycardia, hypotension
What is the antidote for anticholinergic syndrome?
physostigmine
caused by the anti’s and atropine (anti-histamine, antipsychotics, anti depressants and anti parkinsonions
What is the antidote for sympathomimetic toxidrome?
no antidote, treat symptomatically re: seizure, HTN, hyperthermia
typical poisons: cocaine, amphetamines/methamphetamines
What is the antidote for opioid toxidrome?
naloxone (narcan- blocks all receptors)
typical poisons: heroin, methadone, oxy/hydrocodone
List the things that activated charcoal cannot be used to treat.
PHAILS to remove: pesticides hydrocarbons acid/alkali iron lithium solvents
Multiple dose activated charcoal is useful in treating what toxins?
ABCD antimalarials and aminophylline barbiturates and Beta-blockers carbamazepine dapsone
Urinary alkalinization is useful in treating which toxins?
aspirin and phenobarbital overdose
Hemodialysis is used in which overdoses?
ISTUMBLE 'over the dialysis machine' isopropyl alcohol salicylate thiophyline uremia methanol barbiturates lithium ethylene glycol
Hemodialysis is used in which overdoses?
ISTUMBLE 'over the dialysis machine' isopropyl alcohol salicylate thiophyline uremia methanol barbiturates lithium ethylene glycol
Give examples of a few controversial interventions and when they are used.
syrup of ipecac- never indicated
cathartics- mostly never
gastric lavage- sometimes, not if unconscious
whole bowel irrigation for foreign bodies or drug packers
urinary acidification: PCP, amphetamine but not done due to rhabdomyolysis
Give examples of a few controversial interventions and when they are used.
syrup of ipecac- never indicated
cathartics- mostly never
gastric lavage- sometimes, not if unconscious
whole bowel irrigation for foreign bodies or drug packers
urinary acidification: PCP, amphetamine but not done due to rhabdomyolysis
What are antidotes used in toxic alcohols, acetaminophen and lead?
toxic alcohols: fomeprizole, ethanol
acetaminophen (NAC)
lead: succimer (PO), BAL (IM) and CaNa2EDTA (IV)
What are antidotes used in toxic alcohols, acetaminophen and lead?
toxic alcohols: fomeprizole, ethanol
acetaminophen (NAC)
lead: succimer (PO), BAL (IM) and CaNa2EDTA (IV)
List which toxins give an osmolar gap and which toxins give anion gap.
Osmolar: MEDIE- methanol, ethylene glycool, diuretic, isopropyl alcohol, ethanol
MUDPILES: methanol, uremia, diabetic ketoacidosis, propylene glycol, iron poisoning or isoniazid, lactic acidosis, ethylene glycol, salicylates
List which toxins give an osmolar gap and which toxins give anion gap.
Osmolar: MEDIE- methanol, ethylene glycool, diuretic, isopropyl alcohol, ethanol
MUDPILES: methanol, uremia, diabetic ketoacidosis, propylene glycol, iron poisoning or isoniazid, lactic acidosis, ethylene glycol, salicylates
How do you calculate and osmolar gap?
2 Na + Glucose/18 + BUN/2.8
normal range is
How is metabolism of alcohols related to osmolar gap and anion gap?
alcohols cause intoxication and osmolar gap
methanol and ethylene glycol cause AGMA
(metabolism is via alcohol dehydrogenase)
What are the effects of methanol and ethylene glycol?
methanol: blindness/basal
ethylene glycol: renal failure/oxylate crystals
What are the symptoms of aspirin toxicity? How do you treat?
primary respiratory alkalosis (hyperventilation) and metabolic acidosis (formation of lactic and ketoacidosis)
**tinnitus, sweating, N/V
tx: with urinary alkalization to increase excretion
What are the symptoms of aspirin toxicity? How do you treat?
primary respiratory alkalosis (hyperventilation) and metabolic acidosis (formation of lactic and ketoacidosis)
**tinnitus, sweating, N/V
tx: with urinary alkalization to increase excretion
What is the level of toxicity in dosing acetaminophen for adults or children?
toxic >7.5 g for adults in 4 hours
>150 mg/kg for kids in 4 hours
When can you use the Rumack Matthews nomagram to predict acetaminophen toxicity?
when ingestion was at a known time and a known single dose
What are the endpoints for treatment with NAC?
resolution of sxs, undetectable acetaminophen AND normalization of liver markers
What are the blood levels require treatment and what type of treatment?
.
What are the blood levels require treatment and what type of treatment?
treatment mandated if level is
What are the blood levels require treatment and what type of treatment?
treatment mandated if level is succimer OR CaNa2 EDTA
70-100 mug/dL cause severe toxicity; >69–>BAL + CaNa2EDTA
What are the clinical findings of someone with lead toxicity?
CNS- cognitive delay, frank encephalopathy and coma
GI- lead colic, severe and obscure abdmonial pain
NM- wrist drop
Renal PCT dysfunction, necrosis, saturnine gout
Blood-microcytic hypo chromic anemia (basophilic stippling
bone: radio dense metaphysical lines
dental- caries, gingival lead lines
