Toxicology -- SD

Question 1

What are considered to be the “bad boys” for overdoses?

Answer 1

CCB, TCA, ethylene glycol, and alcohol

Question 2

What EKG changes are seen in overdoses?

Answer 2

Arrhythmias, prolonged QT, widened QRS

Question 3

What does MUDPILES stand for?

Answer 3

Methanol, Uremia, DKA, propylene glycol, isoniazid, lactic acidosis, ethylene glycol/ethanol, salicylates

Question 4

How do we calculate an anion gap?

Answer 4

Sodium - (Bicarb + Chloride)

Question 5

An anion gap less than _____ is normal

Answer 5

12

Question 6

Patient is delirious, hyperventilating (Kussmal), and is complaining of tinnitus. What is the likely causative agent of OD?

Answer 6

Aspirin

Question 7

At what levels are salicylates considered to be life threatening?

Answer 7

> 500mg/kg

Question 8

How often do we repeat serum salicylate levels?

Answer 8

Every 2 hours

Question 9

After how many hours do people reach their max absorption of salicylates?

Answer 9

6 hours

Question 10

How do maintain a patient’s pH with an aspirin overdose?

Answer 10

Bicarb

monitor patient’s urine pH

Question 11

What metabolic disorder typically accompanies aspirin overdose?

Answer 11

Metabolic acidosis

Question 12

Do you see ECG changes with an aspirin overdose?

Answer 12

None

Question 13

Gastric lavage can be done up to _______ minutes post ingestion

Answer 13

60

Question 14

What is the treatment of choice for aspirin overdoses?

Answer 14

Dialysis

Question 15

What is the max daily dose of tylenol?

Answer 15

4 grams in adults

Question 16

What is the most common cause of acute liver failure?

Answer 16

Acetaminophen overdose

Question 17

Why do children typically fare better from a tylenol overdose?

Answer 17

because they have more glutathione in their liver

Question 18

tylenol overdose – people get sick right away or days later?

Answer 18

days later!

Question 19

What makes a tylenol overdose even worse?

Answer 19

alcohol

Question 20

When do you draw labs for a tylenol overdose?

Answer 20

immediately and then 4 hours later

Question 21

True or False, tylenol overdose patients will suffer from metabolic acidosis?

Answer 21

False – pH should be normal. If you see acidosis, something else is on board.

Question 22

How soon do we have to give NAC for tylenol overdose? What if the person is pregnant?

Answer 22

Within 8 hours

Anytime if the patient is pregnant

Question 23

What are the four criteria you have to meet to get a liver transplant?

Answer 23

pH less than 7.3

Grade 3+ encephalopathic

Pt greater than 100

Serum creatinine greater than 3.4

Question 24

This type of toxicity often mimics psychological illness

Answer 24

Psychotropic medicatios

Question 25

What two psychotropic medications are considered to be the "bad boys?"

Answer 25

lithium and amitriptyline

Question 26

What are symptoms of serotonin syndrome?

Answer 26

Agitation, confusion, tremor rigidity, hyperreflexia, ataxia

Question 27

What lab must we check for in psychotropic toxicity?

Answer 27

Creatinine kinase -- check for rhabdomyolysis

Question 28

How do we treat psychotropic toxicity?

Answer 28

Benzo's! BP control, fluid for rhabdo, and cooling

Question 29

What dose is a toxic dose in terms of TCA's?

Answer 29

10-20mg/kg

Question 30

When do TCA's reach peak absorption?

Answer 30

1 hour

Question 31

What does SALT stand for? and what toxicity is it connected to?

Answer 31

Connected to TCA's Stands for shock, AMS, wide QRS, terminal R wave in AVR

Question 32

How do we treat a TCA overdose?

Answer 32

Bicarb! Intubation is key in severe OD, serial EKG's, and seizure precautions

Question 33

what are the take home points of TCA toxicity?

Answer 33

1. Initially asymptomatic -- then crash shortly thereafter 2. Look for classic ECG findings 3. Tachy (acidotic) --> give bicarb

Question 34

What two opioids that we talked about are extended release?

Answer 34

Dilaudid, Methadone

Question 35

How do opioid overdose patients present?

Answer 35

Respiratory depression with altered mental status

Question 36

when do you start cardiac issues with an opioid overdose?

Answer 36

Only if the patient has been down a long time!

Question 37

If any patient comes into the ED unresponsive, what blood test should we get?

Answer 37

Blood sugar!

Question 38

What does narcan promote?

Answer 38

aggression

Question 39

What are the take home points from opioid overdose?

Answer 39

1. Opiates last longer than Narcan (sometimes) 2. Usually all issues involve respiratory 3. Wake up angry 4. If still altered -- other ingestion vs. anoxic brain injury

Question 40

What is the legal limit for alcohol?

Answer 40

0.08 or 80 in the medical world

Question 41

This overdose causes vasodilation and bradycardia

Answer 41

Calcium channel blockers (Verapamil)

Question 42

What dose of a CCB do we consider it to be a serious ingestion?

Answer 42

greater than 1 gram

Question 43

What formulation of CCB is the most dangerous?

Answer 43

Extended release

Question 44

How do we treat a CCB overdose?

Answer 44

Calcium chloride, pacing, and pressors

Question 45

Ethylene glycol causes what metabolic disturbance?

Answer 45

Severe metabolic acidosis

Question 46

How do ethylene glycol overdoses typically present?

Answer 46

Kussmal breathing, altered mental status

Question 47

How do we treat an ethylene glycol overdose?

Answer 47

Fluids, bicarb to correct acidosis

Question 48

What is considered to be the treatment of choice for ethylene glycol overdose?

Answer 48

Fomepizole -- other option is ethanol drip

Question 49

What are the take home points from ethylene glycol overdose?

Answer 49

1. Sick as hell 2. Severe acidosis 3. Fomepizole, ethanol drip, dialysis