Toxicology Flashcards
First action when handling an expected ingestion
-ABCs
—-Vomiting, not breathing, check a pH
-SpO2/EtCO2
—When a pulse ox can steer you wrong - carbon monoxide poisoning
—-EtCO2 is a better measure, if they are not breathing, EtCO2 will increase
-EKG
-CNS - blood glucose, seizure
- Toxidromes - clues to certain ingestion
- Imaging
-Alter toxin pharmacokinetics - slow absorbsion, block the drug or increase rate of elimination
Options of treatment when someone ingests something
-Activated charcoal
—Latches onto substances and helps it out of the body and does not allow it to go into the cells or organs
-Gastric lavage - not very useful
-Whole Bowel Irrigation
—Need to drink a gallon of Go Lytely
—Usually do this if you have swallowed packages of drugs that are wrapped
—Also good for long acting drugs like Lithium
-Hemodialysis
—Poisonous alcohol
—Tricyclics
Labs
EKG
Symptoms of cholinergic drugs
i.e. Donepizil
SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastro
Emesis
Symptoms of anticholinergic drugs
Benadryl, Atropine, Benztropine
Blind as a bat
Mad as a hatter
Dry as a bone - Can’t pee
Red as a beet
Tachycardia
EKG changes in different toxic ingestions
Brady arrhythmias?
Tachyarrhythmias?
Long QTc?
Wide QRS?
ST elevations?
Osborn wave?
Bradyarrhythmias
-Digoxin, CCB, beta blockers, clonidine
Tachyarrhythmias
-Stimulants, TCAs, cholinergics
Long QTC
-Antipsychotics, SSRI, TCA, antifungals, Zofran
Wide QRS
-TCA, benadryl, cocaine, lidocaine
ST elevations
- cocaine, amphetamines
Osborn wave (notched right after the S before the T)
-hypothermia
Tylenol OD: Time of onset, pathophys
Rapidly absorbed within 4 hours of taking it
—Should therefore obtain tylenol level at 4, 8, 12 hours
Upper limit of normal is 4g in 24 hours
—Tylenol level of 150
Breaks down into toxic metabolite NAPQI
Normally there is enough glutathione to break it down and metabolize it appropriately in the liver but in overdose, it runs out of glutathione
Tylenol OD: medications for treatment
N-Acetylcysteine (Mucomyst)
-Oral every 4 hours or IV loading dose and then 2 additional doses
-Will definitely need antiemetics
-NAC replaces glutathione to help break down NAPQI
-Might help reverse liver failure
Features of digoxin overdose and treatment
Digoxin decrease the rate of depolarization and conduction through the SA and AV nodes
Digoxin toxicity causes lethargy, confusion, weakness, abd pain, n/v
Obtain Digoxin level 6 hours after last dose
Likely will see hyperK and Salvador Dali wave on EKG
Treat with Activated Charcoal and Digiband - Dig Fab
Features of toxic alcohol poisoning
Visual disturbances, GI bleed, pancreatitis, vomiting
Will see increase in osmolal gap and metabolic acidosis
Give ethanol or fomepizole and plenty of IVF
What are most overdoses treated with?
Supportive care
Salicylate intoxication: Symptoms and treatment
Aspirin overdose
Symptoms do not usually start for several hours after ingestions
Symptoms:
N/v
Tinnitus, dizziness, headache
Dehydration
Hyperthermia
Apnea, cyanosis, metabolic acidosis
Elevated LFTs
Treatment:
Activated charcoal
Sodium bicarb IV to correct severe acidosis
Organophosphate (Insecticide) Poisoning: Symptoms and Treatment
Symptoms:
N/V/D
Excessive salivation
Headache
Blurred Vision and miosis
Bradycardia
Mental confusion
Management:
If external - wash skin thoroughly
If internal - activated charcoal
Should keep atropine close by because of bradycardia
Treatment of a patient with serotonin syndrome
Dantrolene Sodium
Klonopin to treat rigors and agitation
Cooling blankets to control temp
Symptoms and Treatment of beta-blocker OD
Symptoms:
Hypotension
Sinus bradycardia
Delirium
Bronchospasm
Treatment:
Charcoal if appropriate - if recent
Glucagon - if more than 4 hours ago
Atropine, as needed
Stabilization of airway
Symptoms and treatment of ethylene glycol overdose
Symptoms:
First stage (30 mins - 12 hours)
—Loss of coordination
—Headache
—Slurred Speech
—N/V
Second stage (12-24 hours)
—Irregular heartbeat
—Shallow breathing
—Changes in blood pressure
Third stage (24-72 hours)
—Kidney failure
Treatment:
Fomepizole (Antizol)
Ethanol if fomepizole is not available
