Household Toxicity, Hydrocarbons And Alcohols

Question 1

List delayed CC of corrosive ingestion

Answer 1

a-Due to sloughing and devitalized esophageal wall occur after 1 week or later: mediastinitis, pleurisy, pericarditis, TEF.
b-Due to scarring
1. Esophageal obstruction 2ry to stricture
2. Pyoric stenosis and obstruction 2ry to fibrous tissue deposition
3. Malnutrition, dehydration, cachexia 2ry to dysphagia

Question 2

List imp investigations in a case of phenol ingestion

Answer 2

1. Urine turns dark green due to oxidation of phenol metabolites (hydroquinone), also albumin and renal casts may be found.
2. KFT: urea and Cr
3. Methemoglobinemia, dec Hb level and RBCs count

Question 3

Mention one procedure when can be performed in carbolic acid ingestion but not sulfuric acid

Answer 3

Gastric lavage

Question 4

The most fatal effect of kerosene is on the…..system
Describe this effect

Answer 4

Pulmonary
1. Immediate onset of coughing and choking
2. Chemical pneumonitis: respiratory distress, bronchospasm, cyanosis, fever.
3. NCPE

Question 5

Describe the role of decontamination in kerosene ingestion

Answer 5

ONLY indicated when toxic additives are present and ONLY after introduction of ETT

Question 6

What is the DD of alcohol toxicity

Answer 6

Causes of metabolic acidosis with high anion gap, ketoacidosis,hypoglycemia, head trauma, hypothermia, meningitis, intoxication with other CNS depressants as opioids

Question 7

Mention indications for hemodialysis in ethanol toxicity

Answer 7

Ethanol level >400 mg/dl
Severe acidosis pH <7

Question 8

TTT of Wernicke’s encephalopathy

Answer 8

Thiamine 100 mg IV or IM

Question 9

Mention latent manifestations of methanol toxicity

Answer 9

1. Severe metabolic acidosis
2. Visual disturbances, blindness
3. Seizures and coma
4. ARF with myoglobinuria
5. Death

Question 10

Mention specific inv for methanol toxicity

Answer 10

1. Serum methanol (low level doesn’t rule out toxicity as it may have been metabalised in its entirity.
2. Serum formate (better but not available

Question 11

Mention steps in TTT of methanol toxicity

Answer 11

1. Emergency measures (ABC): +control of acidosis and hyperkalemia by slow IV NaHCO3 (keeps formic acid in anionic form)
2. Enhanced elimination by hemodialysis if level exceeds 50 mg/dl or severe refractory acidosis or in precipitation of RF
3. Antidoes: fomepizole or ethanol (competitors for enzyme), folinic acid (enhances conversion of formic acid to CO2 and H20)
4. Symptomatic: diazepam (convulsions), steroids (optic neuritis, cerebral edema)