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Toxicity results when glutathiione stores are depleted and the toxic metabolites accumulate. Early-on pt's have anorexia, nausea, vomiting, malaise, and diaphoresis. Symptoms resolve over 24 hours, being replaced by RUQ abdominal pain and elevated LFT's, and oliguria. These symptoms peak at 3-4 days resulting in either resolution of hepatic damage or progression to complete liver failure.
Acetaminophen toxicity
Antidote for Acetaminophen toxicity
N-acetylcysteine (Mucomyst)
Antidepressants
Tricyclic antidepresseants are usually more serious ingestions than SSRI's.

SSRI ingestion is uaually mild w/ drowsiness or hyperactivity and agitaion, nausea, vomiting, and abdominal pain occuring in a minority of pt's.

Tricyclic antidepressants can cause CNS excitation, extrapyramidal signs, blurred vision, mydriasis, dry mouth, hyperpyrexia, tachycardia and arrhythmias, urianry retention, decreased intestinal peristalsis. Severe findings include seizures, coma, severe arrhythmias, and cardiorespiratory arrest.
CNS alterations including sedation, somnolence, diplopia, dysarthria, apnea, ataxia, and intellectual impairment. If ingested with other agents, severe CNS depression and coma are more common.
Benzodiazepines
Toxicity results when glutathiione stores are depleted and the toxic metabolites accumulate. Early-on pt's have anorexia, nausea, vomiting, malaise, and diaphoresis. Symptoms resolve over 24 hours, being replaced by RUQ abdominal pain and elevated LFT's, and oliguria. These symptoms peak at 3-4 days resulting in either resolution of hepatic damage or progression to complete liver failure.
Acetaminophen toxicity
Antidote for Acetaminophen toxicity
N-acetylcysteine (Mucomyst)
Antidepressants
Tricyclic antidepresseants are usually more serious ingestions than SSRI's.

SSRI ingestion is uaually mild w/ drowsiness or hyperactivity and agitaion, nausea, vomiting, and abdominal pain occuring in a minority of pt's.

Tricyclic antidepressants can cause CNS excitation, extrapyramidal signs, blurred vision, mydriasis, dry mouth, hyperpyrexia, tachycardia and arrhythmias, urianry retention, decreased intestinal peristalsis. Severe findings include seizures, coma, severe arrhythmias, and cardiorespiratory arrest.
CNS alterations including sedation, somnolence, diplopia, dysarthria, apnea, ataxia, and intellectual impairment. If ingested with other agents, severe CNS depression and coma are more common.
Benzodiazepines
Txt of salycylate toxicity
In addition to the initial resuscitation efforts of rehydration and gastric decontamination, you should also administer potassium and alkalinize the urine to enhance the excretion of the salicylate ion. Can also give N-acetylcysteine (Mucomyst)
Antidote for iron tox
Deferoxaime
Antidote for isoniazid tox
Pyridoxine (Vit B6)
Antidote for methanol tox
ethanol
Antidote for opiate tox
naloxone
Antidote for organophosphate (ie pesticides) tox
atropine or
pralidoxime

Txt requires to immediately remove all the person's clothing and thoroughly cleanse all skin surfaces to wash off the toxin.
Antidote for phenothiazine (phenergan) tox
diphenhydramine
Antidote for warfarin tox
Vit K
What can be done if a patient presents to you immediately after ingesting massive amounts of a toxic substance?
In the ingestion of toxic substances, administration of charcoal (to prevent further absorption of the substance in the gut)or ipecac (to induce vomiting) or whole bowel lagage have been indicated to be used only immediately after ingestion of the substance. More than 6 hours after ingestion of a rapidly absorbed substansce such as acetaminophen, these procedures would not help.
At what age do you begine to suspect other causes of exposure to toxic agents other than accidental ingestion.
Beginning at age 13 yo, the incidence of exposure to toxic agents is either intentional (suicide atempt or substrance abuse) or occupational.
Causes basophilic stippling
Lead poisoning. Will also see "lead lines" in the ends of long bones.
Antidote for heavy metal tox (lead, mercury)
For asymptomatic pt's, intramuscular injections of:
Calcium Diisosodium Etylenediaminetetracetate (CaEDTA)
Meso-2,3-dimercaptosuccinic acid (DMSA, succimer)

For hospitalized pt's:
2,3-dimercaptopropranol (BAL) or
CaEDTA