A4 Em Toxicology

Front 1

What is the main thing to remember about iron toxicity?

Back 1

the quiescent period: first GI sx, then seeming resolution, then GI + cardiovascular sx (hypotension, CV collapse, pulmonary edema)

Front 2

What are levels of toxicity and lethality for iron?

Back 2

toxicity: above 20 mg/kg of ELEMENTAL iron ingested

lethality above 180 mg/kg of ELEMENTAL iron ingested

you have to know how much elemental iron is in tablets

Front 3

duration of phases of iron toxicity

Back 3

1-6 hours: stage I, GI sx
12-24 h: stage II quiesence,
12-40 h: stage III, cyanosis, GI sx, CV collapse
2-8 weeks: stage IV, GI scarring

Front 4

dx and tx of iron toxicity

Back 4

dx: draw levels Q4 hours
350-500 mcg/dl is potentially toxic level

chelation with deferroxamine

Front 5

tx of iron toxicity

Back 5

chelation with deferroxamine until red urine disappears

use golytely

Front 6

Iron toxicity is chelated with deferroxamine until ?

Back 6

red urine is cleared

Front 7

What is the main cause of death in TCA overdose?

Back 7

arrhythmia and CV collapse

Front 8

What complications might be seen in a TCA overdose?

Back 8

seizures, respiratory depression
ARDs is a late complication
R R' in AVR, wide QRS

Front 9

What is the treatement for TCA overdose?

Back 9

1. Bicarb to alkalinize
2. Hyperventilation to alkanilize
3. Treat dysrhythmias: phenytoin, lidocaine, but AVOID the Ia PDQ drugs
(procainamide, disopryamide, quinidine)

Front 10

Main symptoms of SSRI overdose

Back 10

CNS depression: ataxia, sedation, coma.
Buproprion has agitation and seizure.

Serotonin syndrome: hypomania, myoclonus, hyperreflexia, diaphoresis, hyperthermia.

Front 11

Treatment for SSRI overdose

Back 11

charcoal
supportive care

consider serotonin antagonists:
cyproheptadine (periactin)
methylsergide (sansert)

Front 12

What are the Hunter criteria for serotonin syndrome?

Back 12

must have taken a serotonergic agent and have one of following:

spontaneous clonus
inducible clonus + agitation or diaphoresis
ocular clonus + agitation or diaphoresis
hyperreflexia + tremor
temperature above 38 + inducible clonus or ocular clonus

Front 13

How long is the observation period for OD of sulfonylureas?

If hypoglycemia develops, how long must they be observed during treatment?

Back 13

8 hours

24 hours

Front 14

What is the treatment for sulfonylurea overdose?

Back 14

Admit patient for 24 hours.

1. Charcoal if ingestion recent
2. Glucose with D5W or D10W.
3. If D5W does not maintain glucose at 90-110, consider octreotide, which blocks insulin release from pancreas.

Watch for lactic acidosis, esp if renal problems, alcoholism, elderly, or recent IV contrast

Front 15

Signs and symptoms of digoxin toxicity?

What constitutes an elevated serum level of digoxin?

Back 15

nausea and vomiting
dysrhythmias, esp. accelerated junctional
hyperkalemia

above 2.0

Front 16

What is the treatment for digoxin toxicity?

Give criteria for treatment.

Back 16

For mild elevations (<10), stop digoxin. For more severe elevations or if there are symptoms, use digibind.

Use digibind if:
1. hyperkalemic (K > 5.5)
2. hemodynamically significant dysrhythmia
3. cardiac arrest
4. dig level > 10 ng/ml

Front 17

What is the difference between verapamil/diltiazem (nondihydropines) and nifedipine (dihydropine) in terms of their physiological effects?

Back 17

verapamil and diltiazem are nonselective CCBs, inhibiting all aspects of conduction, contractility, and vascular tone. Bradycardia, decreased CO, and peripheral vasodilation occur. Diltiazem is less potent than verapamil.

Nifedipine is more selective and vasodilates primarily. The main effect is hypotension.

Front 18

Main presentation of CCB toxicity

Main presentation of BB toxicity

Back 18

bradycardia and hypotension

bradycardia, hypotension, hypoglycemia, bronchoconstriction

Front 19

Treatment for CCB overdose

Back 19

1. Charcoal if within 1-2 hours of ingestion; consider lavage first.
2. IV fluids - 1 liter adults
3. 10 mg IV glucagon (usually for BB overdose, but can work with CCB too in smaller amounts)
4. Calcium chloride > calcium gluconate, 1 g IV bolus, then 0.1-0.2 ml/kg infusion. Bolus may have transient effect on BP.
5. Epinephrine or other pressor
6. Amrinone or milrinone, inhibits camp breakdown from a different path from catecholamines.
7. If refractory to above, consider high dose insulin + glucose; insulin has inotropic effects.
8. To treat bradycardia, atropine and/or pacing.

Front 20

Treatment for BB overdose

Back 20

1. Charcoal if within 1-2 hours of ingestion; consider lavage first.
2.SMALL boluses of IV fluid, cautiously -- this is different from CCB OD treatment
3. Glucagon infusion 50-70 mcg/kg (3-5 mg for 70 kg patient) to max dose of 10-15 mg.
4. Epinephrine or other pressor
5. Amrinone or milrinone, inhibits camp breakdown from a different path from catecholamines.
6. If refractory to above, consider high dose insulin + glucose; insulin has inotropic effects.
7. To treat bradycardia, atropine and/or pacing.
8. If wide-complex tachycardia, consider bicarb.

Front 21

What is the treatment for cholinergic/organophosphate poisoning?

Back 21

pralidoxime + atropine

Front 22

What are symptoms of carbon monoxide poisoning?

Back 22

HA, N/V, altered mental status

CHEST PAIN
CHERRY RED SKIN
(more specific but often absent)

Front 23

What is the treatment for carbon monoxide poisoning?

Back 23

100% O2 or hyperbaric oxygen if availiable

Front 24

What are three categories of carbon monoxide poisoning that should be given hyperbaric oxygen?

Back 24

pregnant patients
any carboxyhemoglobin level > 25
end organ injury

Front 25

What must you use instead of pulseox to determine damage from carbon monoxide?

give levels.

Back 25

carboxyhemoglobin

> 10 is high even for smoker
>25 is highly toxic
> 50 is lethal