Toxicology

Question 1

What’s in a coma cocktail?

Answer 1

O2, narcan, D50 and thiamine

Question 2

Preferred gastic decontamination method if presenting in ED after one hr? Won’t be effective for lithium, iron, ETOH, potassium

Answer 2

activated charcoal

Question 3

First line treatment of seizures that is longer acting.

Answer 3

diazepam

Question 4

When is induced emesis with ipicac most useful as treatment for overdose?

Answer 4

within first few minutes

Question 5

What is the antidote for acetaminophen?

Answer 5

Acetylcysteine

Question 6

What is the antidote for anticholinergics?

Answer 6

Physostigmine

Question 7

What is the antidote for benzos?

Answer 7

Flumazenil

Question 8

What is the antidote for cyanide?

Answer 8

Na nitrite and Na thiosulfate

Question 9

Given with contrast dye to prevent allergic rxn?

Answer 9

mucomyst (acetylcystine)

Question 10

What is the antidote for methanol/polyethylene gylcol?

Answer 10

ethanol

Question 11

What is the antidote for narcotics?

Answer 11

narcan

Question 12

Presentation includes this saying: Blind as a bat (dilated pupils), Red as a beet (vasodilation), Hot as a hare (hyperthermia), Dry as a bone (dry skin), Mad as a hatter (hallucinations/agitation). The bowel and bladder lose their tone (ileus, urinary retention).And the heart runs alone (tachycardia)

Answer 12

anticholinergic overdose

Question 13

Most common cause of change in Osm

Answer 13

ETOH

Question 14

Saturates the glutathione detoxification system. Accumulates in liver and causes delayed hepatotoxicity
24-72 hours post ingestion

Answer 14

acetaminophen overdose

Question 15

What is the toxic overdose of acetaminophin?

Answer 15

> 140 mg/kg

Question 16

How long should you give acetylcysteine therapy in a tyelonol overdose?

Answer 16

140mg/kg orally of a 10%-20% solution. Follow-up with a 70mg/kg dose every 4 hours for 18 doses
or until the Tylenol level is O (zero)

Question 17

Biggest concern with cocaine and amphetamine overdoses

Answer 17

vasospasm (MI)

Question 18

Can be used to treat DBP > 120 in cocaine/amphetamine overdose

Answer 18

nitroprusside

Question 19

Why should you not acidify urine with cocaine/amphetamine overdose?

Answer 19

can result in myogloburia and acute renal failure

Question 20

Should never be used with tricyclic overdose, asthma, or

mechanical bowel or bladder obstruction

Answer 20

physostigmine

Question 21

Name the vitamin K dependent clotting factors

Answer 21

II, VII, IX, X

Question 22

When are peak effects of coumadin seen?

Answer 22

after 1-2 days

Question 23

Crampy abdominal pain, vomiting, profuse watery diarrhea, burning mucosa, conjunctivitis, tremor and seizures. A garlic odor may be on patient?s breath. Periorbital edema after 1-2 days

Answer 23

acute arsenic ingestion

Question 24

Treatment of acute arsenic poisoning

Answer 24

GI decontamination with GI lavage

and charcoal; Administer dimercaperaol(BAL) 3-5mg/kgdose q4h for 5 days

Question 25

Treatment of chronic exposure to arsenic poisoning

Answer 25

penicillamine 100mg/kg/d (max 1 | Gm) orally divided qid (May not reverse neurological damage)

Question 26

What is treatment of CO poisoning?

Answer 26

100% FiO2 for 4 hours

Question 27

Acute ingestion of an overdose is often associated with HYPERkalemia. ECG shows toxic effects of 3rd degree AV block, bradycardia, ventricular ectopy, or paroxysmal atrial tachycardia with AV block

Answer 27

digitalis toxicity

Question 28

Used to treat hyperkalemia associated with digitalis toxicity if > 7 with care to avoid CaCl which would kill the patient. Although generally you won't need to treat because it will decrease with reversal

Answer 28

use the glucose + insulin therapy

Question 29

Used to treat ventricular ectopy from digitalis toxicity

Answer 29

lidocaine

Question 30

What is the antidote for a digoxin overdose?

Answer 30

Digibind (digitalis specific Fab fragment antibodies)

Question 31

Severe gastroenteritis followed by delayed hepatic and renal failure in 48-72 hours. Onset of symptoms is 6-24 hours post ingestion. Treatment is supportive only and hospitalize all with baseline renal and hepatic functions

Answer 31

Amatoxin (Amanita Genus) mushrooms

Question 32

Symptoms are: salivation, miosis, bradycardia, diarrhea. Onset of symptoms is 30 min-1 hour post ingestion. Treatment is supportive and Atropine for severe cholinergic symptoms

Answer 32

Muscarine (Inocybe or Clitocybe) mushrooms

Question 33

Symptoms are hallucinations (used by several NA tribes). Onset is 15-30 minutes post ingestion. MOST COMMONLY seen mushroom poisoning (intentional). Treatment is supportive

Answer 33

Psilocybin (Psilocybe genus) mushrooms

Question 34

Symptoms are anticholinergic: mydriasis, tachycardia, hyperpyrexia, delerium. Onset is 30 min to 2 hours post ingestion. Treatment is supportive and physostigmine for severe sx

Answer 34

Ibotenic acid and muscimol (Amanita muscaria) mushrooms

Question 35

Symptoms are severe gastroenteritis with occasional hemolysis, hepatic and renal failure. Onset of symptoms is 6-12 hours post ingestion. Treatment is supportive and IV pyridoxine may prevent the hepatic/renal failure

Answer 35

Monomethylhydrazine (Gyromitra) mushrooms

Question 36

should be considered in any patient who is unconscious from unknown cause

Answer 36

opiate overdose

Question 37

How do you differentiate clonidine overdose from opiate overdose?

Answer 37

Clonidine overdose may appear identical to opiate | overdoes, but they do NOT respond to naloxone

Question 38

Symptoms include miosis, excessive salivation, bronchospasms, hyperactive bowel sounds, lethargy, muscle fasiculations, and seizures (DUMBELS). Death is from respiratory distress

Answer 38

organophosphate overdose

Question 39

What is the treatment of organophosphate overdose besides aggressive airway management?

Answer 39

Atropine IV in LARGE doses and Pralidoxime (2-PAM Chloride)

Question 40

Symptoms range from severe, paranoid, bizarre violent behavior to quiet stupor. Treatment aimed at limiting seizures and violence using diazepam or haloperidol. Monitor and prevent rhabdomyolysis

Answer 40

PCP overdose

Question 41

What are the three C's of TCA overdose?

Answer 41

Cardiac abnormalities, convulsions and coma

Question 42

What are the treatment options of ventricular arrhythmias and conduction defects from TCA overdose?

Answer 42

NaHCO3 (50-100 mEq IV), Lidocaine 1-2mg/kg, or Phenytoin 15-18mg/kg may be effective

Question 43

What are treatment options of hypotension due to TCA overdose?

Answer 43

NaHCO3 (50-100 mEq IV) and crystalloid (0.9% NaCl)