Flashcards in toxins/pharmacology Deck (76)
What is the appropriate dosing of activated charcoal?
0.5-1 g/kg (max 100g)
What 4 toxins are not removed with charcoal?
CALM = cyanide, alcohol, lithium and heavy metals
A 3 y/o swallowed a battery 3 days ago. He is asymptomatic. What do you do?
Endoscopy. If in the esophagus or stomach it must be removed
When should swallowed coins be removed?
If proximal esophagus - endoscopy ASAP!
If middle to lower esophagus, observe 24 hours if asymptomatic and if does not pass then endoscopy needed
What are 3 initial manifestations of Tylenol toxicity?
Anorexia, nausea and vomiting
How long is the latent phase of acetaminophen toxicity?
1-4 days with significant rise of liver enzymes
What are the important 4hr post Tylenol ingestion levels to remember?
>150 = moderate toxicity
>300 = severe toxicity
Female ingested Tylenol 2 days ago. Acetaminophen level 4 hr post ingestion was 250 and she was treated with N acetylcysteine. Today LFTs are normal. What is her prognosis?
LFTs can be normal until 4 days after ingestion even after severe overdose! Pt is still in danger...
What is the initial management of acetaminophen ingestion ?
Charcoal then 4 hour post ingestion level
If >150mg/kg has been ingested, what should you do?
Immediately give N acetylcysteine, even before obtaining post ingestion levels
If a patient had wintergreen odor on breath, what should you be concerned about?
What is the initial treatment of salicylate ingestion?
Charcoal then 3-6hr post ingestion level
How do you manage ibuprofen ingestion ? What should you NOT do?
Do give supportive care and test for co-ingestion of aspirin or Tylenol
Do not give ipecac or gastric lavage,
What occurs physiologically after aspirin ingestion?
Respiratory alkalosis due to increased breathing --> buildup of organic acids and anion gap metabolic acidosis
What is the formula for anion gap?
Na - (Cl + bicarb)
What is the treatment for anion gap metabolic acidosis secondary to aspirin ingestion and why?
Sodium bicarb to alkalinize the urine
Which ingestion is associated with hypoglycemia ?
At what blood alcohol level can coma, respiratory depression and death occur?
What products contain methanol?
Rubbing alcohol, Windshield washer fluid, cooking fuel, perfumes and antifreeze
Clinical presentation of methanol ingestion ...
Acidosis, increased anion gap and CNS depression
What is the antidote to methanol toxicity and why?
4-methypyrazole or ethanol --> alcohol dehydrogenase antagonist which slows conversion to formaldehyde
What are the classic symptoms of opiate toxicity?
Responsive to painful stimuli
Pinpoint but reactive pupils
Bradycardia, hypotension and low temperature
How can you differentiate opioid toxicity from dka?
Dka has rapid deep breathing with no miotic pupils
Opiates cause shallow breathing with miotic pupils
How can you differentiate opioid toxicity from organophosphate poisoning?
Both have pinpoint pupils but only organophosphate shave sweating, tearing and wheezing
What toxicity would be suspected in a person with dilated pupils and violent behavior?
What is propoxyphene and what can it cause ?
Narcotic analgesic that can cause ventricular arrhythmia, seizures and pulmonary edema
What is the mechanism of action of organophosphates?
What are the classic signs of organophosphate poisoning?
DUMBBELS = diarrhea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, salivation
What are the muscarinic effects of cholinergics and how are they treated?
Bronchospasm and increase pulmonary secretions - give atropine