Flashcards in Toxicology Deck (56):
what must be considered when dealing with toxic pt?
dose (manifestations may be related to how much they took)
time elapsed (how long has it been since you took this?)
altered mental status (frightened, agitated, delerium)
-overdose should always be in the differential when a pt presents with this
differential of AMS
infection (sepsis, elderly)
uremia (kidney failure)
steps to manage patient
ABC -airway (protect it proactively)
D-decontamination (remove garments)
E-easily correctable issues (hypoglycemia, hypoxia, hypotension, hypo/hyperthermia)
what is the most common OTC overdose?
what organ does acetaminophen affect?
what is the max dose in people of acetaminophen?
toxicity is assoc with what dose of acetaminophen
what is the first stage of acetaminophen overdose?
stage 1: asymptomatic, anorexia, nausea/vomiting, LFTs (liver enzymes) rise in the first 24 hours
what is the 2nd stage of acetaminophen overdose?
18-24 hrs post ingestion
continued rise in LFTs and aPTT
oliguria (urine output drops)
what is the 3rd stage of acetaminophen overdose?
72-96 hrs post ingestion
continued abdominal pain
hepatic necrosis and encephalopathy (due to rising ammonia levels because liver can't break down nitrogenous wastes of protein synthesis)
LFTs peak, ammonia and bilirubin continue to rise
what is the 4th stage of acetaminophen overdose?
resolution of hepatic abnormalities of liver failure
LFTs come down
what lab studies will you order with acetaminophen overdose?
arterial blood gasses (ABG)
acetaminophen level (recheck every 4 hrs)
RUQ ultrasound (grossly enlarged gallbladder?)
CT of the head (with evidence of encephalopathy)
EKG (for baseline)
what are examples of salicylates?
oil of wintergreen
what drug is taking the place of aspirin as a common overdose drug?
what is the early presentation of aspirin OD?
early (1-2 hrs post ingestion)
what is the later presentation of aspirin OD?
blood gas abnormalities
-respiratory alkalosis (CO2 is leaving the body)
-cerebral edema (AMS)
(cleared in the liver and kidney)
what labs do you order for aspirin OD?
ABG (blood gasses)
(protein will go up, spill blood in the urine)
what are the normal/abnormal levels of salicylate?
110 mg/dL severe toxicity
what are exampels of opioids
what is the presentation of opioid OD?
pinpoint pupils (lost light reaction-no dilation)
when are the peak effects of opioid with IVs?
10 min with IV route
when are the peak effects of opioid with insufflation?
when are the peak effects of opioid with IM administration? (intermuscular)
when are the peak effects of opioid with oral ingestion?
when are the peak effects of opioid with dermal application?
what labs should you order with opioid OD?
toxicity screen-often times qualitative (opioids, canabis, salycilates, acetaminophen)
abdominal film (body packers)
what is the peak effect of cocaine via inhalation?
what is the peak effect of cocaine via IV?
what is the peak effect of cocaine via nasal?
what is the peak effect of cocaine via oral?
what is mild presentation of cocaine OD?
what is moderate presentation of cocaine OD?
what are the physiologic affects of cocaine
long term use = constrictive cardiomyopathy
what labs would you order with cocaine OD?
what are examples of benzodiazepines
librium (older, not used as much)
tranxene (older, not used as much)
-extremely addictive, designed for short, acute,use
presentation of benzo OD?
coma with normal vital signs
nystagmus (horizontal typically)
ataxia (stumble, clumsy gait)
what labs would you order with benzo OD?
tox screen (if suspect multiple ingestion)
no set test to identify benzos in blood or urine
what are examples of antidepressants?
presentation antidepressant OD?
cardiac arrhythmias (widened QT interval-ventricular dysrythmias )
what labs would you order for antidepressant OD?
tox screen (nothing else involved)
TCA levels (qualitative only)
BAC of 0.01-0.1 presents with
mild coordination deficits
attention and cognition
BAC of 0.1-0.2 presents with
coordination deficits and psychomotor skills, decreased attention, slurred speech, ataxia, impaired judgment and mood variability
BAC of 0.2-0.3 presents with
lack of coordination, incoherent thoughts, confusion and nausea and vomiting
BAC of >0.3 presents with
stupor and loss of consciousness
respiratory depression and death
what is a common complication of vomiting while drunk?
things to consider with ETOH
BAC may not correlate with S & S
watch out for respiratory depression
labs for ETOH
tox screen (if something else is going on)
why is carbon monoxide dangerous?
it has a greater affinity for hemoglobin compared to oxygen (300 times greater)
presentation of acute CO poisoning
headache (most common)
can be misdiagnosed as ETOH intoxication
chest pain (AMI)
presentation of long term CO poisoning
movement disorders (ataxia that doesn't resolve)and
focal neurological deficits
what social group has higher levels of CO?