Toxicology Flashcards
Risks of Exposure
- To what agents are children exposed to at home?
- What are safe levels and durations of exposure, if they exist?
- Accidental versus intentional?
Environmental Exposure
- Methyl Mercury
- Ethyl Alcohol
- Lead
Anticholinergics Overdose side effects (7) and mnemonic
- Increased BP
- Increased HR
- Increased temperature
- Delirium
- Increased pupils
- Decreased peristalsis
- Decreased diaphoresis
– Blind as a bat – Mad as a hatter – Red as a beet – Hot as a hare – Dry as a bone
Cholinergics overdose side effect (4) and SLUDGE mnemonic
- Increased RR
- Increased peristalsis
- Increased diaphoresis
- Decreased pupils
– S Salivation – L Lacrimation – U Urination – D Diarrhea – G Gastrointestinal Distress – E Emesis
Cholinergics
DUMBBELLS
– D Diarrhea – U Urination – M Miosis – B Bradycardia – B Bronchospasms – E Emesis – L Lacrimation – L Lethargy – S Salivation and Seizures
Ethanol overdose side effects (6) and mnemonic
SAMS GIN
- Decreased BP
- Decreased HR
- Decreased RR
- Decreased temp
- Depressed
- Decreased peristalsis
– S Slurred speech
– A Attention impairment
– M Memory impairment
– S Stupor or coma
– G Gait unsteady
– I Incoordination
– N Nystagmus
Opioid overdose side effects (7) and SAD mnemonic
- Decreased BP
- Decreased HR
- Decreased RR
- Decreased temp
- Decreased pupils
- Decreased peristalsis
- Depressed
– S Slurred speech
– A Attention impairment
– D Drowsiness
Ethanol Withdrawal symptoms (8) and PAST NITE mnemonic
- Increased BP
- Increased RR
- Increased HR
- Increased Temp
- Agitated
- Increased pupils
- Increased peristalsis
- Increased diaphoresis
– P Psychomotor agitation
– A Anxiety
– S Seizures
– T Transient hallucinations
– N Nausea or vomiting
– I Insomnia
– T Tremor
– E Excitability
Opioid Withdrawal symptoms (6) and ARMY FINDS mnemonic
- Increased BP
- Increased HR
- Agitated
- Increased pupils
- Increased peristalsis
- Increased diaphoresis
– A Aches
– R Rhinorrhea
– M Mood disorders
– Y Yawning
– F Fever – I Insomnia – N Nausea or vomiting – D Diarrhea – S Sweating
Anion Gap Acidosis Mneumonic for causes
MUD PILES – M Methanol – U Uremia – D Diabetic ketoacidosis – P Propylene glycol – I Isoniazid – L Lactic acidosis – E Ethylene glycol – S Salicylates
GI Decontamination
NOT the standard of care for all patients; don’t do it without poison center or toxicology consult
Considerations
- Type of ingestion
- Quantity and amount of ingestion
- Patient age/weight
- Other precluding medication conditions
Available Agents
- Ipecac syrup
- Activated charcoal –> used more often
Antidotes (4)
Should be used judiciously
– Agent/agents ingested confirmed
– Highly suspected and consistent with toxidrome
– High potential for morbidity or mortality without administration of antidote
– Reversal benefits outweigh the risks
Naloxone (Narcan)
USE
MOA
Use: opioid toxicity & opioid induced itching at low cont. infusions
Mechanism of Action
- Opioid antagonist, directly inhibits opioids from binding to mu-receptor
Naloxone (Narcan)
Dosage forms
PK
Caution
Dosage forms available
- IV/IM
- Nasal spray (4 mg dose)
PK:
- Quick onset and duration
Caution with rapid reversal especially if someone is truly in pain
N-acetylcysteine (NAC, Mucomyst®)
Use
MOA
Dosage forms
Beneficial if…
Use: acetaminophen toxicity
Mechanism of Action
- Free radical scavenger
- Repletes the glutathione
Dosage forms:
- IV
Most beneficial if used within 8 hours of ingestion
