Toxicology: Slide 91 Flashcards Preview

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1

What is the most frequent cause of patients presenting to the ER with AMS?

Ethanol poisoning

2

What are common sources of ethanol?

Aftershave, cough preparations, glass cleaners, hair spray, disinfectants, mouthwash, paint stripper, perfumes, rubbing alcohol, beverages

3

What is anion gap?

Na - HCO3- Cl

4

What is a normal anion gap?

10-14 (12)

5

What toxins can cause a large anion gap?

M: Methanol
U: Uremia
D: DKA (alcohol ketosis, starvation ketosis, ketoacidosis, acetoacetic acid, beta hydroxybutryric acid)
P: Phenformin, metformin
I: Isoniazid, iron, inborn errors of metabolism
L: Lactic acidosis, metformin
E: Ethylene glycol
S: Salicylates

6

What is wood alcohol, produced via distillation of hardwood?

Methanol

7

What are sources of methanol?

Shellac, paint thinner, rubber goods, synthetic textiles, gas line antifreeze, printing solutions, windshield washing solution, carburetor fluid

8

Where can you normally find methanol?

In saliva and expired air

9

Where is dietary methanol found?

Fruits and veggies (as free alcohol, methyl esters of fatty acids, or methoxy groups on polysaccharides such as pectin)

10

What is a food additive that can be converted to methanol?

Aspartame (NutraSweet)
-Ability to convert is really low

11

Describe methanol?

Colorless
Distinctive odor
Bitter taste

12

Does methanol distribute throughout the whole body?

Yes

13

What is responsible for toxicity in methanol poisoning?

Formate (it's major metabolite)

14

How is methanol absorbed?

All routes (rapidly from GI tract with a peak in 30-60min)

15

How much methanol can cause blindness?

4mL

16

How much methanol can cause death?

15mL

17

What other route of methanol ingestion is associated with toxicity?

Inhalation of vapors

18

What is the main route of methanol metabolism?

Via oxidation by alcohol dehydrogenase

19

What is another route of methanol metabolism?

Through expired air

20

How much of methanol is metabolized to formic acid and formaldehyde?

40%

21

What is formaldehyde converted into and what is the clinical significance of this?

Formic acid- 1/2 life is 1-2 minutes and it is non-detectable

22

Is the metabolism of methanol faster than ethanol?

NO... it is 5 times slower than ethanol

23

What system regulates methanol metabolism in each species?

Folate systems

24

What species are susceptible to methanol poisoning and why?

Monkeys and humans
- Absence of large amounts of formate to be metabolized

25

What is the rate limiting step in methanol metabolism?

Availability of folic acid

26

What deficiency makes a patients more susceptible to methanol intoxication?

Folate deficiency

27

What 3 things do you consider in presentation of methanol poisioning?

1. Amount of food in stomach
2. Quality of ethanol consumed
3. Quantity of methanol consumed

28

How many more times toxic is formic acid than methanol?

6 times

29

What 3 things is formic acid responsible for in methanol poisioning?

1. Metabolic acidosis
2. Anion gap
3. Ocular toxicity
-CAUSES MULTISYSTEM PROBLEMS

30

What are the main toxicities discussed from formic acid?

Visual, CNS, GI, Mild inebriation, long latent period, metabolic acidosis