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Lectures > Toxidromes > Flashcards

Toxidromes Flashcards

1
Q

What is the first line treatment for sympathomimetic overdose?

A

Benzo

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2
Q

What is the treatment for a wide QRS for any intoxication?

A

Sodium bicarb

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3
Q

What kills cholinergic intoxication?

A

Bronchorrea

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4
Q

What are the s/sx of nicotinic toxidrome? (MTWHF)

A
  • Mydriasis
  • Tachy
  • Weakness
  • HTN
  • Fasciculation
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5
Q

What is the treatment for nicotinic intox? (2)

A
  • Atropine, doubling every 5 minutes until s/sx resolve

- 2-PAM

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6
Q

What intoxication does belladonna cause?

A

Anticholinergic

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7
Q

When is physostigmine contraindicated in anticholinergic overdose?

A

TCA overdose

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8
Q

When is the pupil reactive: sympathomimetic OD over anticholinergic?

A

Sympathomimetic

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9
Q

What is the narcotic that can cause serotonin syndrome?

A

Meperidine

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10
Q

What is the HARMED mnemonic for serotonin syndrome?

A
  • hyperthermia
  • Autonomic instability
  • R
  • M
  • E
  • D
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11
Q

What is the toxic metabolite of acetaminophen?

A

NAPQI

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12
Q

What is a single toxic dose of acetaminophen?

A

150 mg/kg

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13
Q

How many hours after tylenol ingestion do you measure tylenol levels in the blood to use the nomogram?

A

4 hours

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14
Q

What defines stage 1 tylenol overdose?

A

N/V

Elevated serum acet concen

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15
Q

What defines stage 2 tylenol overdose?

A
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16
Q

What defines stage 3 tylenol overdose?

A
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17
Q

What defines stage 4 tylenol overdose?

A
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18
Q

What is the best predictor of outcome for tylenol overdose?

A

INR

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19
Q

What is the role of APAP levels and the nomogram with chronic ingestions?

A

None

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20
Q

What is the recommended max adult dose of tylenol?

A

4000 mg /day

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21
Q

What is the loading dose for NAC?

A

150 mg/kg over 15-60 minutes

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22
Q

After how many hours should the loading dose of NAC be given before the results of levels come back?

A

After 8 hours

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23
Q

What is the major downside of giving NAC?

A

Anaphylactoid reaction

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24
Q

When can you stop NAC?

A

If levels normalize

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25
Q

When is the IV NAC the only solution to a tylenol OD?

A

If liver failure occurs

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26
Q

What single ingestion in mg/kg of tylenol that is toxic?

A

150 mg/kg

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27
Q

What is the threshold for the nomogram for toxicity?

A

150 microgram/mL

28
Q

What is the initial loading dose of NAC?

A

150 mg/kg

29
Q

What are the CXR findings of an ASA overdose?

A

Noncardiogenic pulmonary edema

30
Q

What is the single toxic dose of ASA?

A

150-200 mg/kg

31
Q

What is the first metabolic derangement with ASA intoxication?

A

respiratory alkalosis, followed by metabolic acidosis

32
Q

What causes seizures with ASA?

A

Acidosis or hypoglycemia

33
Q

What is the classic triad of ASA intoxication?

A

Tinnitus
Hyperventilation
Abdominal pain

34
Q

When should a post ingestion level of ASA be obtained?

A

at least 6 hours post ingestion

35
Q

What is the serious, life threatening level in mg/dL for ASA levels?

A

100 mg/dL

36
Q

How well do serum salicylate levels correspond to intoxication?

A

Not well

37
Q

What is the best way to determine how toxic a patient is with an ASA overdose?

A

Acidosis

38
Q

What is the treatment for ASA overdose?

A
  • Bicarb
  • IVFs
  • dialysis
  • GSC
39
Q

What is the target IVF rate for ASA overdose?

A

2 ml/kg/hr

40
Q

How does bicarb work to eliminate ASA?

A

alkalinization of the urine

41
Q

At what serum level of ASA should you give a bicarb drip?

A

35 mg/dL

42
Q

How do you make a bicarb drip?

A

-One bag of saline, take out 150mL, add 3 amps of bicarb. Run 1-1.5x maintenance fluid rate

43
Q

What is the target urine and serum pH for ASA overdoses?

A 
Urine = 8
Serum = 7.4
44
Q

Why must K be normal for ASA overdose?

A

If K is low, kidneys will exchange H+ to maintain K

45
Q

How often should you monitor ASA OD pts labs?

A

q1 hour unil normal

46
Q

When is dialysis indicated for ASA overdose?

A

coma
intubation
level over 100
Not doing well

47
Q

How is ASA eliminated?

A

Renally and hepatically

48
Q

What usually causes chronic salicylism?

A

Usual dose of ASA, and hepatic or renal disease occurs

49
Q

Which alcohol does not cause a metabolic acidosis?

A

isopropyl alcohol

50
Q

What is propylene glycol, and what does it metabolize to?

A

Diluent, causes lactic acidosis

51
Q

What is the average amount of liquid that an adult mouth can hold?

A

30 mL

52
Q

What is time button batteries need to come out?

A

2 hours

53
Q

What are the three different hang up spots for swallowed object?

A

cricopharyngeal muscle
left bronchus
GE junction

54
Q

Which side does the battery cause burns on: positive of negative?

A

Negative

55
Q

Acid burns - necrosis?

A

Coag

56
Q

Alkali burns = necrosis?

A

Liqufactive

57
Q

What is the inhalant in whippits?

A

Nitrous oxide

58
Q

What is the treatment for cyanide poisoning?

A

Amyl nitrite

59
Q

What is the general toxidrome for inhalants?

A

Like Drunk

60
Q

What is sudden sniffing death syndrome? Treatment?

A
  • ?

- esmolol

61
Q

What are the two major cholinergic pesticides?

A
  • Carbamates

- Organophosphates

62
Q

What is the MOA of cholinergic poisoning?

A

Inhibits acetylcholinesterase

63
Q

What is the MOA of 2-pam?

A

Kicks off organophosphate of acetylcholinesterase

64
Q

What lab abnormality is seen with dextromethorphan?

A

high Cl due to high bromides from DXM being counted as Cl

65
Q

What does benzocaine metabolize to?

A

methhemoglobinemia

Lectures (6 decks)

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