Toxins

Question 1

Digoxin toxicity manifestations and treatment

Answer 1

Arrhythmias - suspect especially if bradycardia and gi symptoms
Management →
- Activated charcoal if <2hrs and protected airway
- treat arrhythmia, end organ dys function or hyperkalemia with digoxin specific antibody (fab) digi bind
- atropine 0.5 mg iv for Brady if antidote not available

Question 2

Cocaine intoxication manifestation and management

Answer 2

EKG → tachy +/- ischemic changes
Airway management (use rocuronium-avoid succinyl choline)
Manage hypo/hyperthermia
Diazepam 5mg iv Q3 -5 mins for agitation and hypertension
Phentolamine 1-5 mg iv for hypertension
Sodium bicarb 1-2 meq/kg iv push for QRS widening

Question 3

EKG manifestations with changes in serum potassium

Answer 3

<2.5 → depressed St segment, biphasic T wave, prominent u wave
>6 → tall t wave
>7.5 → tall wave, wide QRS, long Pr interval
>9 → absent p wave, sinusoidal wave

Question 4

Management of hyperkalemia > 7 mmol /l and ECG changes

Answer 4

1- stabilize myocardium: calcium gluconate 1 -2 amp iv ( 10-20 ml of 10% solution)
2-shift plasma intracellularly:
Regular insulin 10-20 units iv with 1-2 amps of D5OW (give dextrose before insulin) with bedside glucose monitoring q 1hr
Bicarb 1-3 amps diluted in 1L D5W
Beta 2 agonist, salbutamol nebs 10mg inhaled or 0.5 mg iv
3-Increase potassium removal from the body:
Urine → furosemide 40mg or more IV +/- normal saline
Gut → Kayexalate, lactulose
Last resort → Dialysis