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Toxicology Flashcards

(16 cards)

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1
Q

Indications for Gastric Lavage (directly removing stomach contents using an Oreo gastric tube)

A

Ingestion of a substance with high toxic potential AND:

  • within 1 hour of ingestion
  • Ingested substance is not bound by activated charcoal or has no effective antidote
  • potential benefits outweighs the risks
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2
Q

Contraindications for gastric lavage

A
  • Spontaneous emesis
  • Decreased LOC/can’t protect airway (intubate first)
  • Ingestion of hydrocarbons, caustic agents, or foreign bodies
  • Patient has high risk for esophageal or gastric injury (GI bleed, recent surgery, abnormal anatomy)
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3
Q

How do you perform gastric lavage?

A

Use a 36F-40F OG tube for adults.
22F-28F for children
Intubate first if necessary
Place patient in Left Lateral decubitus and head lowered below level of feet
Aspirate available stomach contents
Lavage with 250mL aliquots of warm water or saline
Do this until fluid is clear and 2L minimum has been used
Give activated charcoal if indicated through the tube

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4
Q

Indications for activated charcoal (AC) in a poisoned patient

A
  • Ingestion within 1 hour after ingestion
  • Only if amount ingested is potentially dangerous and can be absorbed by AC
  • Certain agents that may require multi-dose activated charcoal: Carbamazepine, Dapsone, Phenobarbital, Quinine, Theophylline). These undergoenterohepatic or eneteroenteric recirculation or form concentrations.
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5
Q

These substances are not absorbed by activated charcoal and are thus a contraindication to AC use.
What are other contraindications to AC use?

A
  • Metals, Corrosives, Alcohols cannot be absorbed.
  • Caustic substances or Hydrocarbons - do not use AC because if vomiting is induced this could lead to damage
  • > 2 hours since ingestion (unless ingested massive quantities, sustained release substances, or part of multi-dose AC)
  • If EGD is required or patient at risk for GI hemorrhage or perf (eg, b/c caustic agents)
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6
Q

Indications for Whole Bowel Irrigation (WBI) as a means to treat poisoning/overdose

A
  • Removal drug packets (body stuffers) - if no suspicion of packet rupture
  • Large ingestion of sustained release drug
  • Potentially toxic ingestion that cannot be treated with AC (eg, metals)
  • Life-threatening ingestion of Lithium
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7
Q

Contraindications to Whole Bowel Irrigation (WBI) for treatment of poisoning/overdoses

A
  • decreased GI motility
  • Bowel obstruction
  • GI hemorrhage
  • Persistent emesis
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8
Q

How is whole bowel irrigation done?

A

Polyethylene Glycol: 1-2 L/hr usually with naso- or orogastric tube

Endpoint: clear rectal effluent or a total irrigation of 10 L

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9
Q

What is multi-dose activated charcoal and what are the indications for its use?

A

Repeated doses of activated charcoal every 2-4 hours in order to increase poison clearance.

Use for drugs with enterohepatic or enteroenteric recirculation, sustained release drugs, or drugs that form concentrations or bezoars.

These drugs: Carbamazepine, Dapsone, Phenobarbital, Quinine, and Theophylline

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10
Q

Drugs to consider using multi dose activated charcoal

A

Carbamazepine, Dapsone, Phenobarbital, Quinine, and Theophylline

Or sustained release drugs

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11
Q

When is urinary alkalinization indicated for poisoning/overdose? How is it done?

A

Overdose with drugs that are weak organic acids:

  • Aspirin (most common)
  • Methotrexate
  • Phenobarbital

Use Sodium Bicarb infusion: 150 mEq (3 amps)in 1 L D5W at 1.5-2x maintenance rate

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12
Q

Contraindications for urinary alkalinization

A
  • Poisoning with agents that are NOT weak organic acids
  • Agents not primarily cleared by kidneys
  • Patients that cannot tolerate excess sodium/water: CHF, kidney failure
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13
Q

Indications for Hemodialysis for poisoning/overdose

A

Life-threatening poisoning caused by:

  • Lithium
  • Salicylates
  • Phenobarbital
  • Valproic acid
  • Metformin Lactic Acidosis (treats the acidosis, but doesn’t necessarily remove the metformin)
  • Methanol/ethylene glycol
  • Potassium salts
  • Theophylline
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14
Q

Overdoses of these drugs cause bradycardias

A

Beta Blockers
Calcium Channel Blockers
Digoxin (cardiac glycosides)
Clonidine

Other antidysrhythmic agents…

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15
Q

Overdoses of these drugs cause Tachydysrhythmias (sins tach, SVT, VT)

A

Anticholinergic
Stimulants
Sympathomimetics

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16
Q

Overdoses of these drugs cause QRS widening

Study These Flashcards
A

Na+ channel blocking drugs:

  • Quinidine
  • Sedating antihistamines
  • Cocaine
  • TCAs

Toxicology (2 decks)

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