Toxidromes Flashcards
What is treatment strategy for sedative/hypnotic overdose such as alcohol, benzos, muscle relaxants?
Supportive care
What toxidrome is seen with atropine?
Anti-cholinergic
What toxidrome is seen with Jimsonweed?
Anti-cholinergic
What toxidrome is seen with antihistamines?
Anti-cholinergic
What toxidrome is seen with deadly nightshade?
Anti-cholinergic
What are common causes of anti-cholinergic toxidrome?
Atropine, Jimsonweed, Antihistamines, Deadly Nightshade
What are the classic features of the anti-cholinergic toxidrome?
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
What is the treatment for the anti-cholinergic toxidrome?
Physostigmine: naturally occuring cholinesterase inhibitor
Benzos: used to counteract the sympathomimetic response?
What toxidrome is seen with organophosphate poisoning?
Cholinergic
What toxidrome is seen with carbamate poisoning?
Cholinergic
What toxidrome is seen with sarin poisoning?
Cholinergic
What are the primary causes of cholinergic toxidrome?
Organophosphates
Carbamates
Sarin
What are the classic features of the cholinergic toxidrome?
SLUDGE Salivation Lacrimation Urination Diarrhea Gastrointestinal distress Emesis
Also: bradycardia, miosis
What is the treatment for cholinergic toxicity?
Atropine
2-PAM: if organophosphate caused
What toxidrome is seen with cocaine?
Sympathomimetic
What toxidrome is seen with amphetamines?
Sympathomimetic
What toxidrome is seen with ephedrine?
Sympathomimetic
What toxidrome is seen with ma huang?
Sympathomimetic
What are some classic causes of a sympathomimetic toxidrome?
Cocaine
Amphetamines
Ephedrine
Ma Huang
What are the classic signs and symptoms of a sympathomimetic toxidrome?
Agitation Diaphoresis HTN Tachycardia Hallucinations
What is the treatment for a sympathomimetic toxidrome?
Benzos, supportive care
Which toxidromes cause miosis?
Opioid
Cholinergic
Which toxidromes cause mydriasis?
Anti-cholinergic
Sympathomimetic
What is a major differentiating feature between anti-cholinergic and sympathomimetic?
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.
When using activated charcoal, what timeframe is it used, when does it definitely not work, and what must beware of?
Use within 1-2 hours
Won’t work on metals like iron or lithium, or alcohols
Beware of aspiration
Where does methanol toxicity usually come from, and what are the expected effects?
Windshielf washer fluid, antifreeze, photocopier fluid
Metabolized to formaldehyde and formic acid
Causes anion gap metabolic acidosis with retinal toxicity
Where does ethylene glycol come from and what is the primary expected effect?
Antifreeze, brake fluid, cleaning products
Metabolized to oxalic acid leading to renal toxicity
Where isopropanol come from and what are the primary effects?
Rubbing alcohol, perfume, hand sanitizer
Converted to acetone
Leads to ketosis without acidosis
Which of the toxic alcohols lead to retinal toxicity?
Methanol
Which of the toxic alcohols lead to renal toxicity?
Ethylene glycol
Which of the toxic alcohols lead to ketosis without acidosis?
Isopropanol
What mediation is used to treat methanol and ethylene glycol ingestion and what is the MOA?
Fomepizole
Inhibits alcohol dehydrogenase preventing conversion to toxic breakdown products such as formaldehyde and oxalic acid
What is the treatment for methanol overdose?
fomepizole and folate
What is the treatment for ethylene glycol overdose?
fomepizole and thiamine and pyridoxime
Pt states they drank antifreeze. What toxidromes are possible and what is the treatment?
Methanol and Ethylene glycol toxicity
Treat with fomepizole to block the action of ADH
