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7453 Neuro Test 4 > Toxic Alcohols > Flashcards

Toxic Alcohols Flashcards

(78 cards)

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1
Q

Which alcohol is directly toxic?

A

isopropanol

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2
Q

Which comes first in alcohol metabolism alcohol dehydrogenase or aldehyde dehydrogenase?

A

alcohol dehydrogenase

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3
Q

Anion gap present if > __

A

12

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4
Q

Anion gap formula:

A

Na-Cl-HCO3

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5
Q

What is normal osmol gap?

A

10-20

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6
Q

osmolality formula?

A

(2 x Na) + (BUN/2.8) + (glucose/18) + (EtOH/4.6)

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7
Q

Ethanol competitively inhibits ___, which decreases the metabolism of toxic alcohols

A

alcohol dehydrogenase

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8
Q

Ethylene glycol is metabolized by alcohol dehydrogenase into __

A

glycoaldehyde

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9
Q

Ethylene glycol is metabolized by aldehyde dehydrogenase into ___.

A

glycolate > oxalate

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10
Q

Which alcohol is metabolized into formate?

A

methanol

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11
Q

Which alcohol is metabolized into acetone?

A

isopropanol

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12
Q

3 things associated with anion gap PLUS osmolar gap?

A
  • methanol
  • ethylene glycol toxicity
  • alcoholic ketoacidosis
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13
Q

Osmolar gap WITHOUT anion gap is associated with __ alcohol toxicity

A

isopropyl

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14
Q

Osmolar gap formula?

A

measured - calculated

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15
Q

__ is in antifreeze that makes it detectable in urine.

A

fluorescein

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16
Q

Ethylene glycol pea concentration is in __ to __ hours

A

1, 2

rapid GI absorption

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17
Q

Toxic ingestion of ethylene glycol is __ mL

A

100

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18
Q

What is the consensus guideline recommendation for ethylene glycol referral to healthcare facility?

A

children with more than an observed lick, sip, or taste intestine or adult with known accidental ingestion of more than a swallow (10-30mL) should be referred immediately

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19
Q

Concomitant __ ingestion will use up alcohol dehydrogenase and delay metabolism of ethylene glycol.

A

ethanol

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20
Q

Ethylene glycol is metabolized to glycoaldehyde by what enzyme?

A

alcohol dehydrogenase

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21
Q

Ethylene glycol is metabolized into ___ at the final step

A

oxalic acid

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22
Q

__ is needed to metabolize glyoxylic acid (ethylene glycol) into hippuric acid?

A

pyridoxine

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23
Q

___ and ___ are needed to metabolize glyoxylic acid (ethylene glycol) into alpha hydroxy beta ketoadapic acid?

A

thiamine, magnesium

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24
Q

ethylene glycol can cause ___ crystals to deposit in the kidneys, heart, and lungs

A

calcium oxalate

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25
Which ethylene glycol effects happen in 30mins to 12 hours? CNS metabolic renal
CNS n/v, inebriation, seizures
26
Which ethylene glycol effects happen in 2-3 days
renal calcium oxalate, ATN, hematuria/proteinuria
27
Which ethylene glycol effects happen in 12-24 hours?
metabolic cardiopulmonary compromise, AG acidosis
28
consider nasogastric aspiration for ethylene glycol if less than ___ hour
1
29
Is activated charcoal effective for ethylene glycol?
no
30
Use hemodialysis if ethylene glycol > __mg/dL
100
31
What 3 things are used in ethylene glycol shunting therapy?
- thiamine - magnesium - pyridoxine
32
2 ethylene glycol antidotes?
- ethanol - fomepizole alcohol dehydrogenase inhibition
33
Use antidote if ethylene glycol level is > __ mg/dL
20 continue until < 20, AND acidosis is resolved
34
The dose of ethanol as ethylene glycol antidote is __ gm/kg IV bolus, then __ mg/kg/hr infusion.
0.8, 130
35
Fomepizole dose for ethylene glycol antidote?
15g/kg IV load followed by 10mg/kg Q12H x 4 doses increase to 15mg/kg IV Q12
36
Fomepizole does does not have to be adjusted in HD initiated. a. true b. false
b. false
37
Which ethylene glycol antidote is done at ICU level care?
ethanol
38
Which ethylene glycol antidote doe not need levels/monitoring?
fomepizole
39
What is the only FDA approved ethylene glycol antidote?
fomepizole ethanol not FDA approved
40
___mL of methanol may be fatal?
15
41
___mL/kg of methanol may be fatal?
0.25
42
Methanol is metabolized to ___ acid.
formic
43
Which alcohol causes visual complaints like blindness, "snow storm", "seeing the wind"?
methanol
44
Acidosis may be delayed with which alcohol?
methanol
45
Methanol > __ mg/dL is indication for antidote therapy.
25
46
What is used for methanol shunting therapy?
folic acid to accelerate transformation from formic acid
47
What is used for methanol adjunctive therapy?
bicarb therapy increase pH and formic acid dissociation
48
Hemodialysis is especially useful for methanol if level > __ mg/dL
45
49
Which alcohol has no direct anion gap acidosis?
isopropyl unless ketosis causes it
50
Which alcohol has no antidote?
isopropanol
51
Which CYP metabolizes ethanol?
2E1
52
Which alcohol is partially metabolized by the peroxidase-catalase system?
ethanol
53
Nasogastric aspiration is used with what alcohol?
ethanol not activated charcoal
54
Which alcohol is metabolized to acetyl CoA?
ethanol ethanol > acetaldehyde > acetate > acetyl CoA
55
Ethanol causes depletion of NAD+ or NADH?
NAD+ gluconeogenesis pyruvate entering kreb's cycle
56
Ethanol causes accumulation of NAD+ or NADH?
NADH pyruvate conversion to lactate ketone formation
57
What B vitamin is given for ethanol toxicity management?
B1 (thiamine) "banana bag" +/- magnesium
58
What is unregulated in ethanol withdrawal?
glutamate
59
Manifestations of ethanol withdrawal occur up to __ days.
10
60
Which ethanol withdrawal Sx occur in 12-24hrs? autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens
autonomic hyperactivity
61
Which ethanol withdrawal Sx occur in 24-48hrs? autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens
hallucinations, excitation
62
Which ethanol withdrawal Sx occur in 48-96hrs? autonomic hyperactivity, hallucinations, neuronal excitation, delirium tremens
delirium tremens
63
What is very mild CIWA-Ar score?
0-9 Tx with thiamine/supportive care
64
What is mild CIWA-Ar score?
10-15 Tx with thiamine and supportive care and lorazepam therapy
65
What is moderate CIWA-Ar score?
>= 16
66
What is severe CIWA-Ar score?
>= 21
67
Does isopropanol have anion gap?
no
68
Does methanol have anion gap?
yes
69
Does ethylene glycol have anion gap?
yes
70
Does ethanol have anion gap?
yes in AKA
71
Does isopropanol cause ketosis?
yes
72
Does methanol cause ketosis?
no
73
Does ethylene glycol cause ketosis?
no
74
Does ethanol cause ketosis?
yes in AKA
75
What Sx is associated with isopropanol?
gastritis
76
What Sx is associated with methanol?
blindness
77
What Sx is associated with ethylene glycol?
renal failure
78
What Sx is associated with ethanol?
hypoglycemia

7453 Neuro Test 4 (9 decks)

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