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Flashcards in Poisoning Deck (63):
0

SUBSTANCES POORLY ADSORBED BY ACTIVATED CHARCOAL

Alcohols
  Caustics: alkalis and acids
  Cyanide
  Heavy metals (e.g., lead)
  Hydrocarbons
  Iron
  Lithium

- Charcoal is most likely to be effective when given within 1 hr of ingestion

1

Give the antidote to the ff toxin/poison:

Black widow spider

Latrodectus antivenin

2

Give the antidote to the ff toxin/poison:
Botulinum toxin

Botulin antitoxin

3

Give the antidote to the ff toxin/poison:
Calcium channel antagonists

Glucagon and/or insulin and glucose

4

Give the antidote to the ff toxin/poison:
Dystonic reactions

Diphenhydramine and/or benztropine

5

Give the antidote to the ff toxin/poison:
Fluoride, calcium channel blockers

Calcium salts

6

Give the antidote to the ff toxin/poison:
Heparin

Protamine

7

Give the antidote to the ff toxin/poison:
Methotrexate, trimethoprim, pyrimethamine

Folinic acid

8

Give the antidote to the ff toxin/poison:
Rattlesnake envenomation

Crotab-specific Fab antibodies

9

Give the antidote to the ff toxin/poison:
Sodium channel blockade (tricyclic antidepressants, type 1 antiarrhythmics)

Sodium bicarbonate

10


What poison/toxin is associated with the following PE finding?

Odor of Bitter almonds

Cyanide

11

What poison/toxin is associated with the following PE finding?
Odor of acetone

Isopropyl alcohol, methanol, paraldehyde, salicylates

12

What poison/toxin is associated with the following PE finding?
Odor of Alcohol

Ethanol

13

What poison/toxin is associated with the following PE finding?
Odor of Wintergreen

Methyl salicylate

14

What poison/toxin is associated with the following PE finding?
Odor of Garlic

Arsenic, thallium, organophosphates, selenium

15

Toxin associated with the ff OCULAR SIGNS:
Miosis

Opioids (except propoxyphene, meperidine, and pentazocine), organophosphates and other cholinergics, clonidine, phenothiazines, sedative-hypnotics, olanzapine

16

Toxin associated with the ff OCULAR SIGNS:
Mydriasis

Atropine, cocaine, amphetamines, antihistamines, TCAs, carbamazepine, serotonin syndrome, PCP, LSD, post-anoxic encephalopathy

17

Toxin associated with the ff OCULAR SIGNS:
Nystagmus

Phenytoin, barbiturates, sedative-hypnotics, alcohols, carbamazepine, PCP, ketamine, dextromethorphan

18

Toxin associated with the ff OCULAR SIGNS:
Lacrimation

Organophosphates, irritant gas or vapors

19

Toxin associated with the ff OCULAR SIGNS:
Retinal hyperemia

Methanol

20

Cutaneous signs manifested with ingestion of the ff toxins:

Organophosphates, salicylates, cocaine and other sympathomimetics, serotonin syndrome, withdrawal syndromes

Diaphoresis

21

Cutaneous signs manifested with ingestion of the ff toxins:

Thallium, arsenic

Alopecia

22

Cutaneous signs manifested with ingestion of the ff toxins:

Boric acid, elemental mercury, cyanide, carbon monoxide, disulfuram, scombroid, anticholinergics

Erythema

23

Cutaneous signs manifested with ingestion of the ff toxins:

Methemoglobinemia (e.g., benzocaine, dapsone, nitrites, phenazopyridine), amiodarone, silver

Cyanosis (unresponsive to oxygen)

24

Oral signs manifested with ingestion of the ff toxin:

Organophosphates, salicylates, corrosives, ketamine, PCP, strychnine

Salivation

25

Oral signs manifested with ingestion of the ff toxin:

Corrosives, oxalate-containing plants

Oral Burns

26

Oral signs manifested with ingestion of the ff toxin:

Lead, mercury, arsenic, bismuth

Gum lines

27

GI symptom associated with ingestion of the ff toxin:

Antimicrobials, arsenic, iron, boric acid, cholinergics, colchicine, withdrawal

Diarrhea

28

GI symptom associated with ingestion of the ff toxin:

Arsenic, iron, caustics, NSAIDs, salicylates

Hematemesis

29

Cardiac signs associated with ingestion of the ff toxins:

Sympathomimetics (e.g., amphetamines, cocaine), anticholinergics, antidepressants, theophylline, caffeine, antipsychotics, atropine, salicylates, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), withdrawal

Tachycardia

30

Cardiac signs associated with ingestion of the ff toxins:

β-Blockers, calcium channel blockers, digoxin, clonidine and other central α2 agonists, organophosphates, opioids, sedative-hypnotics

Bradycardia

31

Cardiac signs associated with ingestion of the ff toxins:

Sympathomimetics (amphetamines, cocaine, LSD), anticholinergics, clonidine (early), monoamine oxidase inhibitors

Hypertension

32

Cardiac signs associated with ingestion of the ff toxins:

β blockers, calcium channel blockers, cyclic antidepressants, iron, phenothiazines, barbiturates, clonidine, theophylline, opioids, arsenic, amatoxin mushrooms, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), snake envenomation

Hypotension

33

CNS signs associated with ingestion of the ff toxins:

Alcohol, anticonvulsants, benzodiazepines, barbiturates, lithium, dextromethorphan, carbon monoxide, inhalants

Ataxia

34

CNS signs associated with ingestion of the ff toxins:

Opioids, sedative-hypnotics, anticonvulsants, cyclic antidepressants, antipsychotics, ethanol, anticholinergics, clonidine, GHB, alcohols, salicylates, barbiturates

Coma

35

CNS signs associated with ingestion of the ff toxins:

Sympathomimetics, anticholinergics, antidepressants (especially TCAs, bupropion, venlafaxine), isoniazid, camphor, lindane, salicylates, lead, organophosphates, carbamazepine, tramadol, lithium, ginkgo seeds, water hemlock, withdrawal

Seizures

36

CNS signs associated with ingestion of the ff toxins:

Sympathomimetics, anticholinergics, LSD, PCP, hallucinogens, lithium, dextromethorphan, steroids, withdrawal

Delirium/psychosis

37

CNS signs associated with ingestion of the ff toxins:

Lead, arsenic, mercury, organophosphates

Peripheral neuropathy

38

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

ANION GAP METABOLIC ACIDOSIS (MNEMONIC = MUDPILES)

Methanol, metformin
  Uremia*
  Diabetic ketoacidosis
  Paraldehyde, phenformin
  Isoniazid, iron, massive ibuprofen
  Ethylene glycol, ethanol
  Lactic Acidosis (i.e. cyanide, carbon monoxide)
  Salicylates

39

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

ELEVATED OSMOLAR GAP

Alcohols: ethanol, isopropyl, methanol, ethylene glycol

40

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

HYPOGLYCEMIA (MNEMONIC = HOBBIES)

Hypoglycemics, oral: sulfonylureas, meglitinides
  Other: quinine, unripe ackee fruit
  Beta Blockers
  Insulin
  Ethanol
  Salicylates (late)

41

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

RADIOPAQUE SUBSTANCE ON KUB (MNEMONIC = CHIPPED)

Chloral hydrate, calcium carbonate
  Heavy metals (lead, zinc, barium, arsenic, lithium, bismuth, as in Pepto-Bismol)
  Iron
  Phenothiazines
  Play-Doh, potassium chloride
  Enteric-coated pills
  Dental amalgam

42

COMMON AGENTS CAUSING SEIZURES (MNEMONIC = CAPS)

Camphor, carbamazepine, carbon monoxide, cocaine, cyanide
Aminophylline, Amphetamine, anticholinergics, antidepressants (cyclic)
Pb (lead) [also lithium], pesticide (organophosphate), phencyclidine, phenol, phenothiazines, propoxyphene
Salicylates, strychnine

43

Triad of altered mental status, autonomic instability, and neuromuscular hyperactivity (hyperreflexia, tremors, clonus in the lower extremities more than the upper extremities)

serotonin syndrome

44

Two antidotes are useful in treating cholinesterase inhibitor poisoning (organophosphates and carbamates)

atropine and pralidoxime

- DUMBBELS
- Clinical manifestations of organophosphate and carbamate toxicity relate to the accumulation of acetylcholine at peripheral nicotinic and muscarinic synapses and in the CNS

46

Give the antidote:
Acetaminophen/Paracetamol

N-Acetylcysteine PO
*Most effective if given within 8 hr of ingestion

47

Give the antidote:
Anticholinergics ie ipatropium

Physostigmine IV/IM
Note: Do not use if conduction delays on ECG
may cause Bradycardia, asystole, seizures, bronchospasm, vomiting, headache

48

Give the antidote:
Benzodiazepines

Flumazenil IV

49

Give the antidote:
β-Blockers

Glucagon IV

50

Give the antidote:
Calcium channel blockers

Insulin IV (Follow serum potassium and glucose closely)
Calcium salts IV

51

Give the antidote:
Carbon monoxide

Oxygen inhalational

52

Give the antidote:
Cyanide

Amyl nitrate inhalational
Sodium nitrate IV
Sodium thoisulfate IV
Hydoxocobalamin IV (adults)

53

Give the antidote:
Digitalis

Digoxin-specific Fab antibodies (Digibind; Digifab) IV

54

Give the antidote:
Ethylene glycol

Methanol

Fomepizole IV
Infuse slowly over 30 min; increase doses to q4h if being dialyzed

If Fomepizole is not available, treat with an ethanol infusion

55

Give the antidote:
Iron

Deferoxamine IV

56

Give the antidote:
Isoniazid (INH)

Pyridoxine IV

57

Give the antidote:
Lead and other heavy metals (e.g., arsenic, inorganic mercury)

1. BAL (dimercaprol) deep IM
-*Local injection site pain and sterile abscess, nausea, vomiting, fever, salivation, nephrotoxicity
-Caution: Prepared in peanut oil; contraindicated in patients with peanut allergy

2. Calcium disodium EDTA IV

3. Dimercaptosuccinic acid (succimer, DMSA, Chemet) PO

58

Give the antidote:
Methemoglobinemia

Methylene blue, 1% solution IV

59

Give the antidote:
Opioids

Naloxone IV

60

Give the antidote:
Organophosphates

1. Atropine IV/ET
-Tachycardia, dry mouth, blurred vision, urinary retention
2. Pralidoxime (2PAM) IV
-Nausea, dizziness, headache, tachycardia, muscle rigidity, bronchospasm (rapid administration)

61

Give the antidote:
Salicylates

Sodium bicarbonate IV
*Follow potassium closely and replete as necessary
*Avoid severe alkalosis (pH >7.55)

62

Give the antidote:
Sulfonylureas

Octreotide IV/SC

63

Give the antidote:
Tricyclic antidepressants

Sodium bicarbonate
*Indications: QRS widening (>100 ms), hemodynamic instability

Avoid severe alkalosis (pH >7.55)

Follow potassium