Toxicosis Patient management

Question 1

Why do patients with exposure to phosphide pesticides need to be treated in well ventilated areas?

Answer 1

• Creates phosphine gas
  
  • Smells like garlic/rotten eggs
• Asthma-like symptoms
• Nausea
• Headache

Question 2

What toxins alter patient behavior with aggression/dysphoria?

Answer 2

• Amphetamines
• Caffeine
• Anti-depressants
• Theobromine
• Baclofen
• Recreational drugs
• CNS stimulants

Question 3

What are the ideal drugs for treating Agitation/Hyperactivity due to toxicosis?

Answer 3

• Acepromazine
• Chlorpromazine
• Butorphanol

Question 4

What are the ideal drugs for treating Tremors due to toxicosis?

Answer 4

• Methocarbamol
• Benzodiazepines - often less effective
  
  • Diazepam & midazolam

Question 5

What are the ideal drugs for treating Seizures due to Toxicosis?

Answer 5

• Diazepam/Midazolam
  
  • Avoid in toxicities with stimulator effects
    
    • Amphetamines, methyphenidate, SSRIs
• Phenobarbital
• Levetiracetam (Keppra)

Question 6

What is the ideal drug to treat Cerebral Edema due to toxicosis?

Answer 6

• Mannitol

Question 7

What are the ideal fluids for Renal Toxicosis Management?

Answer 7

• Crystalloids
  
  • LRS
  • 0.9% NaCl - ideal for cholecalciferol
  • Norm-R
• Furosemide
• Mannitol

Question 8

What are the ideal drugs for managing Mild liver enzyme elevations due to toxicosis?

Answer 8

• S-Adenosyl-Methionine (SAMe)
  
  • denosyl
• SAMe with Milk thistle
  
  • Denamarin

Question 9

What is the ideal drug for treating toxicosis with a risk of hepatic necrosis?

Answer 9

• N-Acetylcysteine (NAC)

Question 10

What are the ideal drugs to manage tacycardia due to toxicosis?

Answer 10

• Acepromazine
• Butorphanol
• Beta Blockers (ie - Albuterol toxicosis)
  
  • Esmolol
  • Propranolol
  • Metoprolol

Question 11

What are the ideal drugs to manage bradycardia due to toxicosis?

Answer 11

• Atropine
• Calcium gluconate 10%

Question 12

What are the ideal drugs for managing hypertension due to toxicosis?

Answer 12

• Acepromazine
• Amlodipine
• Beta Blocker
  
  • Esmolol
  • Propranolol
• Hydralazine
• ACE inhibitors
• Isoflurane

Question 13

What are the ideal drugs to manage hypotension due to toxicosis?

Answer 13

• IV fluids:
  
  • Cystalloids
  • Colloids
• Vasopressors
  
  • Dopamine
  • Norepinephrine
  • Dobutamine
  • Vasopressin
  • Epinephrine
  • digoxin

Question 14

What are the ideal drugs for managing vomiting due to toxicosis?

Answer 14

• Maropitant (Cerenia)
• Metoclopramide
• Ondansetron
• Dolasetron mesylate

Question 15

What are the ideal GI protectants to use when treating toxicosis?

Answer 15

• H2 blockers
  
  • Famotidine
  • Cimetidine
  • Ranitidine
• Sucralfate
• Proton Pump inhibitors
  
  • Omeprazole
• PG E1 analog
  
  • Misoprostol

Question 16

What are the ideal drugs to treat diarrhea due to toxicosis?

Answer 16

• Metronidazole
• Probiotics
• Fiber
• Bland diet

Question 17

What is the ideal drug for potential ileus due to toxicosis?

Answer 17

Metoclopramide

Question 18

What is an Intralipid emulsion?

Answer 18

• Antidote for fat-soluble toxins
  
  • Ivermectin/Moxidectin
  • Baclofen
  • Beta Blockers
  • Calcium Channel Blockers
  • Local Anesthetics
  • Buproprion
  • Permethrin/Pyrethrins
• Works as a ‘lipid sponge’
• LogD: Measure of lipophilicity
  
  • helps determine potential benefit