Poisoning

Question 1

Anticholinergic effects

Answer 1

(Dry) mydriasis, flushed, increased temp, HR, BP, RR, agitation, hallucinations, delirium

Question 2

Name some anticholinergics

Answer 2

antihistamine, TCA, atropine, antipsychotics, deadly nightshade, jimson weed

Question 3

Cholinergic effects

Answer 3

(Wet) decreased HR, incr/decr BP/RR, confusion, delirium, seizures, coma, miosis, diaphoresis

Question 4

What dose of acetaminophen is toxic

Answer 4

150mg/kg

Question 5

Rx acetaminophen toxicity

Answer 5

activated charcoal and then N-acetylcysteine

Question 6

Stages of acetaminophen toxicity and time course

Answer 6

Stage 1 - nausea, vomiting, anorexia (0-24hr)
Stage 2 - asymptomatic (12-48hr)
Stage 3 - fulminant hepatic failure (2-7days)
Stage 4 - recovery (1-2wks)

Question 7

Pattern: fixed dilated pupils, visual changes, blindness, pancreatitis

Answer 7

methanol

Question 8

Sx isopropanol

Answer 8

gastritis

Question 9

Sx ethylene glycol

Answer 9

renal failure

Question 10

What is toxic from ethylene glycol and methanol

Answer 10

metabolites - glycolate, formate

Question 11

Rx ethylene glycol and methanol

Answer 11

Fomepizate - alcohol dehydrogenase inhigitor
Level >20mg/dL - infuse with ethanol
Level >50mg/dL - hemodialysis

Question 12

Rx for anticholinergics

Answer 12

charcoal and benzos for agitation

Question 13

Rx b-blockers

Answer 13

charcoal, whole bowel irrigation, glucagon, hypoglycemia, hypotension, bradycardia, atropine, milrinone, epinephrine

Question 14

Rx battery in esophagus

Answer 14

emergently remove

Question 15

Rx battery in stomach and beyong

Answer 15

leave in place, reimage in 48hrs, endoscopic removal if accessible at 48hrs

Question 16

When would you need multiple doses of activated charcoal?

Answer 16

for theophylline, phenobarbital, ASA, digoxin

Question 17

What cathartic can be used

Answer 17

Sorbital 1 dose only

Question 18

When is whole bowel irrigation contra-indicated?

Answer 18

Ileus, bowel perforation, bowel obstruction

Question 19

Rx for organophosphates

Answer 19

atropine, pralidoxime

Question 20

Rx for TCA

Answer 20

sodium bicarbonate

Question 21

Rx for ethylene glycol

Answer 21

fomepizole

Question 22

Rx for isoniazide

Answer 22

pyridoxine

Question 23

Rx naloxone

Answer 23

narcotics

Question 24

Rx digitalis

Answer 24

specific Fab

Question 25

Rx benzo

Answer 25

flumazenil

Question 26

Rx acetaminophen

Answer 26

N-acetylcysteine

Question 27

Drain openers, rust remover, oven cleaners, toilet bowl cleaners

Answer 27

acidic <2

Question 28

Ammonia, bleach, laundry detergents, drain openers

Answer 28

alkali

Question 29

Pattern: dyspnea, tachypnea, hypoxemia, cough, wheezing, CNS depression, N/V, abd pain

Answer 29

hydrocarbons (glue, gases)

Question 30

Pattern: tinnitus, resp alkalosis (tachypnea), metabolic acidosis, hyperglycemia

Answer 30

aspirin

Question 31

What are aspirin doses that are asymptomatic, mild-moderate, sever, fatal

Answer 31

asymptomatic - <150mg/kg mild-moderate 150-300mg/kg Severe - 300-500mg/kg Fatal - >500mg/kg

Question 32

Rx aspirin

Answer 32

activated charcaol, whole bowel irrigation, rehydration, alkalinization to decrease CNS penetration and enhance excretion

Question 33

Pattern: confusion, coma, cardiac problems

Answer 33

TCA

Question 34

Rx TCA toxicity

Answer 34

activated charcoal, sodium bicarbonate, seizure treatment, ventricular dysrhythmias, lidocaine or magnesisu, not procainamide

Question 35

Rx for iron toxicity

Answer 35

Xray, lavage, whole bowel irrigation

Question 36

Indcation for deferozamine

Answer 36

``` urine is no longer pink >100mg/kg Fe++ Iron level >500mcg/dL Severe gastroenteritis Iron level 300-500mcg/dL and symptoms ```

Question 37

Iron dose that is toxic

Answer 37

<20mg/kg none 20-60mg/kg mild >60mg/kg moderate/severe

Question 38

Pattern: WBC >15K, glucose >150 vomiting, diarrhea

Answer 38

iron toxicity

Question 39

Dose of NSAID that is toxic

Answer 39

>400mg/kg

Question 40

Pattern: N/V/abdominal pain, GI bleeding, seizures, apnea,metabolic acidosis, renal failure, hepatic failure

Answer 40

NSAID toxicity

Question 41

Rx NSAID toxicity

Answer 41

charcoal, supportive care

Question 42

Rx single magnet

Answer 42

observe

Question 43

Rx multiple magnets

Answer 43

endoscopic removal if <12hours

Question 44

Rx for multiple magnets >12hours

Answer 44

surgical consult and endoscopy

Question 45

Rx for magnet beyond stomach - symptomatic

Answer 45

surgery

Question 46

Rx for magnet beyond stomach - asymptomatic

Answer 46

variable

Question 47

Rx organophosphates

Answer 47

skin decontaminants, charcoal, atropine, pralidoxime