Toxins Flashcards
Dose of activated charcoal
0.5-1 g/kg (max/adult 25-100g)
When charcoal is a poor choice
Cyanide
Alcohol/alkaline/kerosene
Lithium
Heavy metals
Acetaminophen overdose
> 140 mg/kg
Most important predictor of outcome regarding acetaminophen toxicity
Level at 4-10hr post ingestion
First step of acetaminophen ingestion
Activated charcoal (if within first 4 hours)
Management of acetaminophen ingestion is > 140 mg/kg
NAC
Reason NAC is beneficial in acetaminophen toxicity/overdose
Replenishes depleted glutathione stores
“Wintergreen” breath odor
Tinnitus
Respiratory alkalosis (1)
HAGMA (2)
Salicylate toxicity
Management for salicylate toxicity
1) activated charcoal
2) sodium bicarbonate
3) treat hypoglycemia +/- glucose
Anion gap
Na - (Cl + HCO3)
Examples of methanol
Windshield water fluid
Cooking fuel
Perfumes
Antifreeze
Sign/Symptoms of methanol toxicity
HAGMA
CNS depression
Abdominal pain, vomiting
Inebriation
Blurred vision
“Snow field” vision
Edema of optic disc
Methanol toxicity
Management of methanol toxicity
Ethanol
(EtOh dehydrogenase antagonist - slows conversion of methanol to formaldehyde)
Sodium bicarbonate
4-MP (FDA approved in Europe)
Anti-freeze
Ethylene glycol
Drunk
No odor
HAGMA
Ethylene glycol toxicity
3 phases of ethylene glycol toxicity
1) N/V, tachycardia, HTN, met acidosis, Ca oxylate crystals leaving to hypoCa
2) coma and cardiorespiratory failure
3) ATN
Management for ethylene glycol toxicity
Fomepizole
(Prevents breakdown of ethylene glycol to its toxic metabolites - oxalic and glycolic acid)
Salivation/sweating
Lacrimation
Urination
Defecation/diarrhea
Gastrointestinal
Emesis
Organophosphate toxicity
Mechanism of action for organophosphate
Acetylcholinesterase inhibitor
Symptoms of muscarinic cholinergic
Management
Salivation
Lacrimation
Diarrhea
Wheezing
Bradycardia
Tx: atropine
Symptoms of nicotinic cholinergic
Management
Weakness
Paralysis
Muscle fasciculations
Tx: pralidoxime
Mechanism of action for TCAs
Anticholingeric
Cardiac toxicity of TCAs
Management
Prolonged QRS
Tx: NaBicarb until QRS < 100 msec
Depressed sensorium
Bradycardia
Hypotension
Diaphoresis
Management
Beta blocker ingestion
Tx: glucagon (if symptomatic)
Sudden flu-like symptoms
Afebrile
Singed nasal hairs
Management
Carbon monoxide toxicity
Tx: 100% high flow oxygen
Mechanism of action for carbon monoxide toxicity
Competitively bonds Hgb (much higher affinity than O2)
Lowers O2 carrying capacity
Normal SpO2 (pulse Ox cannot distinguish between carboxyHgb and OxyHgb)
Metabolic acidosis
Smell of almonds
Untreated CO poisoning with oxygen
Management
Cyanide poisoning
Tx: hydroxycobalamin. Na thiosulfate, nitrate
Dishwasher detergent
Drain cleaner
deep liquefication necrosis
Respiratory/GI distress
Management
Alkaline ingestion
Tx: supportive +/- endoscopy
Lead level (mcg/dL)
Repeat screening (venous)
Management
5-14: repeat 3 mo. History, screen
15-44: repeat 4 wks. Above + Xray (pica)
45-70: repeat 48 hr. Above + chelation (PO succimer) +/- admission
>
- Repeat now. Admit. Whole bowel irrigation. IM dimercaprol followed by IV edetate Ca disodium)
Symptoms of lead poisoning
Headache
Lethargy
Microcytic anemia (basophilic stippling)
Burton lines on teeth
Lead lines on Xray (marked linear increases in density of metaphysis)
Lab values seen in severe iron ingestion
Serum Iron > 350
WBC > 15k
Glucose > 150
Management for iron ingestion
Chelation (severe symptoms)
Deferoxamine (turns urine pink-red)
Pigmentation and rash
Cutting teeth prematurely (early eruption)
Low birthweight
PCB ingestion
Begins in face/extremities
Leaves scars
Lesions are same stage
Delirium
Smallpox
Begins centrally
Scarring rare
Lesions in varying stages
Varicella
Starts as pruritic papule
Progresses to central bullous lesion
Becomes necrotic
Forms central black painless Escobar
Cutaneous anthrax
Toxin-induced distal RTA (type 1)
Toluene
Osmolal gap without HAGMA
Isopropyl alcohol
