Toxins

Question 1

Dose of activated charcoal

Answer 1

0.5-1 g/kg (max/adult 25-100g)

Question 2

When charcoal is a poor choice

Answer 2

Cyanide
Alcohol/alkaline/kerosene
Lithium
Heavy metals

Question 3

Acetaminophen overdose

Answer 3

> 140 mg/kg

Question 4

Most important predictor of outcome regarding acetaminophen toxicity

Answer 4

Level at 4-10hr post ingestion

Question 5

First step of acetaminophen ingestion

Answer 5

Activated charcoal (if within first 4 hours)

Question 6

Management of acetaminophen ingestion is > 140 mg/kg

Answer 6

NAC

Question 7

Reason NAC is beneficial in acetaminophen toxicity/overdose

Answer 7

Replenishes depleted glutathione stores

Question 8

“Wintergreen” breath odor
Tinnitus
Respiratory alkalosis (1)
HAGMA (2)

Answer 8

Salicylate toxicity

Question 9

Management for salicylate toxicity

Answer 9

1) activated charcoal
2) sodium bicarbonate
3) treat hypoglycemia +/- glucose

Question 10

Anion gap

Answer 10

Na - (Cl + HCO3)

Question 11

Examples of methanol

Answer 11

Windshield water fluid
Cooking fuel
Perfumes
Antifreeze

Question 12

Sign/Symptoms of methanol toxicity

Answer 12

HAGMA
CNS depression
Abdominal pain, vomiting
Inebriation

Question 13

Blurred vision
“Snow field” vision
Edema of optic disc

Answer 13

Methanol toxicity

Question 14

Management of methanol toxicity

Answer 14

Ethanol
(EtOh dehydrogenase antagonist - slows conversion of methanol to formaldehyde)

Sodium bicarbonate

4-MP (FDA approved in Europe)

Question 15

Anti-freeze

Answer 15

Ethylene glycol

Question 16

Drunk
No odor
HAGMA

Answer 16

Ethylene glycol toxicity

Question 17

3 phases of ethylene glycol toxicity

Answer 17

1) N/V, tachycardia, HTN, met acidosis, Ca oxylate crystals leaving to hypoCa

2) coma and cardiorespiratory failure

3) ATN

Question 18

Management for ethylene glycol toxicity

Answer 18

Fomepizole
(Prevents breakdown of ethylene glycol to its toxic metabolites - oxalic and glycolic acid)

Question 19

Salivation/sweating
Lacrimation
Urination
Defecation/diarrhea
Gastrointestinal
Emesis

Answer 19

Organophosphate toxicity

Question 20

Mechanism of action for organophosphate

Answer 20

Acetylcholinesterase inhibitor

Question 21

Symptoms of muscarinic cholinergic

Management

Answer 21

Salivation
Lacrimation
Diarrhea
Wheezing
Bradycardia

Tx: atropine

Question 22

Symptoms of nicotinic cholinergic

Management

Answer 22

Weakness
Paralysis
Muscle fasciculations

Tx: pralidoxime

Question 23

Mechanism of action for TCAs

Answer 23

Anticholingeric

Question 24

Cardiac toxicity of TCAs

Management

Answer 24

Prolonged QRS

Tx: NaBicarb until QRS < 100 msec

Question 25

Depressed sensorium Bradycardia Hypotension Diaphoresis Management

Answer 25

Beta blocker ingestion Tx: glucagon (if symptomatic)

Question 26

Sudden flu-like symptoms Afebrile Singed nasal hairs Management

Answer 26

Carbon monoxide toxicity Tx: 100% high flow oxygen

Question 27

Mechanism of action for carbon monoxide toxicity

Answer 27

Competitively bonds Hgb (much higher affinity than O2) Lowers O2 carrying capacity Normal SpO2 (pulse Ox cannot distinguish between carboxyHgb and OxyHgb)

Question 28

Metabolic acidosis Smell of almonds Untreated CO poisoning with oxygen Management

Answer 28

Cyanide poisoning Tx: hydroxycobalamin. Na thiosulfate, nitrate

Question 29

Dishwasher detergent Drain cleaner deep liquefication necrosis Respiratory/GI distress Management

Answer 29

Alkaline ingestion Tx: supportive +/- endoscopy

Question 30

Lead level (mcg/dL) Repeat screening (venous) Management

Answer 30

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 > 70. Repeat now. Admit. Whole bowel irrigation. IM dimercaprol followed by IV edetate Ca disodium)

Question 31

Symptoms of lead poisoning

Answer 31

Headache Lethargy Microcytic anemia (basophilic stippling) Burton lines on teeth Lead lines on Xray (marked linear increases in density of metaphysis)

Question 32

Lab values seen in severe iron ingestion

Answer 32

Serum Iron > 350 WBC > 15k Glucose > 150

Question 33

Management for iron ingestion

Answer 33

Chelation (severe symptoms) Deferoxamine (turns urine pink-red)

Question 34

Pigmentation and rash Cutting teeth prematurely (early eruption) Low birthweight

Answer 34

PCB ingestion

Question 35

Begins in face/extremities Leaves scars Lesions are same stage Delirium

Answer 35

Smallpox

Question 36

Begins centrally Scarring rare Lesions in varying stages

Answer 36

Varicella

Question 37

Starts as pruritic papule Progresses to central bullous lesion Becomes necrotic Forms central black painless Escobar

Answer 37

Cutaneous anthrax

Question 38

Toxin-induced distal RTA (type 1)

Answer 38

Toluene

Question 39

Osmolal gap without HAGMA

Answer 39

Isopropyl alcohol