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Emergency Medicine > Toxidromes > Flashcards

Toxidromes Flashcards

1
Q

What is treatment strategy for sedative/hypnotic overdose such as alcohol, benzos, muscle relaxants?

A

Supportive care

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2
Q

What toxidrome is seen with atropine?

A

Anti-cholinergic

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3
Q

What toxidrome is seen with Jimsonweed?

A

Anti-cholinergic

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4
Q

What toxidrome is seen with antihistamines?

A

Anti-cholinergic

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5
Q

What toxidrome is seen with deadly nightshade?

A

Anti-cholinergic

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6
Q

What are common causes of anti-cholinergic toxidrome?

A

Atropine, Jimsonweed, Antihistamines, Deadly Nightshade

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7
Q

What are the classic features of the anti-cholinergic toxidrome?

A 
Dry as a bone: dry mouth, urinary retention, no sweating
Mad as a hatter: confused
Hot as a hare: hyperthermia
Red as a beet: flushed
Blind as a bat: mydriasis
Tachycardia
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8
Q

What is the treatment for the anti-cholinergic toxidrome?

A

Physostigmine: naturally occuring cholinesterase inhibitor
Benzos: used to counteract the sympathomimetic response?

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9
Q

What toxidrome is seen with organophosphate poisoning?

A

Cholinergic

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10
Q

What toxidrome is seen with carbamate poisoning?

A

Cholinergic

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11
Q

What toxidrome is seen with sarin poisoning?

A

Cholinergic

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12
Q

What are the primary causes of cholinergic toxidrome?

A

Organophosphates
Carbamates
Sarin

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13
Q

What are the classic features of the cholinergic toxidrome?

A 
SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastrointestinal distress
Emesis

Also: bradycardia, miosis

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14
Q

What is the treatment for cholinergic toxicity?

A

Atropine

2-PAM: if organophosphate caused

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15
Q

What toxidrome is seen with cocaine?

A

Sympathomimetic

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16
Q

What toxidrome is seen with amphetamines?

A

Sympathomimetic

17
Q

What toxidrome is seen with ephedrine?

A

Sympathomimetic

18
Q

What toxidrome is seen with ma huang?

A

Sympathomimetic

19
Q

What are some classic causes of a sympathomimetic toxidrome?

A

Cocaine
Amphetamines
Ephedrine
Ma Huang

20
Q

What are the classic signs and symptoms of a sympathomimetic toxidrome?

A 
Agitation
Diaphoresis
HTN
Tachycardia
Hallucinations
21
Q

What is the treatment for a sympathomimetic toxidrome?

A

Benzos, supportive care

22
Q

Which toxidromes cause miosis?

A

Opioid

Cholinergic

23
Q

Which toxidromes cause mydriasis?

A

Anti-cholinergic

Sympathomimetic

24
Q

What is a major differentiating feature between anti-cholinergic and sympathomimetic?

A

Anti-cholinergic will be dry whereas sympathomimetic will be diaphoretic.
In many other ways the two will be very similar such as tachycardia, and mydriasis.

25
Q

When using activated charcoal, what timeframe is it used, when does it definitely not work, and what must beware of?

A

Use within 1-2 hours
Won’t work on metals like iron or lithium, or alcohols
Beware of aspiration

26
Q

Where does methanol toxicity usually come from, and what are the expected effects?

A

Windshielf washer fluid, antifreeze, photocopier fluid

Metabolized to formaldehyde and formic acid

Causes anion gap metabolic acidosis with retinal toxicity

27
Q

Where does ethylene glycol come from and what is the primary expected effect?

A

Antifreeze, brake fluid, cleaning products

Metabolized to oxalic acid leading to renal toxicity

28
Q

Where isopropanol come from and what are the primary effects?

A

Rubbing alcohol, perfume, hand sanitizer

Converted to acetone
Leads to ketosis without acidosis

29
Q

Which of the toxic alcohols lead to retinal toxicity?

A

Methanol

30
Q

Which of the toxic alcohols lead to renal toxicity?

A

Ethylene glycol

31
Q

Which of the toxic alcohols lead to ketosis without acidosis?

A

Isopropanol

32
Q

What mediation is used to treat methanol and ethylene glycol ingestion and what is the MOA?

A

Fomepizole

Inhibits alcohol dehydrogenase preventing conversion to toxic breakdown products such as formaldehyde and oxalic acid

33
Q

What is the treatment for methanol overdose?

A

fomepizole and folate

34
Q

What is the treatment for ethylene glycol overdose?

A

fomepizole and thiamine and pyridoxime

35
Q

Pt states they drank antifreeze. What toxidromes are possible and what is the treatment?

A

Methanol and Ethylene glycol toxicity

Treat with fomepizole to block the action of ADH

Emergency Medicine (4 decks)

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