Toxicology Approach
Relevant history would include?
Time of ingestion
Time of presentation
What was the reported overdose
Relevant clinical features
Time of ingestion relates to?
Time of onset
Relevant pharmacokinetic criteria for dialysis removal?
Not protein bound
Small molecular size
Water soluble
Not fat soluble / low volume of distribution
Hallucinogenic Toxidrome presents with?
Disorganized thinking (paranoia, delusion, hallucinations)
Delirium
Fever
Dilated Pupils
Antidote for Hallucinogenic toxidrome?
Benzodiazepine
Screening labs would include?
Chem 10
LFTs
CBC
INR
Time of presentation relates to?
Time of onset
Toxic alcohols that can be removed by dialysis?
Methanol
Ethylene glycol
Sympathomimetic Toxidrome presentation?
Dilated pupils
Tachycardia
Hypertension
Diaphoresis
Tremor
Fever
Delirium
Antidote for Sympathomimetic toxidrome?
Benzodiazepine
Screening for toxic alcohols/solvents would include?
Osmolar Gap
Anion Gap
Half life of drug relates to?
Time to clearance of drug
A psychiatric medication that causes nephrogenic DI that can be removed by dialysis?
Lithium
Anticholinergic toxidrome presention?
Hot as a Hare
Dry as a Bone
Blind as a Bat
Red as a Beet
Mad as a Hatter
Antidote for Anticholinergic toxidrome?
Benzodiazepine
Physostigmine (inhibits acetylcholinesterase, avoid in TCA overdose)
Cardiac screening would include?
Protein binding and molecular size relates to?
A drug can be potentially cleared by dialysis or plasmapheresis
A commonly available medication that can result in a triple acid base disorder and can be removed by dialysis?
Salicylate (respiratory alkalosis then metabolic alkalosis then AG metabolic acidosis)
Cholinergic toxidrome presentation?
SLUDGE +
Salivation
Lacrimation
Urination
Diarrhea
GI Cramping
Emesis
Bradycardia
Bronchorrhea
Miotic Pupils
Antidote for Cholinergic toxidrome?
Atropine (central and peripheral muscarinic receptor antagonist)
Pralidoxime for organophosphate poisoning (reactivates acetylcholinesterase)
Routine specific toxin screening includes?
Salicylate level
Tylenol level
Ethanol level
Toxic alcohol levels
Urine tox screen
Water solubility and fat solubility relates to?
Volume of distribution of a drug (clearance) and whether dialysis is an option
A commonly used diabetic medication that can be removed by dialysis?
Metformin
Sedative-Hypnotic toxidrome presentation?
Decreased LOC / drowsiness
Apnea (narcotic / benzodiazepine)
Hypoglycemia (diabetic meds)
Miosis (narcotic)
Antidote for sedative-hypnotic toxidrome?
Narcan
Flumazenil
Glucose