Ingestion Flashcards Preview

Pediatrics > Ingestion > Flashcards

Flashcards in Ingestion Deck (21):
1

Pneumonic for altered mental status

A - alcohol/toxin
E - epilepsy, encephalitis, endocrine, electrolyes
I - infection
O - overdose
U - uremia
T - trauma, temp
I - insulin
P - psychosis
S - stroke, shock, space occupying lesions

2

Rapid initial eval in AMS

ABCs -> life-threatening causes
finger stick glucose

3

Hypoglycemia, hypotension, tachycardia

treat by giving a 25% dextrose bolus and NS bolus (20 cc/kg)
- make sure glucose responding to therapy

4

Cholinergic ingestion

S - salivation
L - lacrimation
U - urination
D - diarrhea
G - GI motility
E - emesis

Bronchospasm, bradycardia

5

Anti-cholingeric ingestion

Blind as bat - mydriasis
Mad as a hat - delirium/seziure
Dry as bone - dry skin
Hot as hades - hyperthermia
Red as beet - flushed, red skin

Tachycardia, urinary retention, ileus

6

Sedative, hypnotic ingestion

blurred vision, hypotension, bradycardia, apnea, hypothermia, depressed mental status

7

Opioids ingestion

miosis, respiratory depression, bradycardia, hypothermia, depressed mental status

8

Sympathomimetics

mydriasis, fever, diaphoresis, tachycardia, agitation, seizures

9

DDx for mydriasis and AMS

TCA - anticholinergic (tachycardia, hypotension, mydriasis, hot skin)
SSRI - serotonin syndrome (diaphoresis, tachycardia, hypotension, agitation, fever, myoclonus, shivering)
Antihistamine - anticholinergic like TCA
Decongestant - sympathomimetic syndrome (agitation, tachycardia, hypertension, sweating, mydriasis, seizure)

10

TCA toxicity

- inhibits reuptake of NE and 5HT
- antagonism of muscarinic ACh receptors
- blockade of sodium and GABA receptors
*refractory hypotension common cause of death

11

Iron toxicity

1. N/V, abdominal pain diarrhea
2. lethargy, tachycardia, metabolic acidosis
3. Shock
4. Hepatic failure

12

Acetaminophen toxicity

1. Asymptomatic or N/V, diaphoresis, malaise
2. Hepatotoxicity (LFTs elevated)
3. Hepatic failure = death

13

Labs for possible ingestion

1. Glucose
2. CBC
3. Electrolytes
4. Calcium
5. EKG
6. Tox screen
7. Acetaminophen level

14

Decontamination of ingestion

1. Considerations: timing, nature of substance ingested, patient characteristics
2. Therapy: ipecac syrup, activated charcoal, gastric lavage, cathartics, hemodialysis, hemoperfusion

15

Activated charcoal

not for small molecules or heavy metals
Used for TCAs or decreased GI motility ingestions

16

Cathartic

accelerates defacation

17

Ipecac

DON'T use when possible aspiration

18

EKG in TCA tox

1. irregular irregularity in rhythm
2. no distinct P waves
3. Widening of QRS
4. Prolonged QT

19

Management of TCA tox

1. Cardiac Monitoring - minimum of 6 hrs
2. Serum Alkalinization - serum pH affects protein binding, reverse acidosis
3. Hypertonic Bicarb - 1 mEq/kg bolus every 3-5 minutes until QRS normalizes
4. Treatment possible arrhythmias, hypotension, seizures

20

Nortrpytiline

2.5 mg/kg can cause significant effects in young kids
- peak effect = 7-8 hrs

21

Glipizide

1 - 10 mg tablet can cause significant effects in young kids
- peak effect = 2-3 hrs