WHAT IS THE TOXIC INGESTION DOSE FOR ACETAMINOPHEN?
>150 MG/KG (>7.5 GRAMS IN ADULTS)
WHAT IS THE TRIAD OF WERNICKE'S ENCEPHALOPATHY AND WHAT IS THE TREATMENT?
MENTAL STATUS CHANGE
OPHTHALMOPLEGIA
ATAXIA
TREATED WITH THIAMINE
KORSAKOFF'S PSYCHOSIS IS AMNESIA AND CONFABULATION
WHAT ARE THE CLOTTING FACTORS THAT WARFARIN BLOCKS?
II, VII, IX, X
GIVE 2 INDICATIONS FOR HYPERBARIC THERAPY FOR CARBON MONOXIDE POISONING?
CARBOXYHEMOGLOBIN LEVEL >25%
MENTAL STATUS CHANGE, SEIZURE, COMA
DYSRHYTHMIA, CARDIAC ISCHEMIA, SYNCOPE
HYPOTENSION
PREGNANCY WITH COHB>20% OR SIGNS OF FETAL DISTRESS
ABNORMAL CEREBELLAR EXAM
MOST MUSHROOM INGESTIONS WITH SYMPTOM ONSET OF <2 HOURS HAVE BENING COURSE, T/F
TRUE
MOST TOXIC MUSHROOMS HAVE A DELAYED ONSET OF INITIAL GI SYMPTOMS (>6 HOURS)
THIS HEAVY METAL WILL CAUSE ENCEPHALOPATHY, COMA, SEIZURES, PERIPHERAL NEUROPATHY (WRIST DROP), ANEMIA, NEPHROPATHY, BELLY PAIN
LEAD
WHAT IS THE ANTIDOTE FOR ACETAMINOPHEN AND WITHIN WHAT TIMEFRAME IS IT MOST BENEFICIAL?
N-ACETYLCYSTEINE
WITHIN 8 HOURS OF INGESTION
WHAT IS THE TREATMENT FOR ETHYLENE GLYCOL POISONING AND WHAT IS ITS TOXIC METABOLITE?
FOMEPIZOLE, ETHANOL (STOPS ALCOHOL DEHYDROGENASE FROM CONVERTING ETHYLENE GLYCOL TO TOXIC METABOLITES)
HEMODIALYSIS IF RENAL INSUFFICIENT, SEVERELY ACIDOTIC OR ETHYLENE GLYCOL LEVEL >50MG/DL
WILL RAISE ANION AND OSMOLAR GAPS
WILL NOT CAUSE KETOSIS
HOW DO YOU TREAT WARFARIN TOXICITY?
MAY GIVE ORAL VITAMIN K FOR NO OR MILD BLEEDING
GIVE 10MG OF VITAMIN K IV FOR SEVERE BLEEDING
FFP OR PROTHROMBIN COMPLEX CONCENTRATES (KCENTRA) FOR SEVERE BLEEDING
THIS TOXIC GAS SMELLS LIKE BITTER ALMONDS
CYANIDE
FIRES INVOLVING PLASTICS, NITROPRUSSIDE INFUSIONS, APRICOT PITS
WHAT ORGAN SYSTEM DOES THIS MUSHROOM EFFECT?
KIDNEYS
ORELLANINE (CORTINARIUS SPP.)
CAUSES RENAL FAILURE
TREATED WITH DIALYSIS AND POSSIBLE TRANSPLANT
THIS HEAVY METAL TOXICITY DEPENDS ON THE FORM AND ROUTE OF EXPOSURE
MERCURY
ELEMENTAL MERCURY - NO ABOSRBED IN GI TRACT, TOXICITY IS FROM INHALATION
INORGANIC MERCURY - GI SYMPTOMS, RENAL DYSFUNCTION
ORGANIC MERCURY - NEUROLOGIC MANIFESTATIONS
WHAT IS THE TOXIC METABOLITE OF ACETAMINOPHEN?
NAPQI
FORMED VIA P450 PATHWAY
THIS ALCOHOL CAUSES A STRONG ACETONE SMELL
ISOPROPANOLOL (RUBBING ALCOHOL)
CONVERTED TO ACETONE
LESS TOXIC THAN ETHYLENE GLYCOL OR METHANOL
CAUSES GASTRITIS, CNS DEPRESSION, HYPOTENSION (INDICATION FOR DIALYSIS)
WILL RAISE OSMOLAR GAP AND CAUSE KETOSIS
WILL NOT RAISE ANION GAP
WHAT TOXIDROME WOULD BE CAUSED BY AN MAOI OVERDOSE?
SYMPATHOMIMETIC LIKE TOXIDROME
MAOI BLOCK BREAKDOWN OF CATECHOLAMINES
AGED MEATS/CHEESES, ETOH, FAVA BEANS CAN CAUSE TYRAMINE REACTION (DANGEROUS INCREASE IN BLOOD PRESSURE)
TREAT SUPPORTIVELY, BENZOS
AVOID BETA BLOCKERS FOR HTN OR TACHYCARDIA
HOW DO YOU TREAT CYANIDE POISONING
IV HYDROXOCOBALAMIN
CYANOKIT
-INHALED AMYL NITRITE, IV SODIUM NITRITE AND IV SODIUM THIOSULFATE
-THESE INDUCE METHEMOGLOBINEMIA, WHICH WILL BIND CYANIDE AND STOP TOXICITY
NAME A SYMPTOM OF POISONING FROM THIS MUSHROOM
SEIZURES
HEPATIC TOXICITY
GYROMITRA SPECIES
TOXIN IS SIMILAR TO INH TOXICITY (SEIZURES ARE TREATED WITH PYRIDOXINE)
WHAT IS THE ANTIDOTE FOR LEAD POISONING?
SUCCIMER
EDTA
DIMERCAPROL
WHAT IS THE ANTIDOTE FOR IRON POISONING?
DEFEROXAMINE CHELATION
"VIN ROSE COLORED" URINE AFTER ADMINISTERING DEFEROXAMINE
CHARCOAL DOES NOT BIND IRON
METHANOL
WINDSHIELD WASHER FLUID, SHELLACS, HILLBILLIES MAKING BAD BOOZE
BLURRED VISION FROM OPTIC DISC HYPEREMIA
NAME 2 SYMPTOMS OF SEROTONIN SYNDROME
INCREASED MUSCLE TONE/RIGIDITY, GREATER IN LOWER THAN UPPER EXTREMITIES
HYPERTHERMIA, AUTONOMIC DYSFUNCTION
CAUSATIVE AGENTS: MEPERIDINE, MAOI, DEXTROMETHORPHAN, SSRI, TCAs, COCAINE
TREATMENT: CYPROHEPTADINE (ANTISEROTONERGIC AGENT)
THIS DRUG OF ABUSE CAUSES ROTARY NYSTAGMUS
PHENYLCYCLIDINE (PCP)
WHAT IS THIS MUSHROOM CALLED?
DEATHCAP
CAUSE OF MOST MUSHROOM DEATHS IN U.S.
HEPATOTOXICITY - COAGULOPATHY, ENCEPHALOPATHY
TREAT WITH ACTIVATED CHARCOAL, NAC
WHAT ARE SOME EARLY SYMPTOMS OF IRON POISONING?
GI TOXICITY: BELLY PAIN, DIARRHEA, VOMITING, GI BLEEDING
VASODILATION --> HYPOTENSION
SHOCK AND LACTIC ACIDOSIS FROM UNCOUPLING OF OXIDATIVE PHOSPHORYLATION
COAGULOPATHY
HEPATIC AND LIVER FAILURE
WHAT IS THE TOXIC METABOLITE OF METHANOL AND HOW DO YOU TREAT IT?
FORMIC ACID
TREATED WITH FOMEPIZOLE, ETOH, HEMODIALYSIS
DIALYSIS INDICATED IN RENAL INSUFFICIENCY, METHANOL LEVEL >25MG/DL, SEVERE ACIDOSIS, VISUAL SYMPTOMS
INCREASES ANION AND OSMOLAR GAP
DOES NOT CAUSE KETOSIS
WHAT ARE 2 SYMPTOMS OF TCA OVERDOSE?
DYSRHYTHMIAS, HTN, SEIZURES
WHAT IS THE TREATMENT OF CHOICE FOR DYSRHYTHMIAS FOR SOMEONE WHO "HUFFS" "BAGS" OR "SNIFFS" HYDROCARBONS?
BETA BLOCKERS
SUDDEN VENTRICULAR DYSRHYTHMIAS CAN BE CAUSED BY CARDIAC SENSITIZATION TO ENDOGENOUS CATECHOLAMINES
ARE IRON PILLS RADIOPAQUE?
YES
>100MS
SODIUM BICARB
3% SALINE AND LIDOCAINE FOR REFRACTORY CASES
NOREPI FOR REFRACTORY HYPOTENSION
LIPID THERAPY FOR SEVERE AND REFRACTORY CASES
HOW TO DO YOU TREAT A CUTANEOUS HYDROGEN FLUORIDE EXPOSURE?
CALCIUM GLUCONATE GEL APPLIED TOPICALLY, AN INTRADERMAL INFILTRATION OR ARTERIAL INFUSION
STRONGLY BINDS CALCIUM AND MAGNESIUM
NAME 3 COMMON THINGS YOU CAN BUY OVER THE COUNTER THAT HAVE SALICYLATES IN THEM
ASPIRIN, OIL OF WINTERGREEN, BISMUTH SUBSALICYLATE (PEPTO)
HOW DO YOU TREAT A BETA BLOCKER OVERDOSE?
GLUCAGON
CALCIUM
PACING
EPINEPHRINE
INTRA-AORTIC BALLOON PUMP
INSULIN/GLUCOSE
LIPID THERAPY
WHAT IS THE ANTIDOTE FOR ISONIAZID POISONING, AND WHAT SYMPTOM WILL IT LIKELY CAUSE?
PYRODXINE (B6)
SKEEZURES
DO SALICYLATES CAUSE RESPIRATORY ALKALOSIS, METABOLIC ACIDOSIS, OR BOTH
BOTH
RESPIRATORY ALKALOSIS FROM CENTRAL RESPIRATORY STIMULATION
METABOLIC ACIDOSIS FROM UNCOUPLING OF OXIDATIVE PHOSPHORYLATION
HOW DO YOU TREAT A CALCIUM CHANNEL BLOCKER OVERDOSE?
CALCIUM!
PRESSORS
INSULIN/GLUCOSE
INTRAAORTIC BALLOON PUMP
ATROPINE, PACING PROBABLY WON'T BE EFFECTIVE
NAME A TREATMENT FOR LITHIUM POISONING
IV FLUIDS
HEMODIALYSIS
INDICATIONS FOR DIALYSIS
-RENAL FAILURE
-INABILITY TO IV HYDRATE (CHF)
-CNS TOXICITY
-SYMPTOMATIC PATIENTS WITH LITHIUM LEVEL >4 IN ACUTE OVERDOSE
WHAT IS ONE SYMPTOM UNIQUE TO SALICYLATE OVERDOSE COMPARED TO OTHER MEDICATIONS?
TINNITUS
N/V, TINNITUS, RESP ALK, MET ACID, CEREBRAL EDEMA, SEIZURES
THIS BLOOD PRESSURE MEDICATION CAN MIMIC OPIATE OVERDOSE
CLONIDINE
SEDATION, HYPOTENSION, MIOSIS, BRADYCARDIA, RESPIRATORY DEPRESSION
HIGH DOSE NARCAN CAN REVERSE MENTAL STATUS DEPRESSION
FLUIDS
PRESSORS (NOREPI, PHENYLEPHRINE)
CHOCOLATE BROWN BLOOD IS INDICATIVE OF WHAT?
METHEMOGLOBINEMIA
NITRITES, NITRATES, DAPSONE, PHAZOPYRIDINE, BENZOCAINE CAN CAUSE OXIDATION OF IRON --> MET-HGB
HOW DO YOU TREAT SALICYLATE OVERDOSE?
URINARY ALKALINIZATION (TO PH >7.5) WITH BICARB
HEMODIALYSIS INDICATIONS:
RENAL FAILURE
LUNG INJURY
MENTAL STATUS CHANGE
SALYCILATE LEVEL >100 IN ACUTE POISONING
SEVERE ACIDOSIS
RISING SALICYLATE LEVEL DESPITE URINE ALKALINIZATION
RISK OF VOLUME OVERLOAD
DIG PLANT
IS PULSE OX RELIABLE IN METHEMOGLOBINEMIA?
NO
WILL READ ABOUT 85%
NEED CO-OX FOR ANALYSIS
WHAT SYMPTOM IS UNIQUE TO DIGITALIS POISONING?
VISUAL ABERRATIONS (YELLOW-GREEN)
METHYLENE BLUE IS THE TREATMENT FOR THIS
METHEMOGLOBINEMIA
WHAT ARE INDICATIONS FOR DIGIFAB?
MALIGNANT DYSRHYTHMIAS
POTASSIUM >5
DIG LEVEL >15 ACUTELY OR >10 AFTER 6 HOURS
PACING IS CONTRAINDICATED DUE TO VENTRICULAR IRRITABILITY
CALCIUM IS ALSO CONTRAINDICATED ("STONE HEART THEORY", GIVING CALCIUM COULD CAUSE IRREVERSIBLE CONTRACTION OF THE MYOCARDIUM
MEDICATIONS THAT CAUSE EXTRAPYRAMIDAL SYMPTOMS (HALDOL, DROPERIDOL, COMPAZINE) CAN CAUSE THIS CONDITION THAT IS A RARE CAUSE OF HYPERTHERMIA
NEUROLEPTIC MALIGNANT SYNDROME
MUSCLE TONE IS INCREASED, "STIFF AND HOT"
TREAT WITH COOLING MEASURES AND BENZOS
A WASTE MANAGEMENT WORKER SUDDENLY LOSES CONSCIOUSNESS IN A SEWER, WHAT IS THE MOST LIKELY CAUSATIVE AGENT
HYDROGEN SULFIDE (H2S)
INHIBITS CYTOCHROME OXIDASE --> CELLULAR HYPOXIA