Flashcards in Toxidromes Deck (90):
1
Garlic odor
1. Dimethyl sulfoxide (DMSO) Arsenic
2. Organophosphates
2
Bitter almonds
Cyanide
3
Rotten eggs
Hydrogen sulfide
Sewer Gas
4
Acetone
Isopropyl Alcohol
Ethanol
5
Shoe polish
Nitrobenzene
6
Peanuts
Vacor (rat poison)
7
Fruity
DKA
Isopropanol
8
Mothballs
Naphthalene
If kids eat 2 of these=Hospital
9
Wintergreen
Methylsalicylate
10
List the causes for a decreased anion gap
1. Lithium
2. Bromide
3. Hypoalbuminemia
4. Multiple Myeloma
11
Define Kussmaul breathing
Acidemia causes Hyperventilation=
Respiratory compensation for metabolic acidosis
12
What is the normal osmolar gap?
< or equal to 10
13
When is gastric lavage effective?
If it's within 60 minutes of ingestion
14
Syrup of ipecac effects
-Plant derivative which works centrally and peripherally to induce vomiting
-Use in remote locations
15
When is IV lipid emulsion indicated?
OD of lipophilic agents (CCB, Beta-Blockers) with cardiac arrest OR
Significant hemodynamic instability failing conventional therapy
16
Complication of IV lipid emulsion
Post-infusion pancreatitis
17
What are the key sx's in anticholinergic toxidrome?
1. Dry armpits
2. Agitated
3. Hyperthermia
18
Anticholinergic toxidrome causes
1. Jimson weed
2. Antihistamines- Benadryl (Diphenhydramine)
3. Antidepressants, TCAs
4. Carbamazepine
19
Anticholinergic toxidrome treatment
1. ABC’s
2. Supportive care
3. Rapid cooling- water and fans
4. Benzodiazepines- Help with agitation
5. Paralytic Agents- Consider
20
When should you consider Physostigmine in Anticholinergic toxidrome? Major ADE's?
If have both central and peripheral effects
CI: Heart block, COPD, Bradycardia
ADE: ASYSTOLE
21
Cholinergic Toxidrome sx's in muscarinic
SLUDGE
22
Cholinergic Toxidrome sx's in Nicotinic
Monday – Miosis
Tuesday – Tachycardia
Wednesday – Weakness
Thursday – Tremors
Friday – Fasciculations
Saturday – Seizures
Sunday – Somnolent
23
Sympathaomimetics Toxidrome sx's
Anticholinergic sx's:
1. ↑BP and HR
2. Hyperthermia
3. Mydriasis
4. Delusions
+
5. Seizure
6. Piloerection (hair standing up)
7. Hyperreflexia
24
Sympathaomimetics Toxidrome causes
Stimulants:
1. Amphetamines
2. Cocaine
3. Pseudoephedrine
4. Caffeine
5. PCP
25
Medications that can cause Serotonin Syndrome
1. SSRI
2. Meperidine (Demerol) + Serotonin enhancing agent
3. Lithium
4. Monoamine oxidase inhibition= Rasagilline
26
What are the triad of sx's of Serotonin Syndrome?
1. Myoclonus
2. MS changes
3. Shivering
+ Agitation
27
Serotonin Syndrome treatment?
Supportive:
1. Remove offending agent
2. Reduce temperature
3. Benzodiazepines
28
Opiate Toxidrome sx's
Everything decreases!
1. Pinpoint pupils
2. Depressed respirations
29
Opiate Toxidrome treatment
1. ABC's
2. Naloxone= Narcan
30
What does a UDS NOT test for?
1. Meperidine
2. Hydrocodone
3. Oxycodone
4. Methadone*
5. Tramadol
31
Antidote for Cholinergic toxidrome
1. Atropine
2. Tupam
32
Sympathomimetics Toxidrome treatment
1. Benzodiazepine
2. Sodium Bicarb-Correct acidosis
3. DO NOT give beta blockers
33
What is the toxic dose of Acetaminophen?
140 mg/kg
34
Toxic effects of acetaminophen toxicity
1. Centrolobular necrosis (liver) = 40%
2. Renal failure
3 Vomiting – MCly seen in children
35
Acetaminophen toxicity antidote
N-acetylcysteine (NAC)
36
Salicyclate Toxicity sx's
1. Vomting, abd. pain
2. GI hemorrhage
3. Hypotension
4. Increased bleeding time
5. Agitation, confusion
37
Salicyclate Toxicity treatment
1. Gastric lavage if within 1 hour of ingestion
2. Activated charcoal
3. Sodium Bicarb
4. Normal saline
38
MCC of seizure in patients with seizure disorder
1. Subtherapeutic level of medication
2. Infection or hyperthermia
3. Alcohol use
4. Head trauma
5. Breakthrough seizure
39
What anticonvulsant can cause a false positive drug screen for amphetamines?
Phenytoin (Dilantin)
40
why can't you give Phenytoin (Dilantin) IM?
Can cause:
1. Thrombophlebitis
2. Sterile abscesses
41
Phenytoin (Dilantin) toxicity sx's
1. Slurred speech
2. Ataxia
3. Nystagmus (horizontal)
4. Visual changes
5. Decreased LOC
42
Phenytoin (Dilantin) toxicity Tx
Supportive
MDAC
43
What is the MCC of coma from overdose?
Barbiturates
44
Barbiturates toxicity sx's
1. CNS depression
2. Hypothermia
3. Urinary retention
4. Hypoglycemia
5. Decreased motor activity
6. Aspiration pneumonia
45
Barbiturates toxicity treatment
1. Supportive
2. Glucose
3. Narcan
4. Charcoal
46
Lithium toxicity treatment
Benzodiazepines
47
What is the MCly used and abused intoxication in the US?
Ethanol
48
List Isopropanol products
1. Rubbing alcohol
2. Jewelry cleaners
3. Paint thinners
49
List Methanol products
1. Wood varnishes
2. Windshield washing fluid
50
Metanol toxicity sx's
1. CNS depression
2. Vision changes**
3. Abdominal pain
4. Hypotension=bad
51
Methanol treatment
1. Supportive
2. IV fluids
3. Ethanol
4. Fomepizole
52
List Ethylene Glycol product
Antifreeze
53
What may you see in 50% of cases of Ethylene Glycol toxicity?
Calcium oxalate crystalluria
54
Ethylene Glycol toxicity sx's
1. CNS depression
2. Tachycardia, tachypnea
3. Hypertension
4. Flank pain, renal failure
5. Hypocalcemia with tetany and QT prolongation
6. Metabolic Acidosis
55
What is the MC dysrhythmia in calcium channel blockers?
1. AV dissociation
2. Bradycardia
3. Increased PR interval
56
Calcium channel blocker treatment
1.CaCl
2. Insulin + Glucose
3. Epinephrine
4. Pacemaker
57
Beta Blocker treatment
1. Glucagon
2. Epinephrine
3. Pacemaker
58
Digoxin treatment
1. Vasopressors
2. Atropine
3. External pacing
59
TCA treatment
1. Fluids, Bicarb, alpha agonists- Tx hypotension
2. Benzo + Barbiturates-Tx seizure
3. Charcoal
60
What other drug combo with TCA will cause death?
TCA + Procainamide
61
What is the MCC of unintentional poisoning death in the US?
Carbon Monoxide
62
Whipples Triad
1. Hypoglycemia: glucose < 60
2. Symptoms of hypoglycemia: Diaphoresis, nausea, AMS
3. Resolution of symptoms with administration of glucose
63
Define Dystonic Reaction
1. Idiosyncratic reaction
2. Sudden onset of abnormal or exaggerated posturing of head, neck, jaw
64
Medications that can cause dystonic reactions
1. Phenothiazines-Phenergan, compazine
2. Butyrophenones-Haldol
3. Reglan
65
Risk Factors for development of dystonic reactions
1. Male sex
2. Young age
3. Cocaine use
4. Hypocalcemia
5. Neurodegenerative disorders
66
Dystonic Reactions clinical presentation
1. Spastic contractures of lips, tongue, face, throat
2. Trismus, tongue protrusions
3. Laryngeal and pharyngeal spasms
4. Fear, anxiety
5. Oculogyric crisis
67
Dystonic Reaction Tx
1. Benadryl x 3-4 days
2. Benzotropine IV or IM
68
What is the MCC of pediatric mortality secondary to poisoning?
Iron poisoning
69
Stage 1 iron poisoning
GI injury: 6-12 hrs
1. V/D, abdominal pain
2. Hypotension, pallor
3. Lethargy
4. Metabolic acidosis
70
Stage 2 iron poisoning
6-24 hrs
Hypovolemia
71
Stage 3 iron poisoning
Multisystem organ failure
72
Lab findings in iron poisoning
1. Increased WBC- Basophilic stippling
2. Increased glucose
73
Iron poisoning treatment
1. Asx after 6 hrs= Discharge
2. Whole Bowel irrigation (WBI)
3. IV Deferoxamine (DFO)
74
What products contain hydrofluoric acid?
1. Glass etching
2. Metal cleaning
3. Electronics manufacturing
4. Rust remover
75
Clinical presentation of hydrofluoric acid toxidrome?
1. Pain out proportion to exam
2. Hypocalcemia
3. Hypomagnesemia
76
hydrofluoric acid toxidrome EKG findings
1. Arrhythmias
2. QT prolongation
77
hydrofluoric acid toxidrome CXR findings
Pulmonary Edema
78
hydrofluoric acid toxidrome treatment
1. Double gloves for providers
2. Copious water irrigation
3. Calcium gluconate
79
What does cocaine show up on a UDS?
benzoylecgomine
80
Cocaine toxidrome treatment
Benzodiazepines
81
Phenycyclidine (PCP) effects
1. Psychosis: Euphoria, agitation, hallucination, "super human strength"
2. CV: Tachycardia, HTN
3. Nystagmus
4. MIOSIS-Pupul constricted
5. Salivation
82
Phenycyclidine (PCP) TX
1. IV fluids
2. Benzodiazepines
83
What is the only opiate associated with seizure?
Propoxyphene
84
Are the eye constricted or dilated with opiates?
Constricted=Miosis
85
Opiate Treatment
Narcan
86
MDMA treatment
Benzodiazepines
87
What does Amphetamines increase the the activity/release of?
1. Dopamine
2. Norepinephrine
88
Increased dopamine activity results in what effects?
1. Restlessness, hyperactivity
2. Decreased sleep
3. Repetitive behavior
89
Increased norepinephrine results in what effects?
1. Mydriasis=Dilation
2. Bronchodilation
3. Vasoconstriction
4. Hypertension
5. Increased HR
90