Poisoning Flashcards
(20 cards)
A 3-year-old boy presents with vomiting, diarrhea, abdominal pain, and lethargy 2 hours after ingesting an unknown number of iron tablets. His labs show high anion gap metabolic acidosis. What are the phases of toxicity, diagnostic steps, management, and toxic dose?
Iron poisoning: 5 phases—GI symptoms, latent phase, shock, hepatic failure, and GI stricture formation. Toxic dose: >20 mg/kg elemental iron is potentially toxic, >60 mg/kg is severely toxic. Diagnosis includes abdominal X-ray (radio-opaque tablets), serum iron at 4–6h, ABG, LFTs. Treat with IV deferoxamine if serum iron >500 mcg/dL or systemic toxicity, supportive care, fluids, and monitoring.
A 5-year-old girl is brought to the ER 6 hours after consuming an unknown amount of paracetamol. She is alert with mild abdominal pain. What are the stages of toxicity, management protocol, and toxic dose?
Acetaminophen toxicity: 4 stages from GI upset to liver failure. Toxic dose: >150 mg/kg in a single ingestion. Measure acetaminophen level ≥4h post-ingestion, use Rumack-Matthew nomogram. Start NAC if toxic range or unknown timing. Monitor LFTs, INR, renal function. ICU care if encephalopathy or liver failure.
A toddler presents with vomiting, miosis, salivation, lacrimation, bradycardia, and muscle twitching after suspected exposure to agricultural chemicals. What is the mechanism of toxicity, clinical approach, treatment, and toxic exposure threshold?
Organophosphates inhibit acetylcholinesterase, leading to an accumulation of acetylcholine (ACh), which affects both muscarinic and nicotinic receptors.
Muscarinic Effects (SLUDGE-M):
Salivation Lacrimation (tearing) Urination Defecation
Gastrointestinal distress (e.g., nausea, vomiting)
Emesis (vomiting)
Miosis (pupil constriction)
Nicotinic Effects:
Fasciculations (muscle twitching)
Muscle weakness
CNS Effects:
Seizures
Toxicity:
The toxic dose of organophosphates varies depending on the specific compound. Even small dermal exposure, especially in children, can be toxic.
Treatment:
1. Atropine:
Dose: 0.02 mg/kg IV, repeat every 5–10 minutes as needed.
Atropine blocks the muscarinic effects of excess ACh.
2. Pralidoxime:
Administer to re-activate acetylcholinesterase and reverse the effects of the poisoning.
3. Decontaminate the skin:
Remove any contaminated clothing and wash exposed areas thoroughly.
4. Secure the airway and provide respiratory support if needed.
5. Monitor vital signs closely for any deterioration or changes.
A 2-year-old drank kerosene (lamp oil). He is coughing but afebrile and stable. What is the major risk, what should be avoided in management, and what is considered a toxic volume?
Hydrocarbon ingestion: risk of aspiration pneumonitis. Toxic dose: as little as 1 mL/kg can be harmful. Avoid gastric lavage, emesis, or activated charcoal. Observe 6–8h, perform chest X-ray if symptoms. Give oxygen, bronchodilators if needed. ICU for respiratory distress.
A 14-month-old is found unresponsive with pinpoint pupils and respiratory depression after being given an unknown syrup. What is the emergency drug, dose, precautions, and minimal toxic opioid dose?
Opioid overdose: classic triad of CNS depression, miosis, respiratory depression. Toxic dose: varies with type, but <1 mg/kg morphine equivalent can cause symptoms in opioid-naïve children. Antidote: Naloxone 0.01–0.1 mg/kg IV/IM; max 2 mg/dose. Repeat doses as needed. Monitor for rebound sedation and withdrawal. Consider infusion for long-acting opioids.
A 6-year-old presents with vomiting, tachypnea, confusion, and ringing in the ears after ingesting unknown tablets. Labs show mixed respiratory alkalosis and metabolic acidosis. What is the likely diagnosis, toxic dose, and treatment?
Salicylate poisoning. Toxic dose: >150 mg/kg may cause symptoms, >300 mg/kg is severe. Symptoms: tinnitus, vomiting, metabolic acidosis, hyperventilation. Labs: elevated salicylate levels, anion gap. Treat with sodium bicarbonate IV for alkalinization, fluids, and hemodialysis if severe.
An adolescent is found drowsy and complaining of blurred vision and abdominal pain. His labs show severe metabolic acidosis with an elevated osmolar gap. What is the suspected toxin, toxic dose, and treatment strategy?
Methanol poisoning. Toxic dose: as little as 0.1 mL/kg can cause symptoms. Presents with visual symptoms (snowfield vision), CNS depression, metabolic acidosis. Labs: high anion gap, high osmolar gap. Treat with fomepizole or ethanol, folinic acid, and dialysis for severe toxicity.
A 4-year-old child with developmental delay and pica has chronic constipation, irritability, and pallor. Labs show microcytic anemia. What is the likely diagnosis, toxic threshold, and management plan?
Lead poisoning. Toxic threshold: blood lead level >5 µg/dL is abnormal; >45 µg/dL requires chelation. Symptoms: anemia, neurocognitive delay, abdominal pain. Confirm with venous blood lead level. Treat with succimer (oral) or EDTA/dimercaprol (severe cases). Remove exposure source.
A toddler swallows a button battery and presents with drooling and refusal to eat. What is the immediate risk, toxic exposure threshold, and urgent step in management?
Button battery ingestion. Toxic effect may begin within 2 hours. Diameter ≥20 mm and age <6 years is highest risk. Risk: esophageal perforation, fistula. Immediate X-ray to localize. If in esophagus, urgent endoscopic removal. Avoid emesis and delay.
A child rescued from a house fire presents with headache, confusion, and dizziness. Vitals are stable but pulse oximetry reads 100%. What is the most likely diagnosis, toxic COHb level, and appropriate management?
Carbon monoxide poisoning. Toxic level: COHb >10% (children), >25% is severe. Presents with nonspecific symptoms (headache, confusion, nausea). Pulse oximetry is misleading. Diagnose with COHb level. Treat with 100% oxygen or hyperbaric oxygen if severe symptoms or high level.
A 2-year-old ingested a liquid solution used for cleaning jewelry. He presents with vomiting, hypocalcemia, and arrhythmia. ECG shows prolonged QT interval. What is the most likely toxin, toxic dose, and treatment?
Likely ingestion: hydrofluoric acid. Toxic dose: as little as 20 mL of 2% solution can be fatal in children. Binds calcium and magnesium → hypocalcemia, arrhythmia. Treat with calcium gluconate IV and topically (if dermal exposure), ECG monitoring, correct electrolytes aggressively.
A 4-year-old ingested multiple tablets of amlodipine. He is now hypotensive and bradycardic. What is the mechanism of toxicity, toxic dose threshold, and appropriate management?
Amlodipine overdose (calcium channel blocker). Toxic dose: >0.2 mg/kg may cause symptoms. Causes hypotension, bradycardia, AV block. Treat with calcium gluconate, high-dose insulin therapy (HDI), fluids, vasopressors, and consider lipid emulsion therapy in refractory cases.
A toddler accidentally drinks a bottle of windshield washer fluid. He is lethargic with signs of metabolic acidosis. What is the suspected toxin, toxic dose, and therapeutic options?
Methanol ingestion from windshield washer fluid. Toxic dose: 0.1 mL/kg can cause toxicity. Leads to CNS depression, metabolic acidosis, vision loss. Treat with fomepizole or ethanol, folinic acid, correct acidosis with bicarbonate, and consider dialysis if severe or high level.
An 18-month-old is brought to the ER after ingesting an unknown number of adult antidepressant pills. He presents with agitation, seizures, tachycardia, and wide QRS on ECG. What is the suspected drug class, toxic dose, and management?
Likely tricyclic antidepressant (TCA) overdose. Toxic dose: >10–15 mg/kg may be life-threatening. Signs: anticholinergic symptoms, seizures, cardiac arrhythmia. Treat with sodium bicarbonate IV (to narrow QRS), benzodiazepines for seizures, and cardiac monitoring.
A 3-year-old presents with abdominal pain, vomiting, and garlic odor on breath. He ingested a traditional herbal remedy. Labs show hemolysis and elevated liver enzymes. What is the likely heavy metal, toxic dose, and treatment?
Likely arsenic poisoning. Toxic dose: 1–3 mg/kg of inorganic arsenic is potentially fatal. Symptoms: GI upset, garlic breath, hemolysis, hepatotoxicity. Diagnose with 24h urinary arsenic. Treat with chelation: dimercaprol (BAL) or DMSA (succimer). Support hydration and organ support.
A 2-year-old ingested multiple tablets of digoxin from his grandmother’s medication box. He presents with nausea, vomiting, bradycardia, and visual disturbances. What is the toxic dose, ECG findings, and specific antidote?
Digoxin toxicity. Toxic dose: >0.1 mg in a child (<5 tablets of 0.25 mg). ECG: bradycardia, heart block, scooped ST segments, arrhythmias. Antidote: digoxin-specific Fab antibody fragments. Supportive care and monitor potassium levels closely.
A child is brought after ingesting a few tablets of clonidine. He is lethargic with miosis, bradycardia, and hypotension. What is the mechanism, toxic dose, and management?
Clonidine overdose. Toxic dose: >0.01 mg/kg may cause toxicity. Central α2-agonist → CNS depression, bradycardia, hypotension, miosis. Treat with supportive care: fluids, atropine for bradycardia, and vasopressors if needed. Naloxone has variable efficacy.
A 3-year-old ingested a topical camphor-containing ointment. He quickly developed seizures and agitation. What is the likely toxin, toxic dose, and acute management?
Camphor toxicity. Toxic dose: >50 mg/kg. Rapid onset seizures (<2h), CNS agitation, vomiting. Treat with benzodiazepines for seizures, supportive care. Activated charcoal only if asymptomatic and within 1 hour.
A 5-year-old presents with vomiting, cyanosis unresponsive to oxygen, and chocolate-colored blood. He had been given a homemade herbal remedy for teething pain. What is the diagnosis, mechanism, and treatment?
Methemoglobinemia due to local anesthetics (e.g., benzocaine). Toxic dose varies; >1–2 mg/kg can induce symptoms. Presents with cyanosis, chocolate-colored blood, SpO2 ~85% on pulse oximetry. Treat with methylene blue 1–2 mg/kg IV over 5 minutes.
An adolescent girl is found unconscious with a bottle of metformin beside her. Labs show lactic acidosis. What is the toxic mechanism, toxic dose, and management strategy?
Metformin overdose. Toxic dose: >35–50 g total (but lactic acidosis can occur at lower doses in renal impairment). Mechanism: inhibits mitochondrial respiration → lactic acidosis. Treat with IV fluids, bicarbonate, and dialysis in severe cases.
