Toxicology -- SD Flashcards
What are considered to be the “bad boys” for overdoses?
CCB, TCA, ethylene glycol, and alcohol
What EKG changes are seen in overdoses?
Arrhythmias, prolonged QT, widened QRS
What does MUDPILES stand for?
Methanol, Uremia, DKA, propylene glycol, isoniazid, lactic acidosis, ethylene glycol/ethanol, salicylates
How do we calculate an anion gap?
Sodium - (Bicarb + Chloride)
An anion gap less than _____ is normal
12
Patient is delirious, hyperventilating (Kussmal), and is complaining of tinnitus. What is the likely causative agent of OD?
Aspirin
At what levels are salicylates considered to be life threatening?
> 500mg/kg
How often do we repeat serum salicylate levels?
Every 2 hours
After how many hours do people reach their max absorption of salicylates?
6 hours
How do maintain a patient’s pH with an aspirin overdose?
Bicarb
monitor patient’s urine pH
What metabolic disorder typically accompanies aspirin overdose?
Metabolic acidosis
Do you see ECG changes with an aspirin overdose?
None
Gastric lavage can be done up to _______ minutes post ingestion
60
What is the treatment of choice for aspirin overdoses?
Dialysis
What is the max daily dose of tylenol?
4 grams in adults
What is the most common cause of acute liver failure?
Acetaminophen overdose
Why do children typically fare better from a tylenol overdose?
because they have more glutathione in their liver
tylenol overdose – people get sick right away or days later?
days later!
What makes a tylenol overdose even worse?
alcohol
When do you draw labs for a tylenol overdose?
immediately and then 4 hours later
True or False, tylenol overdose patients will suffer from metabolic acidosis?
False – pH should be normal. If you see acidosis, something else is on board.
How soon do we have to give NAC for tylenol overdose? What if the person is pregnant?
Within 8 hours
Anytime if the patient is pregnant
What are the four criteria you have to meet to get a liver transplant?
pH less than 7.3
Grade 3+ encephalopathic
Pt greater than 100
Serum creatinine greater than 3.4
This type of toxicity often mimics psychological illness
Psychotropic medicatios
What two psychotropic medications are considered to be the “bad boys?”
lithium and amitriptyline
What are symptoms of serotonin syndrome?
Agitation, confusion, tremor rigidity, hyperreflexia, ataxia
What lab must we check for in psychotropic toxicity?
Creatinine kinase – check for rhabdomyolysis
How do we treat psychotropic toxicity?
Benzo’s!
BP control, fluid for rhabdo, and cooling
What dose is a toxic dose in terms of TCA’s?
10-20mg/kg
When do TCA’s reach peak absorption?
1 hour
What does SALT stand for? and what toxicity is it connected to?
Connected to TCA’s
Stands for shock, AMS, wide QRS, terminal R wave in AVR
How do we treat a TCA overdose?
Bicarb! Intubation is key in severe OD, serial EKG’s, and seizure precautions
what are the take home points of TCA toxicity?
- Initially asymptomatic – then crash shortly thereafter
- Look for classic ECG findings
- Tachy (acidotic) –> give bicarb
What two opioids that we talked about are extended release?
Dilaudid, Methadone
How do opioid overdose patients present?
Respiratory depression with altered mental status
when do you start cardiac issues with an opioid overdose?
Only if the patient has been down a long time!
If any patient comes into the ED unresponsive, what blood test should we get?
Blood sugar!
What does narcan promote?
aggression
What are the take home points from opioid overdose?
- Opiates last longer than Narcan (sometimes)
- Usually all issues involve respiratory
- Wake up angry
- If still altered – other ingestion vs. anoxic brain injury
What is the legal limit for alcohol?
0.08 or 80 in the medical world
This overdose causes vasodilation and bradycardia
Calcium channel blockers (Verapamil)
What dose of a CCB do we consider it to be a serious ingestion?
greater than 1 gram
What formulation of CCB is the most dangerous?
Extended release
How do we treat a CCB overdose?
Calcium chloride, pacing, and pressors
Ethylene glycol causes what metabolic disturbance?
Severe metabolic acidosis
How do ethylene glycol overdoses typically present?
Kussmal breathing, altered mental status
How do we treat an ethylene glycol overdose?
Fluids, bicarb to correct acidosis
What is considered to be the treatment of choice for ethylene glycol overdose?
Fomepizole – other option is ethanol drip
What are the take home points from ethylene glycol overdose?
- Sick as hell
- Severe acidosis
- Fomepizole, ethanol drip, dialysis
