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115 Cards in this Set
- Front
- Back
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A unknown ingestion leads to a toddler choking and vomiting, lethargy, depressed LOC, and calcium oxalate crystals in urine. What substance?
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Car radiator antifreeze
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What is the treatment for cyanosis associated with "popper" abuse?
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Methylene blue to treat methemoglobinemia which causes cyanosis unresponsive to oxygen administration.
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How is a dystonic reaction from promethazine treated?
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Diphenhydramine 1-2 mg/kg IM or IV
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What eye abnormality is associated with barbiturate use?
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Lateral nystagmus
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What eye finding is associated with PCP use?
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Horizontal or verticle nystagmus.
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What eye finding is associated with cocaine abuse?
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Dilated pupils
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What eye finding is associated with marijuana use?
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Conjunctival injection.
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What presents with coma, respiratory depression, miosis, hypotension, bradycardia or tachycardia, delayed gastric emptying, arrhythmias, pulmonary edema and circulatory collapse?
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opiate intoxication
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What acid-base disturbances occur in aspirin overdose?
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Respiratory alkalosis and metabolic acidosis
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What is found in urine with ethylene glycol ingestion?
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Calcium oxalate crystals.
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What symptom is a side effect of aspirin overdose?
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tinnitus
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What symptom is a side effect of methanol ingestion?
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visual changes
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What ingestions cause red skin?
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Carbon monoxide
Boric acid |
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What ingestions cause blue skin?
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Anything that causes cyanosis.
Methemoglobinemia |
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What ingesstions cause an increased anion gap?
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MUDPILES
Methanol Uremia DKA Phenols Iron/INH Lactate Ethanol/Ethylene glycol Salicylates |
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What type of ingestions can be detected by Xrays?
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CHIPES - chloral hydradate, calcium, heavy metals, iron, phenothiazines, enteric coated preparations, sustained release tablets
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What ingestions are charcoal ineffective or contraindicated?
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CHEMICAL CamP
Caustics, Hydrocarbons, Electrolytes, Metals, Iron, Cyanide, Alcohols, Lithium, Camphor and Phosphorous. |
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What are contraindications to gastric lavage?
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Caustic ingestions (acids and alkalis)
Hydrocarbons Sharp-item ingestions |
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Cathartics like sorbitol are useful in toxic ingestions in what circumstances?
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Only when given with activated charcoal but NEVER alone because they cause electrolyte imbalances.
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Whhat is the acute toxic dose for a child < 12 years old who ingests tylenol?
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150 mg/kg
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What is the toxic dose of tylenol in adolescents and adults?
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8-15 grams
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What are symptoms of anticholinergic ingestion?
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Dry as a bone (decreased sweat and UOP)
Red as a beet (flushing) Blind as a bat (mydriasis) Mad as a hatter (agitation, sz) Hot as a hare (hyperthermia) |
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What medications fall in the class of anticholinergic medications/ingestions?
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Antihistamines
Antidepressants (TCAs) Antispasmodics Anti-Parkinson agents Atropine Toxic Plants (jimson weed, mushrooms, deadly nightshade) |
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What are the symptoms of carbamazepine ingestion?
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CNS depression within 6-24 hours - drowsiness, vomiting, ataxia, slurred speech, and/or nystagmus, seizures, respiratory depression
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What toxic ingestion may present with "cog-wheel rigidity"?
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Phenothiazines
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What are ingestions that cause miosis?
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C -cholinergics, clonidine
O -opiates, organophosphates P -phencyclidine, phenothiazine, pilocarpine S - sedatives (barbiturates) |
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What are ingestions that cause mydriasis?
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Anticholinergics
Antihistamines Antidepressants (TCA) Sympathomimetics (amphetamine, cocaine, LSD) |
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What are ingestions that cause diaphoretic skin?
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Sympathomimetics
Organophosphates Aspirin PCP |
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What type of ingestion is characterized by: coughing,choking, gagging, wheezing, severe respiratory distress, CNS depression, and fever?
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Hydrocarbon Ingestion
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What type of toxic ingestions include - mineral spirits, kerosene, gasoline, lamp oil, toluene, propellants, refrigerants
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Hydrocarbon Ingestions
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What are hydrocarbon ingestions known to cause?
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Pulmonary Aspiration
Sensitize to cardiac arrythmias |
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What type of ingestion is characterized by: CNS disturbances, depression, seizures, respiratory depression, GI symptoms, hypothermia, hypoglycemia, and ataxia.
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Ethanol ingestion
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What is the characteristic lab abnormality that suggests ethanol/methanol/ethylene glycol/isopropyl alcohol toxicity?
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High Osmolal Gap
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What type of ingestion is characterized by visual complaints, abdominal pain and metabolic acidosis?
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Methanol ingestion
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What toxic ingestion has an initial periiod of mild, nonspecific complaints followed by a completly different presentation 24 hours later with optic nerve damage, CNS depression & metabolic acidosis?
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Methanol Ingestion
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What ingestion has a visual disturbance described as a snowstorm
(blurry vision and photophobia) |
Methanol ingestion
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What type of toxic ingestions include:
- windshield washer fluid - deicer - antifreeze - canned heat (sterno) - picnic stove fuel |
Methaanol ingestion
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What is ethylene glycol metabolized into?
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glycolic and oxalic acid
(via alcohol dehydrogenase) |
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What are the three stages of intoxication from ethylene glycol ingestion?
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1- (1-12 hrs) appears drunk with nausea, vomiting, drowsiness, slurred speech, lethargy.
2- (12-36 hrs) respiratory problems, tachypnea, cyanosis, pulmonary edema, ARDS, death can occur 3 - (2-3 days) cardiac failure, seizures, cerebral edema, renal failure. |
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Because oxalite glycol (a metabolite of ethylene glycol) chelates calcium, what can occur in the wine?
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Urine may fluoresce with a Woods lamp and calcium oxalate crystals will be found in the urine.
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What symptoms present with organophosphate ingestion?
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Cholinergic toxidrome DUMBBELS
Diarrhea, Urination, Miosis, Bronchorrhea/Bronchospasm, Emesis, Lacrimation, Salivation (miosis + an outpouring of every bodily fluid) |
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How do you treat organophosphate ingestion?
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ABCs
Atropine (May need large doses, can repeat until effective) Pralidoxime (2-PAM) hydrolyzes the bond if given before it becomes permanent. Always use with atropine because 2-PAM doesn't cross blood brain barrier. |
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What ingestion is confirmed by decreased RBC cholinesterase activity (but don't wait to treat).
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Organophosphate Ingestion
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What plants are known for the toxic effects like digitalis?
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foxglove, lily of the valley, oleander
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What plants are known for their toxic effects like atropine?
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Jimson weed, deadly nightshade
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What cardiac anomaly is associated with Ellis-van Creveld syndrome
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Single atrium
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What toxic effects are caused from toxic mushrooms?
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Liver toxicity
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What cardiac anomaly is associated with Cri-du-chat ssyndrome?
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VSD
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What plants have toxic effects similar to cyanide poisoning?
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Pear and apple seeds
Peach pit Bitter Almond |
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What cardiac anomaly is associated with Turner syndrome?
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Bicuspid aortic valves
Coarctation of the aorta |
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What plants are known to cause oral pain?
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Dieffenbachia philodendron
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What plants can cause mild GI symptoms if ingested?
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Poinsettia
Mistletoe Holly |
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What is the treatment of hydrocarbon poisonings?
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- Avoid gastric emptying
- Prevent aspiration - Supportive respiratory care |
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What poisoning presents with decreased pH, increased glucose, increased bili, increased LFTs, PT and WBC?
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Iron
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What poisoning presents as nausea/vomiting, anorexia, stomach pain, GI bleeding, sometimes mental status changes/stupor/coma/seizures
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Ibuprofen
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What poisoning presents with nausea/vomiting, diarrhea, GI bleed, acute liver failure, seizures, shock, coma?
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Iron
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What is the antidote for iron poisoning?
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Deferoxamine chelation
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What poisoning has lab findings of increased serum transaminase levels, increased alk phos, metabolic acidosis with increased anion gap?
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Ibuprofen
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What is the treatment of iron poisoning?
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Gastric lavage
Whole bowel irrigation Dialysis (if severe) |
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What poisoning has symptoms of nausea/vomiting, anorexia which may progress over days to jaundice, abd pain and liver failure?
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Acetominophen
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What poisoning class has:
- Mad as a hatter - Red as a beet - Blind as a bat - Hot as a hare - Dry as a bone memory tool? |
Anticholinergics
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What poisoning presents with drowsiness, delerium, hallucinations, seizures, flushing, fixed dilated pupils, fever, cardiac dysrrhythmias, dry mouth, speech and swallowing difficulties, nausea, and vomiting?
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Anticholinergics
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What is the antidote for anticholinergic poisoning?
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Physostigmine
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What is the treatment of anticholinergic poisonings?
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gastric emptying (early)
activated charcoal cardiorespiratory support seizure control agitation control |
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What is the antidote for carbon monoxide?
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oxygen
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What poisoning presents as lethargy, irritability, confusion, dizziness, headache, nausea, irregular breathing, cyanosis, palpitations, coma, and death?
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Carbon monoxide
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What is the treatment of carbon monoxide poisoning?
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Normobaic oxygen 100% until asymptomatic and carboxyhemoglobin < 5%
Hyperbaric if severe and available |
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What is the antidote to ethanol poisoning?
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none
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What is the treatment of ethanol poisoning?
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Supportive care, glucose, correction of electrolytes, parenteral fluids
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What poisoning presents with lethargy, CNS depression, nausea/vomiting, ataxia, respiratory depression, coma, hypotension, hypothermia?
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Ethanol poisoning
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What is the antidote for ethylene glycol poisoning?
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none
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What poisoning presents with anorexia, vomiting, lethargy, respiratory/cardiovascular collapse?
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Ethylene glycol
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What poisoning presents as tachypnea, coughing, respiratory distress, cyanosis, fever, aspiration, nausea/vomiting, GI discomfort and mental status changes.
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Hydrocarbons
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What are examples of hydrocarbons?
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- fuels
- household cleaners - polishes - other solvents |
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What is the treatment of acetaminophen poisonings?
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gastric emptying (in 1 hr)
activated charcoal (in 4 hours) antidote at 8-10 hours |
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What is the antidote for the acetaminophen overdose?
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Oral N-acetylcysteine
140mg/kg po x 1 dose then 70 mg/kg po q4 x 17doses |
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What is the toxic dose of iron ingestion?
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40mg/kg
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What are the lab indicators of serious/significant iron overdose?
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- serum Fe > 350 mcg/dL
- WBC > 15 - serum glucose> 150 |
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What is the treatment of iron overdose with severe symptoms?
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GI decontamination with whole bowel irrigation and deferoxamine.
DO NOT USE ACTIVATED CHARCOAL OR IPECAC |
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What are the four phases of iron ingestion?
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1) GI 30 min - 6 hr
2) latent phase 6-24 hrs 3) shock, metabolic acidosis and hepatic failure 6-12 hours 4) bowel obstruction 2-8 wks after |
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What specifics occur in phase 4 of iron toxicity and when do they occur?
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Occurs 2-8 wks after ingestion
Bowel obstruction which results from GI tract scarring secondary to corrosive action of iron |
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What specifics occur in phase 3 of iron toxicity and when do they occur?
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As early as 6-12 hours after ing.
- shock - metabolic acidosis which cause mitochondrial dysfunction and death |
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What specifics occur in phase 2 of iron toxicity and when do they occur?
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6-12 hours but can be 24 hrs.
Asymptomatic or latent phase |
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What specifics occur in phase 1 of iron toxicity and when do they occur?
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30 min - 6 hrs
vomiting, diarrhea, hemetemesis, melena and abdominal pain |
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What poisoning is suggested by lab values of increased serum hepatic transaminases and increased prothrombin time?
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Acetaminophen
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When is thalidomide exposure the most teratogenic?
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34-50 days gestation
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When is carbamazepine the most teratogenic?
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15-29 days gestation
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When is methotrexate the most teratogenic?
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6-9 weeks gestation
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When are ACE inhibitors the most teratogenic?
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2nd and 3rd trimester
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When is DES the most teratogenic?
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before 12 weeks gestation
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What teratogenic effects occur from thalidomide use?
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limb defects and ear malformations with deafness
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What teratogenic effects occur from carbamazepine?
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spina bifida
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What teratogenic effects occur from methotrexate?
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craniosynostosis, craniofacial abnormalities and limb defects
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What teratogenic effects occur from ACE inhibitors?
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renal dysgenesis, oligohydramnios and skull ossification defects.
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What teratogenic effects occur from DES?
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vaginal adenocarcinoma developing in the offspring of the fetus at a later age.
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What teratogenic effects occur from lithium?
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Ebstein anomaly
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What teratogenic effects occur from phenytoin?
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growth deficiency, developmental delays, craniofacial anomalies, hypoplastic phalanges/nails
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What teratogenic effects occur from retinoic acid?
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microcephaly, facial nerve palsies, microtia and external auditory canal anomalies, cardiovascular defects, thymic hypoplasia and genitourinary anomalies.
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What teratogenic effects occur from streptomycin?
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hearing loss
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What teratogenic effects occur from tetracycline?
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Bone and tooth staining
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What teratogenic effects occur from valproic acid?
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spina bifida, craniofacial abnormalities and preaxial defects
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What teratogenic effects occur from warfarin?
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nasal hypoplasia,stippled epiphyses, CNS effects, spontaneous abortions
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What teratogenic effects occur from cocaine?
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miscarriage, stillbirth and premature delivery, intracranial hemorrhage.
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What teratogenic effects occur from mercury?
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cerebral atrophy, seizures and developmental delay
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What teratogenic effects occur from cigarette smoking?
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low birth weight, miscarriage, prematurity and stillbirth.
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When is lithium exposure the most teratogenic
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before 8 weeks gestation
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When is phenytoin exposure the most teratogenic
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during the first trimester
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When is retinoic acid exposure the most teratogenic
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2-5 weeks after conception
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When is streptomycin exposure the most teratogenic
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third trimester
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When is tetracycline exposure the most teratogenic
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after 20 weeks gestation
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When is warfarin exposure the most teratogenic?
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6-9 weeks
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When is valproic acid exposure the most teratogenic?
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first 30 days
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When is tetracycline exposure the most teratogenic?
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after 20 weeks gestation
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What is the most common human teratogenic state?
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Diabetes mellitus
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What teratogenic effects are
often associated with diabetes? |
sacral agenesis, situs abnormalities, holoprosencephaly and congenital heart disease
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