Toxins

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Alexander the Great refused to let his troops eat fish due to this toxin; Captain William Bligh described symptoms of this toxin among his sailors on an expedition in 1789.

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Ciguatera (mostly reef fish)

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Most common fish food poisoning in tropical coastal regions;

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Ciguatera; Ciguatera poisoning accounts for more than half of the fish-related foodborne disease outbreaks in the United States

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Symptoms of ciguatera toxin

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GI then neurologic

Front 4

In one highly publicized case, 26 employees developed this toxicity after eating blue marlin in the World Bank cafeteria in Washington, DC, in 1997

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Scombroid. Caused by ingestion of histamine in fish muscle

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Saxitoxin is associated with this ocean phenom.

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Red tide

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Consumption of saxitoxin in this type of seafood may result in perioral tingling, paralysis and resp failure

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Mussels, clams, and oysters, as well as by crabs and snails. PSP (paralytic shellfish poisons) toxins (saxitoxin is most common) block sodium ion channels

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Pufferfish (fugu) poisoning is caused by

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tetrodotoxin

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Treatment of pufferfish poisoning consists of

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Supportive care and intestinal decontamination with gut lavage and charcoal. Case reports suggest that anticholinesterases such as edrophonium may be effective

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INH toxicity antidote

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B6

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Dig toxicity

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Ovine Dig Fab

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cyanide toxicity

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amyl nitrite (inhalation), Na-nitrite (IV), na-thiosulfate IV

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which substance is metabolized to cyanide after ingestion –

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nail glue remover (acetotitrile)

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cyanide antidote kit

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Lilly Cyanide Antidote Package

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LMWH or heparin toxicity

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protamine

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TCA Toxicity

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Sodium Bicarb

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Salicylate toxicity (oil of wintergreen, peptobismol, alka seltzer)

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urine alkalinization, hemodialysis

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Bitter Almonds smell

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Cyanide

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Garlic smell

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Arsenic

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Pulmonary agent first used by the Germans in 1917, smells like newly mowed hay

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Phosgene gas (CG)

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fruity smell

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acetone, isopropyl alcohol, ethanol

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Iron toxicity

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Deferoxamine

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Lead toxicity treatment

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dimercaprol (British Anti-Lewisite or BAL), calcium disodium ethylenediaminetetraacetate (CaNA2EDTA), or meso-2,3-dimercaptosuccinic acid (DMSA); avoid dimercaprol in hepatic insufficiency or peanut allergy, cautious use in renal insufficiency or HTN

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Methemoglobin toxicity treatment (Fe in 3+ rather than 2+ results in inability to bind oxygen)

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methylene blue

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Ethylene glycol toxicity treatment

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Ethanol or fomepizole

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Organophosphate toxicity treatment

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atropine, pralidoxime

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Acetaminophen toxicity treatment

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N-Acetylcysteine oral 140mg/kg loading then 17 doses of 70mg/kg q4hr

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Narcotic antidote

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naloxone

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Benzodiazepine toxicity treatment

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Flumazenil

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Deadliest nerve agent known to man

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VX gas

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Pyridostigmine does not work as a pre-treatment for …

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VX gas and GB (sarin)

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Respiratory alkalosis, anion-gap metabolic acidosis, hyperpnea, tinnitus are al clinical clues of this overdose

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Salicylate poisoning

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Overdose with this substance typically causes an increased osmolar gap and ketosis without significant metabolic acidosis

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Isopropyl alcohol

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Antidote for nitrite overdose

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Methylene blue

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Three classes of medicines that are first-line treatment for anaphylaxis

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Epinephrine, antihistamines, steroids

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A patient with underlying hypertension goes into anaphylaxis that is refractory to epinephrine. In addition to standard measures, you should use this agent.

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Glucagon (pt may be on a B blocker and resistant to epinephrine

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Causes of clinical deterioration, lactic acidosis and altered mental status in a patient on nitroprusside

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cyanide toxicity

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AKA angel dust

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PCP

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AKA Special K or Kit Kats

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Ketamine

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AKA Georgia Home Boy

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GHB

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AKA Roffies or La Rocha

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Rohypnol

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Two most frequent symptoms of mild carbon monoxide poisoning

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Headache and nausea

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Accumulation of this gas is responsible for decompression illness

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Nitrogen

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Medical significance of N-acetyl-p-benzoquinoneimine (NAPQI)

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Toxic metabolite of acetominophen

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Intravenous treatment for cyanide poisoning

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Sodium thiosulfate

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Use this nomogram to assess tylenol toxicity at 4 and 24 hours after ingestion

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modified Rumack-Matthew nomogram

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Medical treatment for mild to moderate salicylate intoxication

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Alkalinization of the urine

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Treatment of choice for severe carbon monoxide toxicity with coma

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Hyperbaric oxygen

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Electrolyte abnormality classically associated with MDMA (3,4-methylenedioxymethamphetamine) intoxication

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Hyponatremia

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Delayed adverse reaction (that typically occurs 1-2 weeks after treatment) common in patients treated with antivenoms for Crotalinae bites (rattlesnakes, copperheads, and cottonmouths)?

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Serum sickness

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Metalloid chronic exposure associated with the hyperkeratosis pictured here as well as with a symmetric sensorimotor polyneuropathy, hepatic angiosarcoma, along with a variety of other CNS, CV, gastrointestinal, and pulmonary disorders

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Arsenic

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Symptoms of cholinergic excess

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SLUDGE = Salivation, lacrimation, urination, defecation, Gastric Emptying; BBB = bradycardia, bronchorrhea, bronchospasm

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2 drugs found in the Mark 1 kit

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Atropine and 2-PAM-Cl

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Of the three vesicants, this is the only one that does not cause immediate pain

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Mustard gas (Lewisite and phosgene oxide cause immediate pain)

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Lab findings in CN poisoning

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Severe anion-gap acidosis, bright red venous blood

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Optic neuritis, AG metabolic acidosis, osmolar gap from ingestion of this

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Methanol

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Ingestion of these 2 alcohols can cause a high anion gap

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Methanol, ethylene glycol

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Reason isopropyl alcohol does not have an increased anion gap

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Isopropyl alcohol is converted to acetone (neutral compound)

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The treatment of choice for lithium toxicity.

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Hemodialysis

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Red retinal veins after exposure to carbon monoxide

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Jett's sign

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Red as a beet, hot as a hare, dry as a bone, blind as a bat, mad as a hatter

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Anticholinergic syndrome

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Salivation, lacrimation, urination, defecation, GI upset, emesis

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Cholinergic syndrome/organophosphate poisoning

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Depressed mental status, depressed respiration, miosis

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Opiate toxiciity

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Depressed mental status, bradycardia, hypothermia, hypotension, pulmonary edema, areflexia

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Barbiturate toxicity

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CNS excitation, seizures, HTN, tachycardia, hallucinations, mydriasis

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Stimulant toxicity (amphetamines, cocaine)