Overdoses part 1 Flashcards by Nayla Mansoor

What is a Dystonic reaction

idiosyncratic reaction NOT dose dependent 2/2 Phenothiazines (phenergan, compazine), Butyrophenones (haldol), and Reglan
–Sudden onset abnormal head, neck, and jaw posture
Spastic contracture of lips, tongue, face, throat
Trismus, torticollis, tongue protrusion
Oculogyric crisis (cant move eyes vertically

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What are Sx of a dystonic reaction

hypotension, decerased LOC, miosis, seizure, coma, urinary retention

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What are effects of an APAP OD

Centrolobular necrosis
Irreversible hepatic necrosis if pH <7.3, bili>4, Cr>3.4, or encephalopathy
-0-24: n/v, pallor, diaphoresis
-24-48: RUQ pain, high LFT
-72-96: LFT peak, coagulopathy, encephalopathy
-4-14d: recover or die

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How do you treat APAP OD

N-acetyl cysteine w/in 8 hours (reduce NAPQI back to APAP)
can give PO or IV (smells like rotten eggs)
+/- reglan for nausea

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How do you tract APAP OD

Rumack-Matthew Nomogram (s/p 4 hours after SINGLE ingestion)

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What are effects of an ASA OD

Vomiting 
GGI bleed
Hypotension
Prolonged PT
Agitation
Lethargy
Tachypnea
Leukocytosis 
**Metabolic Acidosis + Respiratory Alkalosis**

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How do you treat an ASA OD

Gastric lavage
Multi-dose charcoal q4hr
NS at 2-3x maintenance
NaHCO3 bolus + KCl D5W

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When would you need to dialyze an ASA OD patient

Renal failure 
CNS toxicity
Worsening 
Hypokalemia (cant make urine alkaline) 
Serum ASA >100mg

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How can you track ASA OD

Done Nomogram for single ingestion (NOT liquid, chronic, or enteric coated)

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What are anticonvulsants we studied

Phenytoid
Carbamazepine
Barbituates
Valporate

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What are effects of Phenytoin OD

*Horizontal Nystagmus 
slurred speech
ataxia
hallucinations
hyperreflexia
seizure

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How do you treat Phenytoin OD

Supportive 
MDAC (multi dose activated charcoal)

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How should you never administer phenytoin

IM or with dextrose

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What are effects of Carbamazepine OD

Anticholinergic
wide QRS
long PR/QT, bradycardya

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How do you treat Carbamazepine OD

Supportive

MDAC

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What are effects of Barbituate OD

CNS depression
Hypothermia
Hypoglycemia
Aspiration PNA
urine retention

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How do you treat Barbituate OD

Supportive 
Glucose
Narcan
Charcoal
Urinary alkalinization

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What are Sx of Valporate OD

*Drowsy, Confused, AMS
High ammonia
Hyperglycemia 
slow reactive pin point pupils 
Hepatotoxic

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How do you treat Valporate OD

Supportive
Charcoal
L-Carnitine (if high ammonia)

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What are effects of Lithium toxicity (SS, low anion gap)

Hand tremor
Fatigue 
no concentration
Polyuria
Anorexia, N/V/D
Rash
Seizure

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How do you treat Lithium OD

Benzo (NOT dilantin)
Aggressive IV NS
Hemodialysis if >3.5)
charcoal does not work

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What are effects of Ethanol OD

CNS depression 
slurred speech
nystagmus 
hypoglycemia
Metabolic acidosis + anion gap

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How do you treat Ethanol OD

IV fluids (banana bag w/ MVI, thiamine, folate) 
**Charcoal does not work**

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What are effects of Isopropanol OD (rubbing alcohol, paint thinner)

Increased Osmolar gap w/o changing anion gap!

How do you treat Isopropanol OD

IV fluids ventilation HD if hypotension refractory to fluids *charcoal does not work*

What are effects of Methanol toxicity

``` CNS depress Blind Abd pain Hypotension Anion cap Metabolic acidosis + Osmolar gap ```

How do you treat Methanol OD (wood varnish)

``` IVF Fomepizole Ethanol 10% in D5W HD if blind or pH <7.15 *charcoal does not work* ```

What are effects of Ethylene Glycol OD (anti-freeze)

``` CNS depression Tachy tachy HTN Flank pain Renal failure Hypocalcemia (tetany, long QT) Anion gap Metabolic acidosis ```

What will you see on Urine Fluorescence in Ethylene Glycol toxicity

Calcium Oxalate crystals

How do you treat Ethylene Glycol OD

``` IVF Fomepizole Ethanol 10% in D5W HD is severe met acidosis w/ nephrotoxicity *charcoal does not work* ```

What are effects of CCB OD

``` *AV Dissociation, Increased PR interval hypotension bradycardia ileus High Na/hyperglycemia ```

How do you treat CCB OD

``` WBI CaCl (or CaGluconate) bolus in central line Glucagon Epinephrine Insulin and glucose NaHCO3 (if wide QRS) Pacemaker ```

What is the only dialyzable BB

Atenolol

What are effects of BB OD

``` Hypotension bradycardia coma Increased PR and QRS High K, hyperglycemia ```

How do you treat BB OD

Glucagon Insulin-glucose Epinephrine pacemaker

What are effects of Digoxin Toxicity

``` *Proximal Atrial tachycardia w/ block Vision change (see yellow halos) Acute: High K + GI Sx in Chronic: Low K + arrhythmia Vtach in different directions n/v, weak, syncope, AMS ```

How do you treat Digoxin OD

Avoid Ca Digibind (if K>5.5, heart block, plant, or animal toxicity) Vasopressor, atropine, external pacing

When are digoxin levels falsely elevated

newborns pregnant moms chronic renal failure hepatobiliary disease

What are effects of TCA OD

Anticholinergic effects cardiac arrest, arrhythmia, hypotension, pulm edema, mydriasis Increased QRS&QT, RAD, sinus tach

How do you treat TCA OD

``` Fluids NaHCO3 Alpha agonist (NO dopamine) Benzos, Barbituates Vent support charcoal Avoid CCB, BB, physiostigmine ```

TCA + ___= death

Procainamide (class Ia)

What is the MC arrhythmia in TCA OD

Supraventricular with wide QRS

What are effects of Cyanide OD

Tachycardia+HTN--> Bradycardia+hypotension--> asystole HA-->Sz-->coma Dyspnea-->apnea

How do you treat Cyanide OD

100% O2 Hydroxocobalamin +/- Cyanide kit (amyl nitrate + sodium nitrite + sodium thiosulfate)

What are effects of carbon monoxide OD

Asymptomatic *Cherri red skin HA, n/v, no dexterity, flu Sx (must test carboxyHgb level)

How do you treat carbon monoxide OD

Hyperbaric oxygen in COHgb>40%, preggers, neuro sx, coma, ischemia on ECG, refractory despite O2

What are effects of hypoglycemia

Diaphoresis, Nausea, AMS | Whipple's Triad: hypoglycemia (<60) + Sx of hypoglycemia + Resolution of Sx w/ glucose admin

What agents can cause hypoglycemia

``` Insulin Sulfonylurea Bigaunides (metformin, glucophage) -->met acidosis Thiozolidinediones Benzoc acid ```

How do you treat hypoglycemia

``` Glucose replacement Feed patient Glucagon (not for alcoholic, young, old, or malntr) Octreotide Charcoal ```

How do you treat Dystonic reactions

Benadryl (3-4 days to prevent recurrence) | Benztropine (not kids)

Repeat: brief overview of effects of dystonic reactions

``` Hypotension Miosis decreased LOC brady/tachy sz coma urinary retention ```

What is the MCC of peds morality 2/2 poisoning

eat da poop | jk shawn, it's iron

What are effects of Iron OD (stages)

I (6-12h): GI; vomit, diarrhes, abd pain, pallor, lethargy, Metabolic acidosis, hypoglycemia, leukocytosis II (6-24): hypovolemia, Metabolic acidosis, lethargy, hypotension III: organ failure; periph neuropathy, encephalopathy, myocardial depresison, renal/hepatic fail, ischemic bowel

How do you treat Iron OD

``` + KUB or >20 ingested= Lavage WBI 2oz MOM per g ingested Deferixamine If ASx s/p 6 hr, Dc home ```

What is your popcorn lab finding in iron OD

``` Basophilic stippling (WBC) on microscopy Vin Rose urine ```

What does alkali ingestion cause

Liquid Necrosis

What does Acid ingestion cause

Coagulation Necrosis (eschar)

Any caustic ingestion causes what effect

``` Visible burn dysphonia drooling coughing vomiting ```

How do you manage a caustic ingestion

ABC, routine tox labs, upright CXR Endoscopic eval NG tube, steroids, or abx *no charcoal*