Toxidromes Flashcards
What are the findings in a pt with stimulant overdose?
Vitals signs: tachycardia tachypnea hyperthermia HTN
Eye: mydriasis
Skin: diaphoretic
MSE: agitated, hallucination, paranoia, Sz
What are examples of stimulants?
Cocaine, amphetamines, pseudo ephedrine, caffeine, theophylline
What are eg of anticholinergic meds?
Antihistamines Antidepressants: TCA Antipsychotics: phenothiazine Atropine Antispasmodics Belladonna alkaloids: Jimson weed Mushrooms Deadly nightshade
What are the features of anticholinergic intoxication?
Vitals: tachycardia, tachypnea , HTN, hyperthermia
Eyes: mydriasis
MSE: agitation, hallucination, delirium
Skin: dry and flushed
What are eg of hallucinogens?
LSD
Ecstasy
Amphetamines
What is the smell of almonds assoc with?
Cyanide poisoning
What is the mnemonic for drugs causing an incr HR?
F reebace cocaine
A nticholinergics
S ympathomimetica
T heophylline
What’s the mnemonic for drugs causing decr HR?
P ropranolol A nticholinesterase drugs C lonidine E thanol D igoxin
Mnemonic for drugs causing miosis?
C holinergics, clonidine
O piates, organophosphates
P henothiazines
S edatives (barbiturates)
Mnemonic for drugs causing mydriasis?
A ntihistamines
A ntidepressants
A nticholinergics
S ympathomimetics (amphetamines,PCP, cocaine)
Blind as a bat Hot as hare Red as a beet Dry as a bone Mad as hatter This is a mnemonic for remembering the symptom complex assoc with what toxin? And what does each statement mean?
Mad as hatter
Mydriasis Hyperthermia Flushing Decr sweat, decr urine Delirium, hallucinations
These are assoc with anticholinergics (phenothiazine, antihistamines)
What is considered a potentially toxic dose of acetaminophen?
Acutely:
- Minimum dose of 150 mg/kg
- In adolescents and adults: 7.5g
Chronic dose:
150mg/kg/day for >2d
4gm/d for >2d
What is the mx of acute overdose of acetaminophen?
- Prevent further absorption with activated charcoal if within 1/2hr to 1hr of ingestion
- acetaminophen levels: 4hrs s/p ingestion (peak concentration)
- rumack Matthew nomogram to set likelihood of hepatic damage and need for tx w/ n-acetylcysteine (NAC) or acetylcysteine (mucomist)
What is the effect of toxic ingestion a of ibuprofen?
Usu very Rarely serious.
Serious toxicity >400mg/kg
Symptoms mostly GIT
Is iron ingestion concerning?
Yes!! Very serious toxicity can occur! Eg: pre-natal vits, fe supp Toxic dose of elemental fe are: - 20mg/kg GI symptoms - 50mg/kg signif toxicity
What are the features of Fe toxicity?
0-6hrs: GIT stg- nausea, d&v, abd pain, hematemesis, bloody diarrhea, direct damage to GIT mucosa
6-12: stability
W/in 48h: cvs collapse, metab acidosis (high anion gap)
2-3d: hepatic failure
2-6 wks: GIT and pyloric scarring
I 1 is indigestion
R 2 is recovery
O 3-4 oh my gosh
N 5 narrowing
How to dx fe toxicity?
- abd dx: tablets may be visible, fluid and chewable tabs are not
- serum fe level 4h s/p intake: 500 severe toxicity
How to tx fe toxicity?
Chelation with IV deferoxamine for
- mod-severe symptoms regardless of fe level
- Serum fe level >350 mcg/dl
- Pills on radiograph
If someone ingested oil of winter green( a baking product) what type if toxicity wud u be concerned about?
Salicylate toxicity
For salicylate ingestion what dose wud be concerning for acute toxicity?
150mg/kg
What are some acute signs of salicylate toxicity?
Nausea, vomiting, tinnitus, hyperventilation (respiratory alkalosis)
Dehydration, hypoK, metabolic acidosis (it uncouples oxidative phosphorylation),
Serious toxicity: hyperthermia, agitation, confusion, coma, renal failure, death(from pulmonary/cerebral edema, electrolyte imbalance, cvs collapse)
What’s the monitoring and mx for acute salicylate toxicity?
Monitoring: q2 to 4h monitoring of salicylate levels, ABG, chem, coags
Tx: activated charcoal (drug may form a bezoar in stomach), fluid hydration, correct electrolyte disturb (hypoK), raise urine pH w/ IV bicarbonate, hemodialysis
*there is no nomogram to reference
What are the features of acute TCA toxicity? When do symptoms usu occur?
Symptoms usu w/in 30mins to 6h
*CNS features are more prominent in children
*mnemonic: tri-C A
C -coma
C -cadiac dysrhythmia: incr HR, HTN, decr BP, wide QRS and prolonged Qt
C -convulsions
A -acidosis
What is the monitoring and tx for Axute TCA ingestion?
W/u: chem(hypoK), ABG, ECG, urine preg, utox (usu co-ingestions), acetaminophen/salicylate/etoh levels
Tx: protect airway, activated charcoal, alkalinize serum w/ Na-bicarb (7.45-7.55) to prevent dysrhythmia, monitor, EKG monitoring, tx dysrhythmia w/ lidocaine
What is the mechanism by which carbon monoxide poisoning is pathological?
Carbon monoxide has a higher affinity for Hb than O2. Once it binds to one of the 4 spots on Hb it creates carboxy-Hb which doesn’t readily release O2. O2 dissociation curve shifts to the left. So in the presence of adequate O2 the tissues are unable to use it!
What is the typical presentation of carbon monoxide poisoning?
*Family with flu like symptoms in winter!!!
Flu like symptoms: headache, dizziness, nausea, malaise
Visual changes, weakness, syncope, vomiting, ataxia, Sz, coma, death
*cherry red skin
What is the w/u and tx of carbon monoxide poisoning?
W/u: CO [ ] because pulse ox will be normal!!
Tx: high flow O2 (1/2 life is 5h on room air and 30-90 mins on 100% O2), tx anemia, ?use of hyperbaric O2 (in pregnant/neonatal pt’s)
What is the mx of an ingested button battery in the nose, ear or esophagus vs in the stomach? What’s the concern?
Button batteries can cause mucosal burns w/in 1h of ingestion and full thickened burns w/in 4h by caustic leakage if it’s contents or by electrical current. If in the E, N or esoph remove stat if in stomach wait and watch for passage in stool w/ q3d X-rays.
A child as ingested perfume and or mouthwash and presents w/ N&V, ataxia, slurred speech, resp depression and hypothermia. What would be you concern? What are other features of this?
Ethanol toxicity!
Can also cause Sz and coma
*in children <5 can also cause hypoglycemia, due to inhibition of hepatic gluconeogenesis
What is the w/u and tx in a suspected ethanol toxicity?
W/u: ethanol level, osmolar gap (an incr >10 identifies an unknown alcohol ingestion)
Tx:
ABCs, IVF, tx hypoglycemia, reward as needed, +/- screen for other toxins (ethanol may mask other toxicities)
What is a good screening tool to identify a toxic ingestion of alcohols? If abnormal what are the common offenders?
Serum osmolality:
2x Na (mmol/L) + glucose (mg/dl)/18 + BUN (mg/dL)/2.8
Normal is <10
Mnemonic for augmented osmolality gap: MAE DIE
Methanol, acetone, ethanol, diuretics(mannitol, sorbitol), isopropranolol, ethylene glycol
In a pt with calcium channel blocker toxicity, what is the tx?
Insulin and glucose
