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Antidotes and Toxidromes Flashcards

1
Q

Tylenol Tx

A

NAC

PO: 140 mg/kg then 70 mg/kg q 4hrs

IV: 150mg/kg over 1 hr, then 50mg/kg over 4 h4, then 100mg over 16hr

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2
Q

ASA OD Pres

A
  • Nausea/vomiting
  • Tinnitus
  • Confusion
  • Hyperthermia
  • Respiratory alkalosis with Metabolic acidosis
  • Multiple organ failure
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3
Q

ASA Toxic Levels:

A

<150mg/kg = mild

>500mg/kg = Lethal

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4
Q

ASA Tx

A
  • Urinary Alkalinization
    • NaHCO3 2-3 amps IV
    • Then 3 amps in 1L D5W @ 1.5 maintentence
    • Goal urine pH 7.5-8.0
  • Treat hypoK
  • Dialysis
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5
Q

ASA Dialysis Indications

A
  1. Severe Acidosis
  2. End organ damage
  3. Level > 90
  4. Coma
  5. Levels rising with alkalinization
  6. Volume overload
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6
Q

CO Poisoning

  • Half Life
  • Treatment
A
  • CO-Hb t1/2:
    • Room air- 5 hours
    • 100% O2- 1.5 hours
    • Hyperbaric oxygen-0.5 hours
  • Tx: 100% O2 NRB til sx resolve
  • HBOT if…
    • CO > 25% (pregnant > 15%)
    • Neuro - AMS, FND, Sz,
    • Resp failure,
    • Infants,
    • CN tox,
    • pH < 7.2,
    • Cardiac ischemia or arrhythmia
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7
Q

Benzo Tx

A
  • Supportive
  • If Iatrogenic: Flumazenil
    • 0.2mg then increase by 01.mg q1min until effective or 5mg max
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8
Q

Cholinergic Toxidrome Pres

A

DUMBELLS

  • Diarrhea/Diaphoresis
  • Urination
  • Miosis
  • Bradycardia/Bronchospasm
  • Emesis
  • Lacrimation, Low BP
  • Salivation, Seizures
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9
Q

Cholinergic Tx

A
  • Atropine until secretions dry
    • 2 mg IV (0.02 mg/kg)
    • Double for IM
  • 2-PAM aka Pralidoxime 0.1mg/kg IV
  • Ativan for Sz
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10
Q

Anticholinergic Toxidrome

A

Sympatomimetic, but dry

  • Red as a beet (flushed)
  • Dry as a bone
  • Hot as a Hare (incr temp, BP, HR)
  • Blind as a Bat (mydriasis)
  • Mad as a Hatter (delirium)
  • Full as a flask (urinary retention)
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11
Q

Anticholinergic Tx

A

Benzos, Supportive

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12
Q

Narcan Dosing

A

Code Dose = 2mg

Start 0.04, double q 2 min

Drip at 2/3 effective rate per hour

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13
Q

Iron Toxicity

A
  • Gastric Lavage or WBI if early
  • Deferoxamine
    • Indications:
      • > 60 mg/kg ingested
      • Fe level > 500 mcg/dL or >300 with mod-severe sx.
    • Dose
      • 15 mg/kg/hr IV up to 45 mg/kg/hr (max 1g/hr)
        • watch for hypotension - if occurs, provide support for BP and continue deferoxamine
    • Vin rose-colored urine- red wine appearance after deferoxamine chelation
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14
Q

Toxic Alcohol with OG but no AG

A

Isopropyl Alcohol

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15
Q

Ethylene Glycol

  • Metabolite
  • Labs
  • Tx
A
  • Metabolite = Oxalic Acid
    • Anion gap, + osmolar gap, - ketones
  • Urine fluoresce under Wood’s lamp
  • Tx:
    • Fomepizole 15 mg/kg in 100 ml D5W over 30 min
    • Ethanol (competitive inhibitors for ADH)
    • Dialysis
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16
Q

Ethylene Glycol Hemodialysis Indications

A

Renal insufficiency

EG level >50 mg/dL

severe acidosis)

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17
Q

Isopropyl Alcohol

  • Metabolite
  • Labs
  • Tx
A
  • Metabolite → acetone
    • anion gap, + osmolar gap, +ketones
  • Dialysis (refractory hypotension, serum levels > 400-500)
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18
Q

Isopropyl Dialysis Indications

A

Refractory hypotension

Serum levels > 400-500

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19
Q

Methanol

Metabolite

Labs

Tx

A
  • Toxic metabolite: formic acid
    • anion gap, + osmolar gap, - ketones
  • Tx: fomepizole 15 mg/kg
  • ethanol
  • dialysis (renal insufficiency, level >25 mg/dL, severe acidosis, visual symptoms)
20
Q

Fomepizole for…(2)

A

Ethylene Glycol

Methanol

21
Q

General Ind for Dialysis for Toxic Metabolites

A

ARF

Severe Acidosis

22
Q

Methanol Dialysis Indications

A

Renal insufficiency

Level >25 mg/dL

Severe acidosis

Visual symptoms

23
Q

ASA Dialysis Indications

A
  • Serum salicylate level :
    • > 120 mg/dL acutely
    • > 100 mg/dL 6 h post-ingestion.
  • Refractory acidosis.
  • Coma or seizures.
  • Noncardiogenic pulmonary edema.
  • Volume overload.
  • Renal failure.
24
Q

Beta Blocker OD

A
  • Glucagon 5-10mg IV, then 1-5/hr
  • HD Insulin (1u/kg bolus, then 1 u/kg/hr) + dextrose
  • Wide QRS –> Bicarb
  • Hypotension –> Pressors
  • Bradycardia –> Atropine
25
Calcium Channel OD Tx
* Calcium * CaGlu 3g (30mL of 10%) * Cl 1g (10 mL of 10%) - Through CVL * HD Insulin (1u/kg bolus, then 1 u/kg/hr) + dextrose * Wide QRS --\> Bicarb * Hypotension --\> Pressors, IVF * Bradycardia --\> Atropine * Common Meds: Amlodipine, Dilt, Nifedipine
26
Cyanide
* Almond smell * Blocks oxidative phosphorylation * Tx = * First Line - Hydroxycobalamin - 5gm IV * Old - CyanoKit * Amyl nitrite + Sodium Nitrite + Sodium Thiosulfate
27
Elapidae Tx
Supportive Follow NIF
28
Crotalidae Tx
* Labs: CBC (for Plt), Fibrinogen, Fibrin Split Products * Treatment: * Wound Care * Tetanus * Antivenom - CroFab * *
29
CroFab Dosing
* Same dose Peds vs Adults * Mild-Mod - 4 Vials​ * ↑ swelling * Plts \<100K * Fibrinogen \<100 * Severe - 6 vials ​ * Rapidly ↑ swelling * Plts \<25 * Fibrinogen \<25 * ↓BP * Airway compromise * End organ damage * Repeat exam/labs 1hr after AV * Add 4V AV for: * ↑ swelling, plts/fibrinogen ↓ or not improved. * Add 6V AV for severe parameters. * Observe
30
Opiate Withdrawal
* Tx = Supportive, maybe Benzos * YAWNED - ​Y​awning, ​A​gitation, ​W​et, ​N​VD, pilo-​E​rection, ​D​on’t sleep
31
ETOH Withdrawal - Pres - Treatment
* Usually 6-24/48 hrs after * SSSHHT * S​weaty, ​S​z, ​S​hakes, ​H​TN, ​H​allucinations, ​T​achycardia * Treatment * Ativan * Phenobarb * Precedex * +/- Thiamine, Mag * +/- D50
32
TCA OD Presentation
* Anticholinergic * GABA inhibition (seizures) * Peripheral alpha blockade (vasodilation, hypotension), * Decreased cardiac contractility * K channel blockade (QT prolongation) * Na channel blockade (QRS widening, arrhythmia,sz)
33
TCA EKG
Widened QRS QT prolongation (\>100-sz, \>160- ventricular arrhythmia) aVR: - Right axis deviation of terminal QRS (terminal R \> 3 mm in aVR - R:S \>0.7
34
TCA Treatment
* Decontamination: Actichar ± Gastric lavage * Bicarb: * Indications: If QRS \> 100 msec, arrhythmia or ↓BP * Dose: * 2-3 amps (1-2 mEq/kg children) IV, * 3 amps in 1L D5W @ 1.5 x maintenance. * Goal: urine pH 7.5-8.0 * If Szs.... Ativan 0.1 mg/kg IV * Refractory cases: * 3% saline * Lidocaine * NE for hypotension * Lipid therapy * Monitor hypokalemia * Contraindicated: Type Ia, Ic and III antiarrhythmics, beta blockers, flumazenil
35
Dialyzable Drugs
STUMBLE * Salicylates * Theophylline * Uremia * Methanol * Barbiturates * Lithium * Ethylene Glycol
36
Lead Toxicity Ind to Treat Tx
Lead Level \> 70 Dimercaprol --\> 2 hours later --\> CaNaEDTA
37
Charcoal CI Substances
CHAMPS * Caustic * Hydrocarbon * Alcohols * Metals * Pb (Lead) * Salts
38
Physostigmine CI
TCA OD | (Avoid if Long QT, Long QRS)
39
Hydrogen Sulfide - Locations Presentation Tx
* Sewers, hot springs/volcanoes * HA, N/V, Resp Distress, Sz, Sudden LOC * Tx * Remove from environment * 100% O2 * Sodium Nitrite --\> Induce Methemaglobinemia * 10mL of 3% solution over 2 min * +/- HBO
40
Hydrofluoric Acid - Source - Pres - Tx
* Etching * Pres: * Dermal = liq. necrosis, pain-out-of-proportion * Pulmonary = Pulmonary Edema/ARDS * Ingestion = N/V, abdominal pain, perf * Systemic = HypoCa, HypoMg, Hyper K, VF/Torsades, Met Acidosis * Tx: * Remove clothes and irrigate * Skin - CaGlu Gel or SubQ * Inhalation - CaGlu Neb * Electrolyte Replacement - Will need CVL and CaCL + Mg
41
INH - Pres - Tx
Seizure Pyridoxine 4g
42
Digitalis - Sources Symptoms Treatment
* Source * Acute - Digoxin * Chronic - Foxglove/Oleander * Symptoms * yellow-green vision * fatigue * N/V/D * palpitations * syncope * AMS * arrhythmias * Treatment - Digibind * Acute Emergency = 10 vials adult/kids * Chronic Emergency = 4 adults, 2 kids * If Level Known * #Vials = Dig Level x Kg / 100
43
Methemoglobinemia - Source - Pres
* Nitrites, nitrates, dapsone, phenazopyridine, benzocaine * Pres * Cyanosis * Chocolate brown blood * Need co-oximetry analysis, pulse ox reads 85% * Tx: * Methylene blue 1-2 mg/kg IV of 1% sol * If doesn’t improve consider sulfa-Hb
44
Serotonin Syndrome - Serotonergic Drugs - Pres - Tx
* SSRIs, MAOIs, others * Pres = Rapid * Sympathomimetic * Mydriasis * Myclonus * Tx * Stop agent * Cyproheptadine 8mg PO * Supportive
45
NMS - Cause - Pres - Treatment
* Cause - Antipsychotics - new or recent dose change * Pres = Slow * Sympathomimetic * Rigid * Normal pupils * Treatment * Supportive * Hyperventilation, fluid resuscitation, cool, paralyse * Bromocriptine, amantadine (Dopamin antagonists) * Dantrolene
46
Malignant Hyperthermia - Cause - Pres - Treatment
* Inhaled anesthetics (genetic predisposition) * Spasm/rigidity, acidosis, rhabdo * Treatment * Dantrolene * Anesthesia consult

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