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Flashcards in Renal toxicology EM Deck (21)
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1

Osmolar gap equation

Calculated osmolatity = 2(Na+ concentration) + ((glucose/18) + BUN/2.8))

**Serum osmolarity from labs - calculated osmolarity**

If above is greater than 10 = something else that is not normal is in the body
- usually ethanol

***if wanting to determine if it is ethanol, can add EtOH/4.6 to the calculated equation***

2

“DUMPS ALE” mnemonic

Reminds you of the most common causes of a increased anion gap acidosis

DKA
Uremia
Methanol
Paracetamol
Salicylates

Alcohol
Lactic acidosis
Ethylene glycol

3

SLIME TP mnemonic

Reminds you of the most common indications for hemodialysis

Salicylates
Lithium
INH/isoniazid
Methanol
Ethylene glycol

Theophylline
Phenobarbital

4

ME DIE mnemonic

Reminds you of the most common causes for an osmolar gap

Methanol
Ethylene glycol

Diuretics
Isopropanol
Ethanol

5

What is the pH correction rate with pCO2 changes?

Every 10 mmHg drop in pCO2, pH goes up 0.08

6

Why does alkalization of urine become so importaint for salicylate OD?

In acidic conditions, H+ ions bind to ASA to from toxic metabolites.
- in alaklized conditions, H+ ions dissociated from ASA compounds and allow them to be excreted.

7

What does uncoupling oxidative phosphorylation mean in ASA overdose?

ASA uncoupled oxidative phosphorylation which shuts down aerobic respiration and upregulates anaerobic/lactic respiration
- leads to metabolic acidosis with lactic acidosis and anion gap

8

How do we alkaline urine?

Dextrose and sodium bicarbonate IV bolus. Also correct glucose as needed.
- 3 sodium bicarbonate w/ 1 dextrose 5%

Also must give patient potassium replacements
- hypokalemia causes reabsorption of potassium via K+/H+ exchangers. This makes it impossible to alkaline urine if H+ keeps getting pumped into lumen

9

Toxicity of alcohol from least to greatest

EtOH < Isopropyl < Ethylene glycol < Methanol (most dangerous)

10

3 types of ketone bodies

Acetone
- all alcohols

AcetoAcetic acid
- all alcohols

B-hydroxybuterate
- most common in most alcohols and DKA, however isopropanol does NOT produce this!

11

What must you give patients with ethylene glycol poisoning?

pyridoxine and thiamine
- exhausts these stores very quickly so if you dont replenish this the CNS depression wont ever recurrent

**also causes refractory seizures if you DONT give**

12

Why does methanol causes afferent pupillary defects?

Provides direct toxicity to the optic nerve

13

Isoniazid

** big caveat = someone who is from out of country and is being treated for TB without knowing the exact medication and shows status epilepticus = isoniazid toxicity until proven otherwise**

**MUST give pyridoxine/B6 before any other treatments, including diazepam**
- 5 grams of these two must be given
- this is the only way the status epilepticus will respond

14

when do we intubate patients?

If GCS is below 8
- “8 = intub8”
- or they just straight up cant breath

15

Life threatening causes of ataxia in children

1) Cerebellar/frontal tumors

2) Intracranial bleeding
- usually presents with headache

3) strokes

4) Sepsis

5) Toxic exposure

**1-3 = get MRI**

16

How to treat hypotension?

1st = always IV fluids

2nd = pressers (as needed)

17

How to treat pulmonary edema

1) diuresis via diuretics

2) PEP

**need to give both**

18

How to treat hemorrhagic gastritis

1) antacids

2) endoscopy

3) give blood as needed

19

Why is fomephazole not indicated for isopropyl alcohol?

Short half life and duration of symptoms is usually self limiting in IA.

Usually just needs safety net and treatment of complications
- also can give IV ethanol or activated charcoal as needed

20

What two signs does ethylene glycol poisoning often present with?

Trousseau sign
- twitching of facial muscles by tapping the area over the facial nerve

Chvostek sign
- twitching of facial muscles by tapping just anterior to the ear

**both are caused by hypocalcemic tetanus**

21

What is the most common cause of methanol poisoning?

Ingestion of windshield washer fluid