Toxin Poisoning

Question 1

Abdominal pain, vomiting, severe watery diarrhea, delirium, hypotension from dehydration. QT prolongation. Garlic odor on patient’s breath or stool.

Answer 1

Arsenic poisoning. Pesticides/insecticides, contaminated water, metallurgy, mining, glass making.

Question 2

Molecular mechanism of Arsenic poisoning

Answer 2

Binds sulfhydryl groups, inhibiting cellular respiration via inhibition of pyruvate dehydrogenase

Question 3

Treatment of Arsenic poisoning

Answer 3

Dimercaprol forms non-toxic soluble chelates

Question 4

Constipation, anemia, irritability and confusion

Answer 4

Acute lead toxicity

Question 5

Treatment of acute lead toxicity

Answer 5

CaNa2EDTA forms non-ionizing salts to increase lead urinary excretion

Question 6

Treatment for iron overdose or overload

Answer 6

Deferoxamine chelates iron and facilitates its urinary excretion

Question 7

Confusion, flushing (cherry-red skin color), abdominal pain, and vomiting

Answer 7

Cyanide poisoning

Question 8

Treatment for cyanide poisoning

Answer 8

Hydroxycobalamin (vitamin B12 precursor) binds intracellular cyanide forming cyanocobalamin for urinary excretion

Question 9

Gray or blue colored skin, shortness of breath, and “chocolate colored” blood

Answer 9

Methemoglobinemia

Question 10

Treatment for Methemoglobinemia

Answer 10

Methylene blue acts as an artificial electron transporter for reduction of methemoglobin through the NADPH pathway

Question 11

Mechanism of action and effects of amatoxins (poisonous mushrooms)

Answer 11

Concentrate in the liver and halt mRNA synthesis by binding RNA pol 2 (DNA-dependent RNA polymerase II) resulting in apoptosis. Abdominal pain, vomiting, severe cholera-like diarrhea; leads to acute renal and hepatic failure. Alpha-amantin in urine can confirm dx.