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Toxicology Flashcards

(53 cards)

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1
Q

What are the 5 most common exposures for less than 5 yos

A 
Cosmetic/personal care products
Household cleaning products
Analgesics
Foreign bodies/toys
Topical preparations
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2
Q

How do infants compare to adolescents in toxic exposures?

A 
Easier to obtain exposure history
Typically presents within hours of exposure
More likely a non-toxic exposure
Typically, smaller amount ingested
Larger weight-based dose
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3
Q

When do we include pediatric toxic exposures to assessments?

A 
Altered consciousness
Cardiac distress
Metabolic disturbances
Neurologic dysfunction
Pulmonary distress
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4
Q

What do we assess in cardiopulmonary distress?

A 
HR
RR
BP
Temp
Skin tone
Skin color
Hydration status
Peripheral pulses
Perfusion
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5
Q

What is the antidote for Heparin?

A

Protamine

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6
Q

What is the antidote for Cyanide

A

sodium amyl nitrite/sodium thiosulfate

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7
Q

What is the antidote for TCAs and salicylates

A

Sodium bicarbonate

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8
Q

What is the antidote for warfarin

A

Vit K

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9
Q

What is the antidote for diphenhydramine

A

Benzos/sodium bicarbonate

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10
Q

What is the antidote for benzocaine

A

Methylene blue

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11
Q

What is the antidote for propranolol

A

Pressor support
Glucagon
Insulin
Dextrose

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12
Q

How is APAP metabolized

A 
Glucoronidation (increases until age 3)
Sulfation
CYP450
Glutathione
Covalent binding - APAP-protein causes cell death
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13
Q

Antidote for APAP

A

N-acetylcysteine (NAC)

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14
Q

ADR of IV NAC

A

Anaphylactoid reaction

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15
Q

What is measured in metabolic disturbances in pediatric poisonings

A

Basic metabolic panel changes
Anion gap changes
Serum concentrations as warranted

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16
Q

Basic metabolic panel

A 
Na
K
CO2
BUN
Scr
Glu
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17
Q

Anion gap equation

A

Na - [Cl + Co2]

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18
Q

What causes an elevated anion gap

A 
M - Methanol
U - uremia
D - Diabetic ketoacidosis
P - Propylene glycol
I - Isoniazid, iron, infection
L - Lactic acidosis
E - Ethanol, ethylene glycol
S - Salcylates
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19
Q

Pediatric decontamination

A

Activated charcoal
Syrup of ipecac
Gastric lavage
Bowel irrigation

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20
Q

How does activated charcoal work in pediatric poisonings

A 
High SA promoting absorption
Ionic binding and van der Waals forces bind toxins
Give = 1 hour post ingestion
10 activated charcoal per 1 toxin
Does not effectively absorb  EtOHs
0.5-2 g/kg in pediatric pts
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21
Q

How does syrup of ipecac work in poisonings

A

Stimulates chemoreceptor trigger zones

Vomiting occurs within 20 minutes

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22
Q

How does gastric lavage work in poisonings

Study These Flashcards
A

10ml/kg warm water instilled and removed until contents are clear

23
Q

How does bowel irrigation work in poisonings

Study These Flashcards
A

Pharmacologic stimulation of the GI tract
PEG and/or electrolyte flushes
For this to work it needs to be further down GI tract

24
Q

IV NAC administration

Study These Flashcards
A

24 hour infusion

25
IV NAC concentration issues
More free water (hyponatremia, seizures) | 40 mg/ml
26
Enteral NAC ADR
N/V/D
27
Enteral NAC administration
72 hour regimen
28
Ethylene glycol (where is it found, why is it ingested)
Engine coolant | Sweet taste
29
What are the steps in metabolism of ethylene glycol
Ethylene glycol to glycoaldehyde via alcohol dehydrogenase Glycoaldehydre to glycolic acid via aldehyde dehydrogenase Glycolic acid to glycoxylic acid Glycoxylic acid to oxalic acid
30
ADRs of Ethylene glycol
``` < 5 hours Ataxia CNS depression Coma Mental Status Change ```
31
ADRs of glycolic acid
12-24 hours | Metabolic acidosis
32
ADRs of glycoxylic acid
``` Metabolites 12-24 hours CV collapse CHF Respiratory depression Tachycardia ```
33
ADRs of oxalic acid
``` 1-3 days ECG changes Hypocalcemia Nephrotoxicity Tetany ```
34
Supportive care of ethylene glycol poisonings
Thiamine (100 mg/d) | Pyridoxine (100 mg/d)
35
Methanol locations
Solvents Antifreeze Fuels Windshield wiper fluid
36
Methanol supportive care
Folic or folinic acid 1 mg/kg q4-6h
37
Methanol/ethylene glycol toxicity therapies
Ethanol Fomepizole Higher affinity for alcohol dehydrogenase than toxins (Fomepizole > ethanol) Continue until toxin concentration < 25
38
Ethanol administration
``` IV or enteral IV requires central access Goal serum concentration: 100-150 LD: 8ml/kg/h of 10% ethanol over 1 hour MD: 0.8 mL/kg/h continuous infusion ```
39
Ethanol ADRs
``` CNS depression Hypoglycemia Hyponatremia Hypothermia Respiratory depression ```
40
Fomepizole MOA
Competitive alcohol dehydrogenase inhibitor
41
Fomepizole advantages
No central access required No mental status changes No metabolic variations
42
Fomepizole administration
LD: 15 mg/kg x 1, then 10 mg/kg q12h x 4 MD: 15 mg/kg q12h
43
S/sx of toxic opioid exposures
``` Attention impairment Coma Constipation Drowsiness Loss of consciousness Memory impairment Nausea Pupillary constriction Respiratory depression Over sedation Slurred speech ```
44
Naloxone/Naltrexone MOA
Pure opioid antagonist | Competitive inhibitor
45
Naloxone dosing for toxic opioid exposures
= 20 kg: 0.1 mg/kg/dose > 20 kg: 2 mg/dose Every 2-3 minutes
46
Naltrexone dosing
Titrate up once opioid free Typical MD - 50 mg/d Once daily dosing
47
Antidote for organophosphates/carbamates
Atropine/pralidoxime
48
Antidote for malignant hyperthermia caused by the disease process such as neuroleptic malignant syndrome or heat stroke; caused by drug toxicity such as from monoamine oxidase inhibitors or baclofen withdrawal
Dantrolene
49
Antidote for iron
Deferoxamine
50
Antidote for dig
digifab
51
Antidote for benzos
Flumazenil
52
Antidote for lead
Edetate calcium disodium (EDTA) Dimercaprol Succimer
53
Antidote for methemoglobinemia
Methylene blue

Pediatrics (9 decks)

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