Poisoning

Question 1

Signs

Answer 1

• Coma
• Toxicity
• Metabolic acidosis
• Heart rhythm problems
• GI signs
• Convulsions

Question 2

Systemic & Pulmonary Poisoning

Answer 2

1- Hydrocarbons:
Aspiration Pneumonia, NO lavage or inducing vomiting
2- Caustic:
GI signs and burns, Low fever
3- Alkali:
Liquefactive necrosis in esophagus, if recent infection or dilation antibiotic
4- Acidic:
Pulmonary, Coagulative necrosis, Less damage

Question 3

Metabolic Acidosis

Answer 3

• Check ABG, Electrolytes, Urine pH
• Methanol, Ethylene Glycol
• Immediate

Question 4

Anion Gap Metabolic Acidosis

Answer 4

MUDPILES
Methanol/Metformin
Uremia
Diabetic ketoacidois
Paraldehyde/Phenformin
Isoniazid/Iron
Lactic acidosis (Cyanide, CO)
Ethanol/Ethylene glycol
Salicylate/Starvation/Seizures

Question 5

Hypoglycemia

Answer 5

HOBBIES
Hypoglycemics: Sulfunylureas
Other: Quinine
Beta Blockers
Insulin
Ethanol
Salicylates

Question 6

Hyperglycemia

Answer 6

• Salicylates
• Isoniazid
• Iron
• Phenothiazines
• Sympathomimetics

Question 7

Hypocalcemia

Answer 7

• Oxalates
• Ethylene Glycol
• Fluoride

Question 8

Radiopaque Substance on KUB

Answer 8

CHIPPED
Chloral hydrate/Ca Carbonate
Heavy metals
Iron
Phenothiazines
Play-Doh/Potassium chloride
Enteric coated pills
Dental amalgam

Question 9

Arrhythmias

Answer 9

• QT Prolonged: Phenothiazines, Antihistamines
• Wide QRS: Quinidines, TCAs
• Sinus Bradycardia: Digoxin, Cyanide, Cholinergics, Betablockers

Question 10

Toxic Syndromes

Answer 10

• Acetaminophen
• Amphetamines, Cocaine, Sympathomimetics
• Anticholinergics
• CO
• Cyanide
• Ethylene Glycol
• Iron
• Narcotics
• Cholinergics

Question 11

Acetaminophen syndrome

Answer 11

• Vomit
• Diarrhea
• Pale
• Late jaundice (Liver failure) 72-96h

Question 12

Amphetamines, Cocaine, Sympathomimetics

Answer 12

• Tachycardia
• Hypertension
• Hyperthermia
• Psychosis & Paranoia
• Seizure
• Mydriasis
• Aggression

Question 13

Anticholinergics

Answer 13

• Mania
• Delirium
• Fever
• Red & Dry skin
• Dry mouth
• Tachycardia
• Mydriasis
• Urinary Retention

Question 14

CO

Answer 14

• Headaches
• Vertigo
• Coma

Question 15

Cyanide

Answer 15

• Coma
• Seizure
• Hyperpnea
• Bitter almond smell

Question 16

Ethylene Glycol

Answer 16

• Metabolic Acidosis
• Hyperosmolarity
• Hypocalcemia
• Oxalate Crystaluria

Question 17

Iron

Answer 17

• Bloody vomit
• Hypotension
• Liver Failure
• Leukocytosis
• Hyperglycemia
• CHIPPED
• Yersinia sepsis

Question 18

Narcotics

Answer 18

• Coma
• Respiratory Depression
• Hypotension
• Pinpoint Pupil
• Bradycardia

Question 19

Cholinergics (Nicotine, Organophosphates)

Answer 19

• Myosis
• Drooling
• Frequency
• Lacrimation
• Bronchospasm
• Muscle Weakness
• Nausea, Diarrhea
• Coma
• Confusion
• Pulmonary edema
• Bradycardia

Question 20

Poisoning Treatment

Answer 20

1- Supportive
2- Clear GI
3- Other

Question 21

Supportive treatment

Answer 21

• ABC
• Decreased consciousness + Suspicion of poison:
  1- Glucose 1g/kg IV
  2- O2 100%
  3- Naloxan

Question 22

Clearing GI

Answer 22

• Ipecac syrup
• Gastric lavage
• Active charcoal
• Laxatives
• PEG-ES (Polyethylene Glycol-Electrolyte Solution)

Question 23

Active Charcoal

Answer 23

1hr after swallowing
Repeated doses in life threatening poisoning
NOT effective:
- Heavy Metals
- Hydrocarbons
- Caustic
- Alcohols
- Glycol
- Water-soluble Solutions
- Prohibited with Laxatives

Question 24

Other Treatments

Answer 24

• Constant supportive care
• Special Antidote
• Active blood detoxification

Question 25

Tissue Damaging Poisons

Answer 25

- Methanol - Aspirin - Acetaminophen - Theophylline - Iron - Ethylene Glycol

Question 26

Active blood detoxification

Answer 26

= **Hemoperfusion or Dialysis** - For tissue damaging poisons - Preventing Long Supportive Care

Question 27

Lethal substances that interfere with O2 delivery

Answer 27

- CO - Hydrocarbons - Opioids

Question 28

Lethal substances that interfere with Heart Activity

Answer 28

- Ca channel blockers (amlodipine,...) - Adrenergics - TCAs

Question 29

Acetaminophen antidote

Answer 29

NAC _{*Most effective in 16h*}

Question 30

Benzodiazepin antidote

Answer 30

Flumazenil _{*Seizure & Arrhythmia*}

Question 31

Beta Blocker antidote

Answer 31

- Atropine - Isoproterenol

Question 32

Ca channel blockers antidote

Answer 32

Glucagon

Question 33

CO antidote

Answer 33

Oxygen

Question 34

TCAs antidote

Answer 34

Sodium Bicarbonate

Question 35

Iron antidote

Answer 35

Deferoxamin _{*Hypotension*}

Question 36

Lead antidote

Answer 36

- EDTA - Dimercaprol - Succimer _{*Weakly control for liver and bone marrow toxicity*}

Question 37

Nitrite / Methemoglobinemia antidote

Answer 37

Methylene Blue _{*blood change in severe forms* *high dose causes methemoglobinemia*}

Question 38

Opiates antidote

Answer 38

Naloxan

Question 39

Organophosphates antidote

Answer 39

- Atropin - Pralidoxime

Question 40

Sympathomimetics antidote

Answer 40

- Phentolamine - Beta Blockers - Antihypertensives _{*Needs vital sign control*}