Ingestion

Question 1

Pneumonic for altered mental status

Answer 1

A - alcohol/toxin
E - epilepsy, encephalitis, endocrine, electrolyes 
I - infection
O - overdose
U - uremia
T - trauma, temp
I - insulin
P - psychosis
S - stroke, shock, space occupying lesions

Question 2

Rapid initial eval in AMS

Answer 2

ABCs -> life-threatening causes

finger stick glucose

Question 3

Hypoglycemia, hypotension, tachycardia

Answer 3

treat by giving a 25% dextrose bolus and NS bolus (20 cc/kg)

- make sure glucose responding to therapy

Question 4

Cholinergic ingestion

Answer 4

S - salivation
L - lacrimation
U - urination
D - diarrhea
G - GI motility
E - emesis

Bronchospasm, bradycardia

Question 5

Anti-cholingeric ingestion

Answer 5

Blind as bat - mydriasis
Mad as a hat - delirium/seziure
Dry as bone - dry skin
Hot as hades - hyperthermia
Red as beet - flushed, red skin

Tachycardia, urinary retention, ileus

Question 6

Sedative, hypnotic ingestion

Answer 6

blurred vision, hypotension, bradycardia, apnea, hypothermia, depressed mental status

Question 7

Opioids ingestion

Answer 7

miosis, respiratory depression, bradycardia, hypothermia, depressed mental status

Question 8

Sympathomimetics

Answer 8

mydriasis, fever, diaphoresis, tachycardia, agitation, seizures

Question 9

DDx for mydriasis and AMS

Answer 9

TCA - anticholinergic (tachycardia, hypotension, mydriasis, hot skin)
SSRI - serotonin syndrome (diaphoresis, tachycardia, hypotension, agitation, fever, myoclonus, shivering)
Antihistamine - anticholinergic like TCA
Decongestant - sympathomimetic syndrome (agitation, tachycardia, hypertension, sweating, mydriasis, seizure)

Question 10

TCA toxicity

Answer 10

• inhibits reuptake of NE and 5HT
• antagonism of muscarinic ACh receptors
• blockade of sodium and GABA receptors
• refractory hypotension common cause of death

Question 11

Iron toxicity

Answer 11

1. N/V, abdominal pain diarrhea
2. lethargy, tachycardia, metabolic acidosis
3. Shock
4. Hepatic failure

Question 12

Acetaminophen toxicity

Answer 12

1. Asymptomatic or N/V, diaphoresis, malaise
2. Hepatotoxicity (LFTs elevated)
3. Hepatic failure = death

Question 13

Labs for possible ingestion

Answer 13

1. Glucose
2. CBC
3. Electrolytes
4. Calcium
5. EKG
6. Tox screen
7. Acetaminophen level

Question 14

Decontamination of ingestion

Answer 14

1. Considerations: timing, nature of substance ingested, patient characteristics
2. Therapy: ipecac syrup, activated charcoal, gastric lavage, cathartics, hemodialysis, hemoperfusion

Question 15

Activated charcoal

Answer 15

not for small molecules or heavy metals

Used for TCAs or decreased GI motility ingestions

Question 16

Cathartic

Answer 16

accelerates defacation

Question 17

Ipecac

Answer 17

DON’T use when possible aspiration

Question 18

EKG in TCA tox

Answer 18

1. irregular irregularity in rhythm
2. no distinct P waves
3. Widening of QRS
4. Prolonged QT

Question 19

Management of TCA tox

Answer 19

1. Cardiac Monitoring - minimum of 6 hrs
2. Serum Alkalinization - serum pH affects protein binding, reverse acidosis
3. Hypertonic Bicarb - 1 mEq/kg bolus every 3-5 minutes until QRS normalizes
4. Treatment possible arrhythmias, hypotension, seizures

Question 20

Nortrpytiline

Answer 20

2. 5 mg/kg can cause significant effects in young kids

- peak effect = 7-8 hrs

Question 21

Glipizide

Answer 21

1 - 10 mg tablet can cause significant effects in young kids

- peak effect = 2-3 hrs