Toxcicity

Question 1

6-24 hrs pt has reflex hyperactivity. Anxiety, tremors, sweating after alcohol cessation. 48-96 hrs pt develops hypertension, agitation, tachycardia, hallucinations and fever - what is this called? What is the dx? Rx?

Answer 1

Delirium tremens. Alcohol withdrawal. Rx: Lorazepam.

Question 1

Air traffic controller conplains if HA, dizziness and fatigue. On labs there is noted polycythemia Dx?

Answer 1

CO poisoning

Question 2

IV drug user comes in with N/V/D, athralgias, joint pain, restlessness, dysphoria, rhinorrhea, lacrimation. Dx? Rx?

Answer 2

Opiod Withdrawal. Start Methadone.

Question 3

How to Rx Excess Bicarbonate?

Answer 3

Normal saline.

Question 4

Pt presents with normal cognition but has White Tongue and Heavy Saliva he is Unable to Swallow. Dx?

Answer 4

Caustic Poisoning

Question 5

HA, N, V, Abdominal pain flushed skin and Bitter Almond Odor. Dx?

Answer 5

Cyanide Poisoning

Question 7

When is Gastric lavage helpful? What are the 2 contraindications for this?

Answer 7

In the first 1hr of ingestion of a substance. Do not use in AMS - aspiration pneumonia and some one who has ingested a Caustic Substance due to causing more erosion of the oropharynx.

Question 8

1. Management of acetominophen toxicity? 2.. What to do when > 24 hrs? 3. Dont know the amount ingestion? 4. What to give in the meantime?

Answer 8

1. Do the Rumack-Mathew monogram to determine if pt needs antidote ( N-actelysteine at least within 8 hrs) based on Acetominophen level starting at 4 hrs. This Graph provides information on the likelihood of hepatoxicity of acetominophen based on plasma levels and hours since ingestion. 2. No therapy 3. Get level 4. Charcoal.

Question 8

What to administer first when pts enters ED with AMS.

Answer 8

Naloxone and Dextrose (AMS most commonly due to opioid or hypoglycemia)

Question 9

Name the only 3 indications for whole bowel irrigation (Go lyletly.) Can be used orally if pt is awake and alert if not place NG tube.

Answer 9

1. Massive iron ingestion 2. Lithium Toxicity 3. Swallowing cocaine products (smuggling drugs)

Question 11

Why not give flumazenil immediately after Benzo intoxication.

Answer 11

Give flumazenil to early can precipate a seizure.

Question 11

Tinnitus, hyperventilation, respiratory alkalosis progressing to metabolic acidosis (Increased anion gap due overproduction of lactate). Dx? Rx?

Answer 11

Aspirin Overdose. Alkalize the urine.

Question 12

Why is the pulse ox normal in CO poisoning? Rx? Severe Rx? Most common cause of death?

Answer 12

CO does not prevent 02 from binding to hemoglobin it just prevents it from lifting off. 100% 02. Hyperbaric 02. MI most common cause of death.

Question 13

When to give Charcoal for Rx of toxicity?

Answer 13

Anytime it is superior to Gastric Lavage( Place a NG tube and giving saline and sucking out the poisoin) and Ipecac (induces vomiting by irritating the gastric mucousa and stimulating the chemo receptor trigger zone.) Charcoal is easier and less invasive.

Question 14

Causes brown blood, Dyspnea, Cyanosis, confusion, seizures and metabolic acidosis. Benzocaine and other anesthetics can cause this as well has nitrates. Dx? Test? Best initial Rx? Most effective Rx?

Answer 14

Methemoglobinemia. P02 will be normal most accurate test is met level. Best initial therapy is 100% Most effective is Methylene blue (decreases 1/2 life of methemoglobin)

Question 15

Salivation, Lacrimation, Polyuria, Diarrhea, Bronchospasm, bronchorrhea and respiratory arrest if severe. Dx? First step in management?

Answer 15

Organophosphate (Insecticide) Poisoning and Nerve gas (warfare.) Atropine to block Actelycholine. Remove all clothing and wash the body since the clothes would be soaked with vomitus which will cause re absorption of the substances in the skin.

Question 17

Abdominal pain, ATN, Sideroblastic anemia, Wrist Drop/Hand clumsiness and memory loss. Dx? Best initial diagnostic test? Most accurate test? Rx?

Answer 17

Lead poisoning. Best initial test is FFP. Mot accurate is lead level. (Remember most accurate test for sideroblastic anemia (due to alcohol or X-linked defect in Aminolevulinic acid synthase gene) is Prussion Blue stain not for lead poisoning. Rx: Succimer (PO), EDTA (IV), Dimercaprol (IM)

Question 18

Lung toxicity, interstitial fibrosis (if inhaled). Nervousness, jittery, twitching and some hallucinations (If taken orally.) Dx? Test? Rx?

Answer 18

Mercury Poisoning. Drug Level. Nothing to reverse lung fibrosis/toxicity. Succimer (PO) and Dimercaprol (IM) to Rx neurological problems.

Question 19

Present in Wood alcohol, cleaning solutions and paint thinners. What is the toxic metabolite? Common presentation? Diagnostic abnormality? Rx?

Answer 19

Methanol Poisoning. Formic acid/formaldehyde. Ocular toxcitiy. Retinal inflammation. Fomepizole and Dialysis.

Question 19

Formular for serum osmolality? Formular for osmolal gap? Which 2 substances increase the osmal gap.

Answer 19

Serum Osmolality = 2xNa + Bun/2.8 + glucose/18. Measured - Calculated = gap. Methanol and Ethylene glycol both increase this.

Question 20

1. Risk and rx for Neuroleptic malginant syndrome? 2. Risk and rx for Malignant Hyperthermia. They both have the same presentation elvelated CPK, K+ level and Hyperthermia.

Answer 20

1. Antipsychotic (Block dopamine) meds, give Dantrolene or Bromocriptine (Dopamine aganoist) 2. Anesthetics give Dantrolene.

Question 21

What is Present in Antifreeze. What is the toxic metabolite? Diagnostic abnormality? Rx?

Answer 21

Ethylene glycol from antifreeze. Oxalic acid/oxalate. Hypocalcemia (oxalate binds calcium )+ Enveloped/Rhomboid shaped crystals on UA. Fomepizole.

Question 22

Rx for Heat cramps/exhaustion? Rx for Heat stroke?

Answer 22

1. Oral fluids + Electrolytes. 2. IV fluids + Electrolytes + Evaporation.

Question 23

Best initial step in a hypothermic pt? Most common cause of death?

Answer 23

1. EKG 2. Cardiac arrhythmia on EKG.

Question 24

Respiratory rate of 6, hypotension, hypothermia, bradycardia, pupils can be dilated or constricted. Dx? Next step in management?

Answer 24

Opioid intoxication. Give Naloxone.

Question 25

In drowining has how does Salt water drowning present? How does fresh water drowning present.

Answer 25

1. CHF with Wet Heavy lungs. 2. Fresh water is hypotnic so RBC burst from absorbing the hypotonic fluid.

Question 27

What is the next step in management when some one ingest lye (Perm/Hair relaxant) (Na or K+ hydroxide)

Answer 27

Upper Endoscopy to Assess Damage of Esophagus.

Question 28

Pt with hx of allergies, develops dry mouth, pupillary dilation (5>mm), urinary retention, constipation. Dx? Rx?

Answer 28

Diphenhydramine toxicity (Anticholinergic). Rx: Physostigmine.

Question 29

Dry mouth, pupillary dilation (>4mm), constipation, urinary retention and QRS prolongation (>120ms). Dx? Rx?

Answer 29

TCA overdose (Anticholinergic and Cardiotoxic, Confusion). Alkalinize blood with Sodium Bicarbonate.

Question 30

Management of Lead levels in children? 1. 20-40? 2. 40-75? 3. >75?

Answer 30

1. Retest in 3 months 2. PO Succimer or IV EDTA 3. IV EDTA + IM Dimercaperal (used in all heavy metal poisoning lead, copper, mercury arsenic (BAL) Hospitalize.

Question 31

Side effect of Cyclosporine and Mychophenolate?

Answer 31

1. Tremors, HTN, Nephro, Hyperkalemia, Gum Hypertrophy 2. Bone Marrow Suppression.

Question 32

Management when child ingest iron?

Answer 32

Defuroxime.