Toxidromes and others

Question 1

When is activated charcoal NO indicated ( for what ingestions)

Answer 1

CHAMPS
C- camphor and caustics ( NaOH, KOH, CL)
H-hydrocarbones ( kerosene, gasoline, mineral oil)
A- Alcohol- ethanol, methanol. ethylene glycol , acids and alkalis
M- Metal ( arsenic, iron, mercury, lead)
P- pestisides ( organophosphates)

Question 2

Arrhythmia associated with CCB

Answer 2

AV/SA node blocks and Prolonged QT

Question 3

Arrhythmia associated with Beta Blockers

Answer 3

Ventricular Arrhythmia’s

Question 4

Pearls- ALWAYS calls poison control when ingestion is suspected

Answer 4

call poison control- even in ED

Question 5

Charcoal is useful following what ingestions

Answer 5

Carbamazepine, dapsone, phenobarbital, quinine, theophylline, salicylates, slow release preparations, dig and phenytoin
GIVE within ONE hour of ingestion

Question 6

Terry overdosed on Acetaminophen after getting kicked off the soccer team.. when should you check a Acetaminophen level and what labs do you want to monitor

Answer 6

Check level at 4 hours,plot of monogram.. ( determines the severity of the toxicity)

Check LFTs/PT/PTT, lytes..

Question 7

What is Alkalization and when is it indicated

Answer 7

Administering sodium bicarbonate IV to achieve urinary Ph 7-9..

Useful in eliminated: salicylates, barbiturates, methotrexate

Question 8

Pearl

Answer 8

AST in the most sensitive lab test of hepatotxicity

Question 9

Mgmt for acetaminophen OD

Answer 9

NAC within 8 hours of ingestion

Activated charcoal may be given 1-2 hours of ingestion

Question 10

Mgmt of Methanol and Ethylene glycol

Answer 10

NO charcoal. 
Aggressive alkalization ( give sodium bicarb)

Question 11

Antidote for Methanol and Ethylene glycol

Answer 11

Fomepizole ( for high anion gap acidosis consistent with ingestion of alcohol)

Question 12

Mgmt of TCA’s ( anticholinergic)

Answer 12

Gastric lavage followed by activated charcoal, supportive therapy ( fluids, antiarrythmias, vasopressors), sodium bicarb

Rhythm that is common– prolonged QT

Question 13

MGMT of CCB OD

Answer 13

ABCs, activated charcoal, calcium infusion, glucagon, hyperinsulinemia/euglycemia therapy- continuous insulin and dextrose infusion

Question 14

Mgmt of BB oD

Answer 14

same as CCB

Question 15

Mgmt of oral hypoglycemia OD

Answer 15

IV dextrose, glucagon, corticosteriods, diazoxide, octreotide ( treatment of choice for sulfonylurea induced hypoglycemia , avoids the need for IV dextrose)

Question 16

Sympathomimetics toxidrome

Answer 16

HTN, tachycardia, arrhythmia’s, mydriasis, anxiety, excessive speech, anxiety, tremor, insomnia and hyperthermia

TX: consider benzos, lidocain, sodium bicarb, nitropruside and nitroglycerin- avoid Beta Blockers

Question 17

Cholinergic toxidrome ( insectiside)

Answer 17

Characterized by SLUDE - salivation, lacrimation, urination, defecation, gastric cramping, emesis

others:increased secretions, confusion agitation coma, seizure, muscle weakness

Question 18

antidote for a cholinergic OD

Answer 18

anticholinergic

Question 19

anticholinergic toxidrome * TCAS, antidepressants)

Answer 19

hot as a fire, red as a beet,dry as a bone, blind as a bat, mad as a hatter..

hot, red/flushed/decreased salivation, urinary retention, mydriasis, mad, delirium

Antidote: physostimine

Question 20

opioid toxidrome

Answer 20

coma, miosis, respiratory depression, bradycardia, hypotensions

Antidote: narcan

Question 21

iron

Answer 21

chelation therapy when level is >45.. kids 1-5 are at greatest risk of toxicity.