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PHM 702: Pulm and ToXXX > toXXX > Flashcards

toXXX Flashcards

1
Q

Poison control #

A

1-800-222-1222

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2
Q

What information to collect when a patient calls or presents with substance poisoning

A
  • Age, weight
  • PMH
  • Time of exposure and route
  • Present s/s
  • Exact name of product, formulation, strength
    • How much has been ingested
  • Occupation
  • Were there suicide notes?
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3
Q

General management to a patient with substance poisoning

ABCDE

A
  • Airway
  • Breathing
  • Cirulaation
  • Dextrose/Decontamination
  • EKG/Elimination
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4
Q

Non-pharm for substance poisoning

A
  • If the agent was inhaled: remove pt from the exposure area
  • If agent is topical/derm: irrigate with soap and water
  • If agent is ingested: can consider orgogastric (“stomach pumping”)
  • hemodialysis can also be considered for specific situations
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5
Q

When to use orgogastric methods in substance poisoning

stomach pumping

A
  • Ingestant has potential for serious toxicities
  • No antidotes exist
  • Time window gives reason to believe agent may still be in stomach
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6
Q

When to use hemodialysis in substance poisoning

A
  • Other elimination strategies not effective or are contraindicated
  • Ingestant has potential to produce serious ADR
  • Agent is able to be removed through filtration
  • EXTRIP is a good source to find out if hemodialysis would work

ex: ASA and tox alcohols

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7
Q

GI decontamination methods (pharm-ish) for substance poisoning

A
  • do NOT use Ipecac
  • Can consider activated charcoal: enhances gastric dialysis of certain drugs and prevents prolonged absorption or enterhepatic recirculation
  • Can consider PEG3350 with electrolytes (whole bowel irrigation)
    • golytely, nulytely, colyte, NOT miralax
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8
Q

When to use activated charcoal in substance poisoning

A
  • Most benefit if used within an hour of ingestion (doesn’t mean you can’t use it if it’s been mmore than an hour)
    • It helps prevent absorption
  • No benefit if the ingested substance is
    • Ionized metals: lithium, iron
    • Alcohols
    • Gasoline
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9
Q

Activated charcoal dosing

A
  • sometimes the first dose is formualted with sorbitol to improve palatability tho no big evidence for benefit of sorbitol
    • 1g/kg
  • pediatric dosing
    • 0.5-1g/kg OR
    • multiple dose: loading dose of 1g/kg followed by 0.5g/kg Q4-6H up to 24 hrs
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10
Q

Activated charcoal AE

A

vomitting, black tarry stools
- Do NOT want pt to vomit this up and have it in their airways

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11
Q

When to use whole bowel irrigation in substance poisoning and dose

A
  • Goal is to minimize time that ingestant is in GI tract for absormption
  • Beneficial for XR products, metals (Fe), and body packers (people who store packets of illicit drugs in their GI system to smuggle across borders)
  • 1-2 L/hr or until rectal effluent is clear
  • peds: NG is easier to use
    • 0.5L/hr in small children Q4-h H
    • 1.2-2L/hr in older chilren/adolescants Q4-6 H
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12
Q

Toxidrome defininiotn

A

s/s that point to a class of toxin based on understanding of pharmacology

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13
Q

Drug(s) that have adrenergic/sympathomimetic toxidrome

A
  • Cocaine
  • Amphetamines
  • Bathsalts
  • Pseudoephedrine
  • Nootropics
  • Bupropion
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14
Q

Drug(s) that have cholinergic toxidrome

A

Organophosphates
Pesticides

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15
Q

Drug(s) that have anticholinergic toxidrome

A
  • TCAs
  • antihistamines (like benadryl)
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16
Q

Drug(s) that have sedative/hypnotic toxidrome

A
  • Benzos
  • EtOH
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17
Q

Drug(s) that have opioid toxidrome

A
  • opioids
  • heroin
  • morphine
  • loperamide (need 30-200mg → cross BBB and PGP can’t kick it out)
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18
Q

Adrenergic/sympathomimetic toxidrome S/S

A
  • Enlarged pupils
  • Increased BP
  • Increased HR
  • Increased RR
  • Increased temp
  • Bowel sounds
  • Tremor
  • Seizures
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19
Q

Cholinergic toxidrome S/S

A
  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • Gastric cramps
  • Emesis
  • Bradycardia
  • Bronchorrhea
  • Bronchospasm
  • Pinpoint pupils
  • Bowel sounds
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20
Q

Anticholinergic toxidroe S/S

A
  • Blind as a bag
  • Hot as a hare
  • Dry as a bone
  • Red as a beet
  • Mad as a hatter (agitated)
  • Enlarged pupils
  • Increased BP
  • Increased HR
  • Increased RR
  • Increased temp
  • Urinary retention
  • Tremor
  • Seizures
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21
Q

Sedative/hypnotic toxidrome S/S

A

Sleepy with normal vitals
- bp, hr, rr may be a little decreased

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22
Q

Opioid toxidrome S/S

A
  • Unresponsive to painful stimuli
  • Pinpoint pupils
  • Low RR
  • Low BP
  • Low HR
  • Low temp
  • Hyporeflexia
  • Decreased mental status

Loperamide can cause arrhythmias

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23
Q

Treatment for pts with cholinergic toxidrome

A

Atropine: inhibits muscarinc actions of ACh
- 1mg IV titrated to effect, no MDD

Pralidoxime: reactivates cholinesterase
- 30mg/kg IV load
- 8-10mg/kg/hr continuous infusion

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24
Q

Treatment for pts with anticholinergic toxidrome d/t antihistamine overdose

A

Physostigmine: ACh inhibitor
- 0.5 - 2 mg IV

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25
Q

Treatment for pts with benzo overdose

A

Benzos alone aren’t that bad, can be handled with monitoring, supportive care; intuation if needed
- NOT LETHAL

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26
Q

The problem with flumazenil and when to use it

A

Can send someone who is benzo overdosed (not lethal) into withdrawal (lethal)
_
So when to use flumazenil?
- procedural sedation
- in peds accidental overdose who are not benzo dependent
- Z-drug overdose (not really tho)

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27
Q

Flumazenil dosing

A

competitivte antag at benzo receptor site
- 0.2mg IV over 15 seconds
- peds: 0.01 mg/kg IV
- onset: 1-2 min

idk if this is just for benzo overdose or in general

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28
Q

Opioid overdose treatment

A

IV naloxone dose
- 0.4mg for non-opioid dependent
- 0.04mg for opioid dependent pt
- titrate to effect (ideally)
- continuous inf: 1/2 of initial effective dose as bolus then 2/3 of effective dose/hr
Protect airway or breath for them

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29
Q

Naloxone IV vs. nasal

A
  • IV: quick onset, quick wear off
  • IN: longer onset and duration
  • IM: somewhere inbetween
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30
Q

Naloxone AE

A
  • flash pulmonary edema: treat with nitroglycerin, diuretic, and positive pressure ventilation
  • runny nose
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31
Q

Loperamide overdose treatment

A
  • Naloxone
  • IF CARDIAC DISTURBANCE
    • IV Mg
    • Sodium bicarb
    • IV isoproteronol or transcutaneous pacer
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32
Q

What drug levels do we like to draw in patients who present with overdose/substance poisoning?

A
  • Digoxin
  • Vanco
  • Phenytoin
  • Lithium
  • APAP - no toxidrome
  • ASA - unique toxidrome
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33
Q

Polysubstance overdose approach

A
  • Eliminate: activated charcoal
  • Admin antidotes: naloxone, NAC
  • Supportive care: benzos
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34
Q

Benzo withdrawal s/s

A
  • Severe sleep disturbance
  • Irritability
  • Increased tension and anxiety
  • Panic attacks
  • Sweating
  • Difficulty in concentration
  • Dry retching and nausea
  • Palpitations
  • Headache
  • Psychotic reaction
  • Seizures
  • Death
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35
Q

Which is deadlier? benzo overdose or benzo withdrawal

A

WITHDRAWAL

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36
Q

OTC that can cause asa/ salicylates overdose

A
  • Peptobismol
  • Alkaselzter
  • Oil of wintergreen: 98% methyl salicyalte (98g/100ml)
  • Icy hot
  • Bengay
  • ASA
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37
Q

ASA/salicylate toxic levels (adults)

A
  • Toxic at >150mg/kg
  • Life threatening at >500mg/kg
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38
Q

ASA/salicylate mechanism of tox

A

metabolic acidosis and uncoupled oxidative phosphorylation (can’t produce ATP and excess H+)

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39
Q

ASA/salicylate overdose S/S

A
  • Resp: tachypnea/hyperpnea
  • GI: disrupt nucosal barrier, N/V, hemorrhagic gastritis, bezoar formation
  • CNS: neuoronal energy depletion, hypoglycorrachia (hypoclycemia in brain only), AMS, tinnitus, hyperpyresxia, tachycardia, fever, coma, seizures
  • Non-cardiogenic pulmonary edmea
  • Renal and hepatic injury
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40
Q

ASA/salicylate overdose acid/base labs

A
  • Early on in overdose: resp alkalosis
  • Middle of overdose: mixed metabolic acidosis and resp alkalosis
  • Late/preterminal overdose: metabolic and resp acidosis
    - Body can no longer compensate and you can’t even compensate by breathing hard
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41
Q

What is a bezoar formation

A

concrete ball of salicylate in stomach that can break off and release more drug into system

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42
Q

ASA/salicylate overdose electroytes presentation

A
  • Hypo or hyperglycemia
  • Increased fluid and electrolyte losses
  • Increased anion gap
  • Urine: ketones in urine
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43
Q

ASA/salicylate overdose treatment

A
  • Airway, breathing, circulation (do NOT ventilate)
  • Enhance elimination
    • Multiple doses of activated charcoal (1g/kg)
    • Urine alkalization (we want a pH >7.5)
    • Can consider hemodialysis
  • Dextrose (even if normal glucose levels): 0.5-1g/kg
  • Fluid maintenance
    • Serum pH 7.45-7.55
    • 150 mEq of sodium bicarb in D5W at twice maintenance rate (alkalinize urine)
    • Treat spefic AE too (seizures, edema, etc.)
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44
Q

ASA/salicylate overdose monitorng

A

Monitor Q2H
- Mental status
- Urine and blood pH
- Salicylate levels
- Fluid and electrolytes
- Maintain K (often low)

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45
Q

ASA/salycylate overdose: if pt is on hemodilaysis for the overdose, when to stop

A

Stay on hemodilaysis until clear inprovement in pt AND salicylate level <19mg/dL
- Or 4-6 hrs if you can’t get labs

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46
Q

ASA/salicylate overdse: who qualifies for hemodialysis

A
  • Serum level >100mg/dL in pts with acute
  • Serum level >60mg/dL in pts with chronic
  • Neurologic deterioration
  • Seizures
  • Intractable acidosis (pH <7.2)
  • Renal failure
  • Pulmonary edema
47
Q

Purpose of urine alkalinzation in asa/salicylate overdose

A

shift salicylate into un-ionized form → move across barriers → more excretion

48
Q

If you overdose on an antidepressant, will it present as serotonin syndrome?

A

Very unlikely, usually only see serotonin syndrome if polypharmarcy with multiple serotenergic agents or with drug specific for 5HT2A or 5HT1A

49
Q

Serotonin syndrome presentation

A
  • Spontaneous clonus
  • Agitation
  • Diaphoresis
  • Hyperthermia
  • Tremor
  • Hyperreflexia
  • Diarrhea
  • AMS
  • Incoordination
50
Q

SSRI overdose presentation

A

Seroternergic features
- AMS
- Tachycardia
- Myoclonus
- Tremors
- Diarrhea

51
Q

Serotonin syndrome antidone

A

cyproheptadine but it is very anticholinergic, so not used often
- Can use benzos and propranolol for symptom treatment

52
Q

Serotoin overdose treatment

A
  • Supportive care
  • Monitoring
  • Escitalopram and citalopram are most likely to cause seizures and QTc prolongation
53
Q

List the TCAs

A
  • amitriptyline
  • nortriptyline
  • doxepin
  • imipramine
  • desipramine
54
Q

TCAs MOA and related overdose S/S

A
  • Catechol reuptake inhibitior: hypotension
  • Alpha adrenergic blocker: hypotension
  • GABA antag: seizure
  • Sodium channel blocker: dysarrythmias → lethal

initial increase in BP and HR and then quick drop; anticholinergic toxidrome

55
Q

TCA and EKG/ECG

A
  • If there’s an R wave in aVR: there was some exposure to TCA (not necessarily a TCA overdose, but it is present)
  • Elevated QRS → increased risk of seizure
  • Bigger R wave amplitude → higher incidence of seizure
56
Q

TCA overdose treatment

don’t worry about the treatments for specific s/s for this card

A
  • If pt came in early enough; can consider
    - orogastric lavage (GI flush) or activated charcoal
  • hypertonic sodium bicarb 1-2 mEq/kg bolus and then 150 mEq in 1L D5W at twice maintenance rate (150-200 ml/hr); give until
    - Do this until QRS narrows
    - We would also like to see blood pH go back to normal (<7.5) but fixing QRS is more important
57
Q

Hypertonic sodium bicarb MOA in TCA overdose

A
  • Sodium (hypertonic sodium like 3% NaCl) → prevents lethal sodium channel blockade
  • Alkalinzation (via hyperventiliation) may also be effective
58
Q

TCA overdose: additional treatment if pt is experiencing seizures

A
  • Benzos
  • Barbituates
  • do NOT give phenytoin: can increase frequency and duration of VT
  • do NOT give flumazenil: prevents benzo protection against seizure and can worsen seizures
59
Q

TCA overdose: addition treatment if dysrhythmias aren’t going away

A
  • Mg
  • Lidocaine (replace TCA with a more benign sodium channel blocker)
60
Q

TCA overdose: additional treatment if pt is hypotensive

A
  • Ne, E, vasopressin, phenylephrine
  • Methylene blue, lipid emulsion, high dose insulin
61
Q

Bupropion overdose S/S

A
  • May be asymptomatic until like 24 hrs later when they suddenly have a seizure -> hold pt until certain no seizures
  • Widening of QRS complex but does NOT respond to sodium bicarb
  • Sympathomimetic crisis
  • Cardiogenic shock
  • Status epilepticus
  • Lazarus effect (pronouced dead but then randomly wakes up later)
  • Death
62
Q

Bupropion overdsoe treatment

A
  • Supportive care
  • Maybe lipid emulsion and ECMO
  • Maybe orogastric lavage or activated charcoal or whole bowel irrigation
  • IF HTN, can try benzos
63
Q

Antihypertensive overdose general presentation

A

Toxidrome: bradycardia, hypotension

  • Cardiac: AV blocks and CHF
    • Sotalol can cause torsades
  • CNS: depressed LOC
    • Propranolol can cause seizures
64
Q

Differentiation dx between CCB and BB overdose

A

CCB has elevated glucose

65
Q

CCB specific overdose presentaiton

A
  • Alert initially
  • Elevated blood sugar
  • Hypotension (d/t vasodilation)
  • non-DHP CCBs:
    • decreased ventricular contratility
    • sinus node depression
    • AV node depression -> various blocks
66
Q

CCB and BB overdose treatment

A
  1. GI decontamination if applicable
  2. fluids: isotonic crystalloids (0.9 NaCl, LR)
  3. atropine: 0.5-1mg Q5min 3x
  4. calcium
    - CaCl (can cause sclerosing): 1-3g IV
    - Ca gluconate: 3-9g IV
  5. high dose insulin (HIET)
    - 1 U/kg bolus then 1-10 U/kg/hhr
    - give glucose to counteract insulin
    - maintain glucose >100 mg/dL
    - 30-60 min onset
  6. potassium prn to maintain 2.8-3.5 mg/dL

Same as BB

67
Q

Other than the normal treatment steps, what other agents might you use in the setting of CCB and BB overdose?

A
  • vasopressors: NE and E
    - can be used as monotherapy in mild overdose
    - can also be used as bridge insulin
  • inotropes: dobutaminne (CCB), milrinone (BB)
  • cardiac pacing
  • intralipid:
    - pull toxin off of site
    - modulate myocardial energy
  • ECMO
  • BB ONLY: glucagon 3-5mg bolus then 3-5mg/hr + zofran (n/v)
68
Q

Why can glucagon be considered in BB overdose but not CCB?

A

it’s like a beta agonist that bypasses the beta receptor

69
Q

Glucagon AE

A

vomiting (zofran ppx)
- avoid use in pts wtih AMS

70
Q

Alpha agonist specific overdose s/s

A
  • Decreased mental status
  • Small pupils
  • No delay in onset
  • CLONIDINE SPECIFIC
    • transient HTN and tachycardia before suddenly going to bradycardia and hypotension
    • CNS depression
    • Respiratory depression
71
Q

Alpha agonist overdose treatment

A
  • Suportive care
  • Clondine: naloxone for respiratory depression
    - 5-10mg bolus
    - can start an infusion if response
72
Q

Acute digoxin toxicity s/s

A
  • Predistribution
    • N/V
    • Hyperkalemia: guaranteed death if K >5.5
  • Post distribution (6 hrs)
    • Hypotension
    • Bradycardia
    • Dysrhythmias
    • Death
73
Q

Chronic digoxin toxicity S/S

A

less typical and K level is unhelpful

74
Q

Digifab indication in chronic digoxin tox

A
  • Post-distribution (>6 hrs after ingestion) level of >6 mcg/L
  • Progressing or severe signs of tox
75
Q

Digifab dosing in practice

A

2 vials and then titrate to effect
- Give every hr if no response is seen

76
Q

Acute digoxin tox treatment

A
  • GI decontamination: activated charcoal, repeat doses needed in renal failure
  • Digifab if appropriate
    • K >5
    • Digoxin level >20 mg/dL
    • Progresing signs of tox
  • Temporizing measures: Ca if patient is looking bad (high K+)

But too much calcium induces “stone heart” = irreversible contraction of heart
Data says still give calcium too

77
Q

MUDPILES

A
  • M - Methanol
  • U – Uremia
  • D – DKA, SKA, AKA
  • P – Phenformin (metformin), Paraldehyde
  • I – Isoniazid, INH
  • L – Lactate, CO, CN, MetHb
  • E – Ethylene Glycol
  • S – Salicylates

Causes of anion gap metabolic acidosis

78
Q

Anion gap calculation

A

Calculating anion gap: gap = Na - (Cl + HCO3)

normal = 4-12

79
Q

Clinical presentation after ingestion of toxic alcohols

A
  • Early:
    • AMS - like they’re drunk
    • GI distress
  • Late:
    • High anion gap metabolic acidosis
    • Specific differences between EtOHs
      • Methanol: visual changes “blind”
      • Ethylene glycol: nephrotox, hypocalcemia
80
Q

Toxic alcohols

A
  • Methanol: high volatility - in gasline antifreeze and windshield washer fluid
  • Ethylene glycol: low volatility - in engine fluid
81
Q

What labs to look at in pts who present for ingestion of toxic alcohol

A
  • Electrolytes - and treat where needed
  • Arterial blood gas
  • Ethanol level
  • Methanol and ethylene glycol levels
    • The labs won’t return until the next day, so for the first day that they present, you don’t really know which they have
  • Measured osmolality
82
Q

Management/treatment of ingestion of toxic alcohols

A
  • GI decontamination: useless
  • alcohol dehydrogenase (ADH) inhibitor: ethanol OR 4-methylpyrazole-fomepizole (4-MP, Antiol: preferred agent)
  • Supplementation
    • ethylene glycol
      • B6 pyroxidone IV 100mg QD
      • B1 thiamine IV 100mg QD
    • methanol
      • folic acid: 1mg/kg Q4-6H for 24hrs
    • Mg
  • Sodium bicarb: to correct acidosis

supplement doses are from peds lecture, idk what adult doses are

83
Q

Ethanol dosing in ingestion of toxic alcohols

A
  • adults:1g/kg to maintain a BAC of ~100 mg/dL
  • peds: loading dose of 8 ml/kg over 1 hr → 0.8 ml/kg/hr IV
    • Goal serum [ ]: 100-150 mg/dL
    • Goal [ ] of toxic alcohols: <25 mg/dL
84
Q

Ethanol formulations

A
  • IV 10% soln
  • PO: shots x 4
85
Q

Ethanol AE

A
  • CNS inebriation
  • thrombophlebitis (IV)
  • GI symptoms
86
Q

4-MP (fomepizaole) AE

A
  • HA
  • Dizziness
  • Minor allergic reactions
87
Q

4-MP (fomepizaole) dosing in ingestion of toxic alcohols

A
  • 15 mg/kg load, then 10mg/kg Q12h x4, then 15mg/kg Q12H
    • Dilute in NS or D5W and infuse over 30 min
    • Lower then re-up dose d/t autoinduction
    • Dose increased during hemodialys
  • peds: same dosing as adults
    • goal toxic alcohol [ ]: <25 mg/dL
88
Q

Who needs hemodilaysis in pts who have ingested toxic alcolhols

A
  • Methanol or ethylene glycol level 25-50 mg/dL
  • High osmal gap (>10) without aother cause
    • A normal gap could mean pt is doing well or tthat pt is doing trash, not super specific or helpful
  • End organ manifestations of tox (renal, vision)
  • Severe metabolic acidosis
89
Q

CB1 receptors

A
  • CNS
  • GPCRs
  • Motor activity
  • Thinking
  • Pain perception
90
Q

CB2 receptors

A
  • Periphery
  • GPCRs
  • Immune modulation
  • Anti-inflammatory
91
Q

Unwanted effects form phytocannabinoids

A
  • Short term memory difficulties
  • Agitaion
  • Feeling intense
  • Anx
  • Dizziness
  • Lightheadedness
  • Confusion
  • Loss of coordination
92
Q

Phytocannabioids

A
  • natural cannabis
  • THC parital agonism at CB1 receptor
93
Q

Sythetic cannabinoids

A
  • Full agonist (act on CB1 AND CB2)
  • Higher receptor affinity
  • Longer half lives
94
Q

Synthetic cannabinoids tox clincal presentation

A
  • CNS depression
  • Disorientation
  • Restlessness/agitation
  • Hallucinations
  • Seizures
  • Comativeness
  • Anx
  • Mydriasis
  • Tachycardia
  • Vomitting
95
Q

Synthetic cannabinoids tox labs

A
  • Hypokalemia
  • Increased blood glucose
  • Increased SCr
  • Increased WBC
  • Increased Creatinine kinase
96
Q

synthetic cannabinoids tox treatment

A
  • Agitation: treat with benzos
  • Seizures: treat with benzos
  • Dehydration: treat with IV crystalloids
  • HTN/tachycardia: treat with benzos ad if benzos don’t work, IV antihypertensives
97
Q

synthetic cannabinoids n/v moa and dx

A
  • excessive vomitting d/t dysregulation of endocannabinoid system and alteration in TRPV2 receptor
  • dx
    • Hx of regluar cannabis use
    • Cyclic N/V
    • Generalized diffuse abdominal pain
    • Compulsive hot showers with symptom improvement
98
Q

synthetic cannabinoid n/v presentation: pre-emetic phase

A
  • months-years
  • diffuse abdominal dyscomfort
  • feelings of agitaiton or stress
  • morning nausea
  • fear of vomiting
  • Often pts will self treat with more marijuana
99
Q

synthetic cannabinoid n/v presentaito: hyperemetic phase

A
  • 24-48 hrs
  • Cyclic episodes of N/V
  • Diffuse, severe abdominal pain
100
Q

Synthetic cannabinoid n/v presentation: recovery phsase

A
  • Only upon cessation of cannabis (may take a month for full resolution)
  • Bowel regimens
  • Fluids
  • Electrolyte replacement
101
Q

synthetic canabinod n/v treatment

A
  • Activate TRPV1
    • Hot showers
    • Caapsaicin topical cream
  • Anti-nausea
    • Haloperidol - better opiton
    • Ondansetron
    • Benzos: inhibitory effect on medullary and vestibular nuclei associated with n/v
  • Supportive care
    • Fluids
    • Electrolytes
102
Q

Cocaine specific tox s/s

A
  • euphoria
  • seizures
  • dysrhythmias
  • HTN
  • coronary artery spasm MI
103
Q

cocaine speific tox treatment

A
  • benzos
  • supportive care
104
Q

amphetamines specfic tox s/s

A
  • agitation
  • seizures
  • hyperthermia
  • HTN
  • delirium

longer acting than cocaine

105
Q

Amphetamine specific tox treatment

A
  • benzos or barbituates
  • anti-htn
  • supportice care
106
Q

Bath salts specific tox s/s

A
  • agitation
  • tachycardia
  • insomnia
  • paranoia
  • seizures
  • violent unpredictable behavior
107
Q

Bath salts specific tox treatment

A

supportive care

108
Q

sympathomimetic (general) treatment

A
  • Elimination strategies (charcoal)
  • Clinical effects: Benzos
  • Airway protection: intubation
  • Hyperthermia: Ice baths, benzos, antipyretics
  • Dysrrthmias: Sodim bicarb, lidocaine
  • Rhabdo: Fliuds
  • Antihypertensives
  • Anti-psych
  • Electrolyte management
109
Q

Peds poisoning labs to get

A
  • Lab evals as is relevant to the H&P and pt presentation
    • but almost always at least serum chemistries and acid-base
    • strong consideration for serum APAP (also salicylates, ethanol, iron) d/t easy access/OTC status
110
Q

toxic APAP doses in peds

A

> 200mg/kg PO or >60mg/kg IV

111
Q

Peds apap overdose treatment

A
  • GI contamination with activated charcoal if it has been less than an hr
  • NAC dosing
    • PO: 140mg/kg x1 → 70mg/kg Q4H x17
    • IV (more often used): 150mg/kg over 1 hr → 50mg/kg over 4 hrs → 100mg/kg over 16 hrs
      • To prevent hypoNa, product should be diluted to a [ ] of 40mg/dL
112
Q

household cleaners/caustic exposures: possible causes and treatment

A
  • Cleaners: bleaches, detergents, soaps
  • Caustics: toilet cleanere, drain cleaner, oven cleaner
  • JUST SUSPPORTIVE CARE
    • If GI injury can consider PPIs
    • do NOT use GI decontamination
113
Q

Foreign body ingestion treatment

A

GI decontamination: manual removal if esophagaeal impact suspected

114
Q

Peds cough and cold: overdose/tox treatment

A
  • Products should be avoided in pts < 6 per FDA 2017
  • Use activated charcoal
  • Symptomatic management
    • HTN: labeatol, nicardipine
    • Arrhythmias: amiodarone
    • Seizures: benzos

Fatalities due to pseudoephedrine

PHM 702: Pulm and ToXXX (14 decks)

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