Toxicology

Question 1

salicylates fatal ingestion amount?

Answer 1

10-30g

Question 2

activated charcoal for salicylates?

Answer 2

if within 1 hour

Question 3

goal of treatment for salicylate overdose?

Answer 3

alkalosis, serum ph 7.5-7.59, urine pH 6.5-8

Question 4

how does alkalosis work in salicylate overdose?

Answer 4

favors the unprotonated anion and is excreted in the urine, if protonated it can cross the BBB

Question 5

Level when to use HD in salicylate OD?

Answer 5

severe sx, >120 mg/dl in serum, or >100 6 hr post ingestion

Question 6

isopropyl alcohol acid base?

Answer 6

only osmolar GAP, no AGAP, no acidosis, but ketones in urine

Question 7

breakdown product of isopropyl?

Answer 7

acetone- smelly breath

Question 8

osmolar gap?

Answer 8

serum osm- calc osm, normal <10

Question 9

calculated osmolarity?

Answer 9

2Na+BUN/2.8+glc/18

Question 10

treatment for isopropyl alcohol ingestion?

Answer 10

fluids and pressors if needed

Question 11

HD for isopropyl alcohol?

Answer 11

level >500, coma, resistant sx

Question 12

ethylene glycol(antifreeze) breaks down into?

Answer 12

oxalate

Question 13

oxalate effect? how does it look?

Answer 13

renal failure/ dumbell shaped crystals

Question 14

Methanol breaks down into what?

Answer 14

formic acid

Question 15

alcogol dehydrogenase does what?

Answer 15

methanol to formaldehyde

Question 16

alcohol dehydrogenase is inhibited by what 2 things?

Answer 16

ethanol(level 100-150 mg/dl) and fomepizole

Question 17

formic acid causes what?

Answer 17

blurred vision, photophobia, blindness, optic disc hyperemia

Question 18

methanol and ethylene glycol acid base?

Answer 18

osmolar gap and AGAP

Question 19

propylene glycol tox seen in what circumstance?

Answer 19

dilutent in lorazepam infusion

Question 20

propylene glycol acid bae?

Answer 20

AGAP, osmolar GAP, AKI, lactic acidosis

Question 21

CCB overdose tx?

Answer 21

calcium, glucagon, lipid emulsion, insulin .1-10U/kg

Question 22

why cant you use dialysis for CCB overdose?

Answer 22

highly protein bound

Question 23

tx for BB OD?

Answer 23

glucagon, lipid emulsion

Question 24

MC tx for BB OD?

Answer 24

atropine and fluids

Question 25

how does glucagon work in BB OD?

Answer 25

inc cAMP, inc contractility

Question 26

symtpoms of BB OD?

Answer 26

bronchospasm, hypoglycemia, AV block, bradycardia

Question 27

CCB OD tx?

Answer 27

high dose calcium, then high dose insulin, then lipid emulsion therapy

Question 28

MOA of high dose insulin in CCB OD?

Answer 28

increases ical leading to increase ionotropy

Question 29

high dose insulin dosing?

Answer 29

1U/kg bolus, then 1-10 U/kg/hr. make sure to fix K and glc prior

Question 30

pathophys of methemoglobinemia?

Answer 30

contains the Fe3 instead of Fe2 which shifts the oxygen dissociation curve left and has higher affinity for o2 and does not unload to tissues

Question 31

how to measure methemoglobinemia?

Answer 31

co oximetry levels with methemoglobin levels, >30% severe

Question 32

causes of methemoglobinemia?

Answer 32

topical benzocaine, dapsone, primaquine, rasburicase in G6PD patients

Question 33

tx for methemoglobinemia?

Answer 33

methylene blue

Question 34

patient with low sat that is not responsive to supplemental O2, but normal Po2?

Answer 34

methemoglobinemia

Question 35

MOA of acetaminophen toxicitiy?

Answer 35

overwhelming the glutatione conjugation

Question 36

time frame for giving charcoal in acetaminophen tox?

Answer 36

within 1 hour

Question 37

tx for acetaminophen OD?

Answer 37

16h NAC protocol

Question 38

poor prognostic factors with tylenol OD?

Answer 38

acidosis, renal failure, INR>6, grade III HE

Question 39

when not to use the Rumack Matthew nomogram?

Answer 39

chronic tylenol use, chronic alcohol use, preexisting liver disease, unknown time of ingestion

Question 40

treatment for heavy metal intoxication?

Answer 40

dimercaprol

Question 41

how does insulin work for CCB OD?

Answer 41

Chronotropy and ionotropy

Question 42

when to transfer to a liver center for tylenol OD?

Answer 42

early signs of hepatic dysfucntion or massive ingestion of >30g or a serum level of >500 mg/L

Question 43

ethylene glycol urine findings?

Answer 43

calcium oxalate monohydrate crystlas, dumbbell shaped

Question 44

initial management strategy for acetaminophen overdose?

Answer 44

if confirmed give NAC, dont wait for lab value

Question 45

best treatment for isopropyl alcohol intoxication?

Answer 45

IV fluids, HD reserved for levels over 500 and severe symptoms

Question 46

aspirin overdose electrolyte disturbances?

Answer 46

low serum uric acid, lactic acid from uncoupling, hypokalemia, AGAP acidosis, resp alkalosis

Question 47

complication from salicylate toxicity need to watch for?

Answer 47

hypoglycemia