Toxicology/Poisoning/Overdose Flashcards by Tyler Rzucidlo

When is gastric lavage potentially useful?

in the first hour of ingestion

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When is gastric lavage potentially dangerous?

AMS: aspiration

Caustic Ingestion: burns the esophagus and oropharynx

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What are the only indications for Whole Bowel Irrigation?

Massive iron ingestion, Lithium and swallowing drug-filled packets (smuggling)

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What conditions is any type of gastric emptying always the wrong answer for?

Caustics: alkali and acids
AMS
Acetaminophen overdose

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What are the most common causes of death by overdose?

Acetaminophen
Aspirin

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What can be given to anyone with a pill overdose?

Charcoal: won’t cause any harm

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What dose does Acetaminophen cause toxicity at?

> 8-10 grams

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What dose does Acetaminophen cause fatality at?

> 12-15 grams

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What is the first line management for Acetaminophen overdose?

N-Acetylcysteine

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What do you give if the acetaminophen overdose was >24 hours ago?

no therapy

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What is the first step in management if you are unsure how much acetaminophen was ingested?

Get a drug level

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Is charcoal contraindicated with N-Acetylcysteine?

No: charcoal does not make N-Acetylcysteine ineffective

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What decreases the amount of Acetaminophen needed to cause toxicity?

Alcoholism

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How does an Aspirin overdose commonly present?

Tinnitus and Hyperventilation
Respiratory Alkalosis progressing to Metabolic acidosis
Renal toxicity and AMS
Increased anion gap

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How does aspirin impact coagulation?

interferes with prothrombin production and raises the prothrombin time (PT)

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How do you treat and Aspirin overdose?

Alkalinize the urine to increase the rate of aspirin excreteion

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What are common symptoms of Tricyclic Antidepressent (TCA) toxicity?

Seizures and Arrhythmia

Anticholinergic: Dry mouth, constipation, urinary retention

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What arrhythmia is commonly seen on EKG in TCA toxicity?

Widened QRS complex

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What is the best initial test in a patient with suspected TCA overdose?

EKG

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how do you treat TCA overdose?

Sodium Bicarbonate: bicarbonate protects the heart against arrhythmia

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What do Caustics cause?

mechanical damage to the oropharynx, esophagus and stomach including perforation

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What happens if you give acid to reverse alkali or alkali to reverse acid?

Exothermic reaction that worsens the damage

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How do you manage Caustic ingestion?

High volume water to flush out caustics and evaluate degree of damage with endoscopy

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What is the #1 cause of death in fires?

Carbon monoxide poisoning

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What are common clues to Carbon monoxide poisoning in the patient history?

Gas heaters, wood-burning stoves Automobile exhaust

What is the effect of Carbon Monoxide?

CO binds oxygen to form carboxyhemoglobin which will not release oxygen to tissue: acting functionally like an anemia

How does Carbon Monoxide poisoning present?

Dyspnea, lightheadedness, confusion, seizures and death from MI

How does Carbon Monoxide poisoning present on pO2?

normal pO2 because oxygen does not detach from hemoglobin

What is the most accurate test for Carbon Monoxide poisoning?

Carboxyhemoglobin level: expect to see a low bicarbonate and low pH (metabolic acidosis) when CO is very high

What is the best initial therapy for Carbon Monoxide poisoning?

remove the exposure and give 100% oxygen

How does 100% oxygen treat carbon monoxide poisoning?

Detaches CO from Hgb and shortens the half-life of carboxyhemoglobin

What do you use for "severe" CO poisoning?

Hyperbaric oxygen

What is defined as "Severe" CO Poisoning?

CNS symptoms Cardiac Symptoms Metabolic acidosis

What is Methemoglobinemia?

Oxidized hgb locked into the ferric state: brown in color and will not carry oxygen

What are common causes of Methemoglobinemia?

Benzocaine and other local anesthetics Nitrites and Nitroglycerin Dapsone

What is the result of Methemoglobinemia formation?

Oxygen is never delivered to tissues because Methemoglobinemia will never pick up oxygen

What are symptoms of Methemoglobinemia?

Dyspnea, Cyanosis, Headache, confusion, seizures, and metabolic acidosis

What is the most accurate test for Methemeglobinemia?

Methemoglobin level

What is the best initial treatment for Methemeglobinemia?

100% oxygen

What is the most effective treatment for Methemeglobinemia?

Methylene Blue: decreases half-life

How do Organophosphate (insecticide) Poisoning and Nerve gas poising act?

They cause a massive increase in Ach levels by inhibiting its metabolism

How do Organophosphate (insecticide) Poisoning and Nerve gas poising present?

Salivation Lacrimation Polyuria Diarrhea Bronchospasm, Bronchorrhea and respiratory arrest

How do you treat Organophosphate (insecticide) Poisoning and Nerve gas poising?

Atropine

How are Organophosphate (insecticide) Poisoning and Nerve gas absorbed?

Through the skin

What predisposes to Digoxin Toxicity?

Hypokalemia: because K and Digoxin compete for the same binding sites on Na/K ATPase: less K bound = more digoxin bound

What is the most common symptom of Digoxin toxicity?

GI disturbance: N/V, abdominal pain

What are other common symptoms of Digoxin Toxicity?

Hyperkalemia Inhibition of Na/K ATPase Confusion Visual Disturbance: yellow halos around objects Rhthym disturbances: Brachycardia, atrial tachycardia, AV block , Ventricular ectopy

What is the most accurate test for Digoxin toxicity?

Digoxin level

What are the best initial tests for suspected Digoxin Toxicity?

K level and EKG

What will an EKG show in Digoxin Toxicity?

Downsloping of the ST segment in all leads

What arrhythmia is most common in Digoxin Toxicity?

Atrial Tachycardia with variable AV block

How do you treat Digoxin Toxicity?

Control K level and Digoxin-specific Ab to rapidly remove digoxin from circulation

How does lead poisoning present?

Abdominal Pain: lead colic Renal Tubule Toxicity (ATN) Anemia: Sideroblastic Peripheral Neuropathies: wrist drop CNS abnormalities: Memory loss and confusion

What is the most accurate test for lead poisoning?

lead level

How does lead lead to anemia?

interferes with Hemoglobin production

What lab value is elevated in lead poisoning?

Free Erythrocyte Protoporphyrin

What is the most accurate test for Sideroblastic anemia?

Prussian Blue Stain: detects Fe built up in the RBC mitochondria

How do you treat lead poisoning?

Chelating agents to remove lead from body

What is the only oral Lead chelating agent?

Succimer

What are 2 common parenteral lead chelating agents?

Ethylenediaminetetraaacetic acid (EDTA) and Dimercaprol (BAL)

How does mercury poisoning present?

Neurologic issues: Nervous, Jittery, twitchy, hallucinations Inhaled mercury: interstitial fibrosis

How do you manage Mercury poisoning?

Chelating agents to remove from body: dimercaprol and succimer

What do both Methanol and Ethylene Glycol Toxicity cause?

Metabolic acidosis with increased anion gap

What is the best initial therapy for both methanol and Ethylene Glycol toxicity?

Fomepizole to inhibit alcohol dehydrogenase and prevent production of toxic metabolites

What is the most effective therapy for both methanol and ethylene glycol toxicity?

Dialysis: only way to effectively remove them from the body

What are common sources of Methanol?

wood alcohol, cleaning solutions, pain thinner

What toxic metabolites are formed by Methanol?

Formic acid, Formaldehyde

How does Methanol Toxicity present?

Ocular Toxicity

What is the initial diagnostic abnormality in Methanol toxicity?

Retinal inflammation

What is a common source of Ethylene glycol?

Antifreeze

What are the toxic metabolites produced by Ethylene Glycol?

Oxalic acid, Oxalate

How does Ethylene Glycol toxicity present?

Renal Toxicity

What is the initial diagnostic abnormality in Ethylene Glycol Toxicity?

Hypocalcemia, Envelope-shaped oxalate crystals in the urine

What is the most common injury from snake bite?

local wound

What does tissue damage from snake bites result from?

Proteases and lipases

What causes death from snake bites?

Hemolytic toxin: hemolysis, DIC, damage do endothelial lining of tissues Neurotoxin: Respiratory paralysis, ptosis, dysphagia, diplopia

How do you treat snake bites?

Pressure, Immobilization to decrease movement of venom and antivenin

What do all spider bites present with?

Sudden, sharp pain

How does a black widow spider bite present?

Abdominal pain and muscle pain

What lab test abnormality is seen with black widow spider bites?

Hypocalcemia

How do you treat Black widow spider bites?

Calcium and antivenin

How do brown recluse spider bites present?

Local skin necrosis, bullae and blebs

What lab test abnormalities are seen with brown recluse spider bites ?

none

How do you treat brown recluse spider bites?

Debridement

How are Dog, Cat and Human bites managed?

Amoxicillin/Clavulanate (Augmentin) Tdap if >5 years since last booster

What is the most common pathogen from Dog and cat bites?

Pasteurella Multocida

What is the most common pathogen form human bites?

Eikenella Corrodens

When is a rabies vaccine indicated?

Animal has AMS/acting bizarre behavior Attack unprovoked by a stray dog that cannot be observed or diagnosed

How does Cannabinoid Hyperemesis syndrome present?

Recurrent episodes of N/V and crampy abdominal pain with history of marijuana use that improves with a hot shower or bath

What are the treatment options for Cannabinoid Hyperemesis Syndrome?

Antiemetics: Ondansetron Benzodiazepines: Lorazepam

Toxicology/Poisoning/Overdose Flashcards

(90 cards)