General Poison Information
Which of the following are jobs of Poison Control? (Select All That Apply)
A. 12-hour coverage during the day for poison information
B. Poison control has regional patient transport services
C. Collects data and medical records to participate in large scale data collection programs.
D. Provides educational programs for health professionals
E. All of the above
A - Not correct as poison control is 24-hour coverage
B - Correct
C - Correct
D - Correct
E - Not correct due to A
What is given for acetaminophen toxicity and name 1 ADR should be watched for when giving IV of this antidote?
1. N-acetylcysteine
2. Anaphylaxis – 9-14%, Urticaria, angioedema much more common
What clinical indications warrant Digoxin Immune Fab?
HR < 40, 2nd and 3rd-degree block, VT, VF, fast atrial arrhythmias, or a high K+ due to acute digoxin toxicity (not renal failure) are all potentially life-threatening and could warrant Digoxin immune Fab.
Select All that apply - which of these are sources for poison information?
A. Poisindex
B. Toxicologic Emergencies – Goldfrank
C. Management of Poisoning and Drug Overdose
D. Common Toxicology and Poison Ideology - Eliefen
E. Medical Toxicology – Ellenhorn
F. Poisoning and Drug Overdose - Olson
G. Watch For Kids - Guide to Poison management in Pediatrics
D and G are incorrect
A patient comes in with hypoglycemia, fever, vomiting, and CNS symptoms such as disorientation, and irritability. The doctor takes a salicylate level and finds the level to be 100 mg/dL, the doctor should be concerned about what side effects at this level. In addition, what is the treatment?
45-65 mg/dl hyperpyrexia
65-90 mg/dl lethargy
90-120 mg/dl seizures and coma
>120 death
Treatment: bicarb/l D5W with additional K if urine doesn't alkalinize
The goal to enhance elimination through the pH of the urine Alkalinization
Monitor pH, K, I/O and pulmonary status
How can you tell the difference between acute and chronic dig toxicity?
Chronic - Cardiovascular any arrhythmia, fatigue, weakness, anorexia, vision issues, confusion, hallucination
Acute: N/V mental status changes, hyperkalemia, bradycardia, heart block, tachyarrythmias no ventricular arrhythmias
Thiamine
Dextrose
Naloxone
Methanol or Ethylene Glycol or both?
Confusion
Ocular toxicity - being in a snowfield
N/V
Seizures/Coma/CNS depression
Pancreatitis
Renal - flank pain
Pulmonary edema
Urinary crystals
Alcohol breath
Metabolized to formic acid
Metabolized to glyoxylic acid
Confusion
Ocular toxicity - being in a snowfield = M
N/V = B
Seizures/Coma/CNS depression = B
Pancreatitis = M
Renal - flank pain = E
Pulmonary edema = E
Urinary crystals = E
Alcohol breath = M
Metabolized to formic acid = M
Metabolized to glyoxylic acid = E
How to treat acute vs chronic toxicity for dig?
Acute - Lavage and activated charcoal to enhance elimination
Give Dig fragments if indicated (life-threatening)
Chronic - not many choices
When is a gastric lavage procedure warranted?
Generally felt to be indicated for life-threatening overdoses that
present within 1 hour of ingestion
Contraindicated in corrosive
Complications - aspiration, perforation
Can both Fomepizole and 4 methylpyrazole be used in ME and EG poisoning?
Which co-factor goes with Methanol and which goes with EG?
Leucovorin
Thiamine
Yes
Leucovorin - M
Thiamine - E
Which opiates need a higher dose of Naloxone to respond?
diphenoxylate/atropine,methadone, fentanyl, buprenorphine, diphenoxylate, pentazocine
List 1 substance that can't be absorbed by activated charcoal.
Alcohol, Glycols Li, Fe, CN, hydrocarbons, acids, organophosphates
Calculate a Naloxone drip for a patient who has been on 4mg for 2 min, then 10mg for 2 minutes when the patient finally had a response. What should be the continuous IV given?
Naloxone - .4-2 mg IV then 4, 10 and 15 mg q 2 min until response. If continuous infusion
needed, administer 2/3 of the dose which caused a response at an hourly rate.
Which of the following are non-toxic?
Aluminum foil
Bleach 3%
Corticosteroids
Antibiotic ointment
Kitty litter
Dishwasher soap
All of them
For TCA toxicity what is the first line? Why?
a. Type IA antiarrhythmic
b. Na BiCarb
Na Bicarb - NaBicarb works to change protein binding in the heart through pH changes which pulls TCA out of the heart. Na bicarb ALSO provides Na to stabilize the membrane and decrease and prevent arrhythmias. It also helps treat hypotension. It does NOT enhance excretion of TCA in the urine. It does NOT prevent seizures.
Type IA antiarrhythmic - TCA are already Type 1A antiarrhythmic as they impact sodium channels and if given these then causes arrhythmias like VT and Vfib.
Patient is experiencing the following symptoms:
Irritability
Tremor
Hyperreflexia
Fever
Trismus (lockjaw)
Which medication could be causing this?
A. Sertraline
B. Opiates
C. Cocaine
D. Caffeine
E. Baclofen
Sertraline (Toxidrome Serotonin)
ORGANOPHOSPHATE POISONING -
For using Atropine what is the indicator that a patient is no longer poisoned?
When is Pralidoxime indicated?
A. Nicotinic effects such as pupil dilation pulse increases works to clear rales and dry pulmonary secretion
B. Indicated for muscle and diaphragm weakness, fasciculations
Coma, seizure within 48 hours