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Toxicology Flashcards

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1
Q

Toxic dose of aspirin

A

200-300 mg/kg

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2
Q

Salicylate toxicity acid-base

A

Respiratory alkalosis + anion gap metabolic acidosis

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3
Q

Hemodialysis indication in salicylate toxicity

A

Level >100 mg/dL in acute overdose and >50 mg/dL in chronic overdose
Coma
Rising levels despite alkalinization
Kidney failure
Pulmonary edema
Altered MS
Clinical deterioration

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4
Q

What is the antidote for malignant hyperthermia

A

Dantrolene

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5
Q

Triad of serotonin syndrome

A

Autonomic instability (tachycardia, diarrhea, shivering, mydriasis, diaphoresis)
AMS
Increased neuromuscular activity (clonus, hyperreflexia, tremor, seizures)

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6
Q

Which opioid cause mydriasis in overdose?

A

Meperidine

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7
Q

What is the toxic metabolite of methanol?

A

Formic acid

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8
Q

What is the toxic metabolite of isopropanol?

A

Acetone

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9
Q

Acid base of isopropanol intox?

A

Elevated osmolar gap, ketosis without acidosis

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10
Q

Triad of opiate toxidrome?

A

CNS depression
Respiratory depression
Pinpoint pupils

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11
Q

Expected finding in ethanol ingestion (pediatrics)?

A

Hypoglycemia

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12
Q

Treatment of ethylene glycol poisoning?

A

Fomepizole

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13
Q

Isoniazid toxicity acid-base and antidote?

A

Anion gap metabolic acidosis
Pyridoxine (B6)

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14
Q

Coma +anion gap metabolic acidosis + increased lactate, seen in which toxicity?

A

Cyanide

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15
Q

Cyanide treatment?

A

Hydroxocobalamin
Cyanide kit (nitrites and sodium thiosulfates)

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16
Q

What is the difference between BB and CBB?

A

Both present as bradycardia, hypotension
Betablockers = HYPOglycemia
Calcium channel blockers = HYPERglycemia

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17
Q

Treatment of BB toxicity?

A

Glucagon
HIGH dose insulin 1 unit/kg

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18
Q

Treatment of anticholinergic

A

Supportive
Physostigmine for agitation (CI in TCA)

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19
Q

Physostigmine complications and CI?

A

Complications: dysrhythmias and seizures (only give of normal QRS)
CI: TCA

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20
Q

Serum pH goal in TCA tox, and how to maintain

A

7.5-7.55
Sodium bicarb 150 mEq in 1L D5W

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21
Q

What to avoid in malignant hyperthermia patients?

A

Depolarizing muscle relaxants (succ, suxamethonium, and decamethonium)
Volatile anesthetics: halothane, sevo, des, iso, enflurane

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22
Q

Most common ECG finding in digoxin tox

A

MOST COMMON is PVC
Other findings: Atrial tach with AV block, bidirectional v.tach, slow a.fib

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23
Q

Initial dose in digoxin tox in unknown ingestion?

24
Q

Poor prognosis in digoxin tox?

25
Haloperidol and methadone can cause what ECG changes?
QTC prolongation
26
Indications for hyperbaric oxygen therapy due to CO poising?
Evidence of end-organ damage LOC, coma, seizures Confusion, focal findings, or cognitive deficits MI, life-threatening dysrhythmia Persistent symptoms after tx. With 1 atm O2 COHb lvel >25% (15% in pregnant)
27
What to avoid when taking metronidazole or TCA?
Metro - > Ethanol: Results in disulfiram-like reaction TCA -> diary
28
Digoxin is seen in which plants?
Fox glove Oleander Lilly of the valley
29
Digoxin-specific antibody dosing?
If unknown or cardiac arrest: 10 vials (5 in peds) Known amount: (?mg X 0.8) / 0.5 Known serum: [(serum level ng/mL x weight in kg) / 100]
30
Indication for dialysis in ASA tox
Serum >100 mg/dL in acute and >60 in chronic Rapidly rising salicylate level Altered MS (cerebral edema) Kidney or liver failure Pulmonary edema Severe acid/base abnormality Worsening clinical
31
How much will administration of 50 mL of sodium bicarbonate change serum pH?
For every 50 mL of sodium bicarbonate administered, serum pH increases by 0.1
32
What is the chelation therapy in lead and when to start in children?
Dimercaprol If asymptomatic start equal to or above 70 microg/dL
33
Patient presents with pain out of proportion after exposure to material: What is it? What electrolyte imbalance is seen? How to treat?
Hydrofluoric acid HYPOcalcemia and HYPOmagnesemia, and HYPERkalemia Calcium gluconate
34
Blood smear reveals: microcytic anemia with basophilic stippling, what is the diagnosis
Lead poising
35
Valproic acid tox present with what in the blood and what is the antidote?
Elevated serum ammonia level, hypernatremia, hypocalcemia, metabolic acidosis L-carnitine
36
What ECG finding necessitates starting sodium bicarbonate infusion in TCA overdose?
QRS interval >100 ms
37
Oxymetazoline can present with similar toxicity to what?
Clonidine Result in bradycardia, hypotension, and miosis
38
Jimsonweed which toxidrome?
Anticholinergic
39
Iron tox antidote
Deferoxamine
40
Organophosphate (cholinergic tox) antidote
Atropine Pralidoxime
41
Methanol tox produces what compund
Formic acid
42
How to calculate anion gap?
Sodium (Na) - [Calcium (Cl) + HCo3]
43
What is CI in cocaine (sympathomimetic) patients? Ex: methamphetamine, MDMA (ecstasy), ephedrine, bath salts
Metoprolol
44
How do MDMA patients present?
Hyperthermia, dehydration, and HYPOnatremic
45
Patients takes MDMA and dextromethorphan will present with what toxidrome?
Serotonin syndrome
46
PCP present with what physical finding?
Nystagmus
47
What is the endpoint for atropine treatment?
Resolution of bronchorrhea
48
Toxic metabolite of ethylene glycol?
Oxalic acid
49
Non-ionizing radiation?
Microwave
50
Indication of emergent hemodialysis following acute ethylene glycol overdose?
Glycolic acid level > 8 mmol/L
51
What 2 co-factors adjuncts should be given in acute ethylene glycol overdose?
Thiamine and pyridoxine
52
How to distinguish between naloxone and clonidine?
Clonidine present with bradycardia and hypotension, though initially presenting with hypertension
53
Indications for deferoxamine chelation therapy?
Iron level > 500 mcg/dL Shock Acidosis AMS Severe refractory GI symptoms
54
Hemodialysis in lithium toxicity?
Lithium concentration > 5 mEq/L Lithium concentration > 4 mEq/L AND IMPAIRED KIDNEY FUNCTION Presence of seizure, AMS, dangerous dysrhythmias Elevated lithium concentration in symptomatic patients with CI to aggressive hydration (ex: HF)
55
What toxic alcohol does no produce lactic acidosis?
Isopropanol

Emergency (3 decks)

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