Toxidromes

Question 1

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

Answer 1

Supportive care

Question 2

What toxidrome is seen with atropine?

Answer 2

Anti-cholinergic

Question 3

What toxidrome is seen with Jimsonweed?

Answer 3

Anti-cholinergic

Question 4

What toxidrome is seen with antihistamines?

Answer 4

Anti-cholinergic

Question 5

What toxidrome is seen with deadly nightshade?

Answer 5

Anti-cholinergic

Question 6

What are common causes of anti-cholinergic toxidrome?

Answer 6

Atropine, Jimsonweed, Antihistamines, Deadly Nightshade

Question 7

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

Answer 7

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

Question 8

What is the treatment for the anti-cholinergic toxidrome?

Answer 8

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

Question 9

What toxidrome is seen with organophosphate poisoning?

Answer 9

Cholinergic

Question 10

What toxidrome is seen with carbamate poisoning?

Answer 10

Cholinergic

Question 11

What toxidrome is seen with sarin poisoning?

Answer 11

Cholinergic

Question 12

What are the primary causes of cholinergic toxidrome?

Answer 12

Organophosphates
Carbamates
Sarin

Question 13

What are the classic features of the cholinergic toxidrome?

Answer 13

SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastrointestinal distress
Emesis

Also: bradycardia, miosis

Question 14

What is the treatment for cholinergic toxicity?

Answer 14

Atropine

2-PAM: if organophosphate caused

Question 15

What toxidrome is seen with cocaine?

Answer 15

Sympathomimetic

Question 16

What toxidrome is seen with amphetamines?

Answer 16

Sympathomimetic

Question 17

What toxidrome is seen with ephedrine?

Answer 17

Sympathomimetic

Question 18

What toxidrome is seen with ma huang?

Answer 18

Sympathomimetic

Question 19

What are some classic causes of a sympathomimetic toxidrome?

Answer 19

Cocaine
Amphetamines
Ephedrine
Ma Huang

Question 20

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

Answer 20

Agitation
Diaphoresis
HTN
Tachycardia
Hallucinations

Question 21

What is the treatment for a sympathomimetic toxidrome?

Answer 21

Benzos, supportive care

Question 22

Which toxidromes cause miosis?

Answer 22

Opioid

Cholinergic

Question 23

Which toxidromes cause mydriasis?

Answer 23

Anti-cholinergic

Sympathomimetic

Question 24

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

Answer 24

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.

Question 25

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

Answer 25

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

Question 26

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

Answer 26

Windshielf washer fluid, antifreeze, photocopier fluid Metabolized to formaldehyde and formic acid Causes anion gap metabolic acidosis with retinal toxicity

Question 27

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

Answer 27

Antifreeze, brake fluid, cleaning products Metabolized to oxalic acid leading to renal toxicity

Question 28

Where isopropanol come from and what are the primary effects?

Answer 28

Rubbing alcohol, perfume, hand sanitizer Converted to acetone Leads to ketosis without acidosis

Question 29

Which of the toxic alcohols lead to retinal toxicity?

Answer 29

Methanol

Question 30

Which of the toxic alcohols lead to renal toxicity?

Answer 30

Ethylene glycol

Question 31

Which of the toxic alcohols lead to ketosis without acidosis?

Answer 31

Isopropanol

Question 32

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

Answer 32

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

Question 33

What is the treatment for methanol overdose?

Answer 33

fomepizole and folate

Question 34

What is the treatment for ethylene glycol overdose?

Answer 34

fomepizole and thiamine and pyridoxime

Question 35

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

Answer 35

Methanol and Ethylene glycol toxicity Treat with fomepizole to block the action of ADH