What agents ⬆︎risk for Methemoglobinemia - 3
- Nitrities
- Local/topical anesthetics
- Dapsone
Pulse Ox Saturation will be low and PaO2 will “seem” to be normal
How does the pulse ox read for methemoglobinemia? ; why?
reads low (< 85%) but this does NOT actually represent the oxygen levels - it’s like this because of low affinity of methemoglobin for O2
The actual saturation is actually even lower even though PaO2 may read normal!
Dark chocolate colored blood
Dark chocolate colored blood = ______ ; MOA for tx?
Methemoglobinemia ; Methyelene Blue accepts an electron from NADPH which converts –> LeukoMethylene blue. LM reduces Methomoglobin back to Hgb
Houses built before what year at ⬆︎risk for lead poisoning?
1978
false positives occur so be sure to confirm with venous blood draw!
What are the Lead chelating agents?-2 ; At what lead level do you use them?
- Dimercaptosuccinic acid (45-69)
- Dimercaprol with EDTA ( ≥70 or acute encephalopathy)
Be sure to confirm lead levels with venous lead level before starting tx
Antidote for Cyanide toxicity - 3
- Hydroxocobalamin
- Sodium Thiosulfate
- Nitrites (incudes methmeglobinemia)
empircally treat smoke inhalation pts!
What is the MOA for Sodium Bicarbonate in TCA OD
⬆︎extracellular sodium and ⬆︎pH to alleviate cardio-depressent action on sodium channels
cp for Arsenic toxicity - 3
3 P’s
- Painful Polyneuropathy
- Pigmentation abnormalities
- Pancytopenia
RF: pressure treated wood, pesticides
What’s the most serious consequences of methanol intoxication? - 2
- VISION LOSS
- Coma
What is the most reliable sign of opioid intoxication
Respiratory Depression
cp for Carbon Monoxide poisoning?-3 ; Dx?
- Pinkish skin hue
- GI distress
- HA
Dx = Carboxyhemoglobin levels
This can present very similarly to Cyanide (also pinkish skin with bitter almond breath) and Methemoglobin (bluish skin) poisoning so be careful!
Victims of smoke inhalation injury should be empircally treated for what chemical intoxication? ; What are the treatments?-3
Cyanide toxicity ;
- HydroxyCobalamin
- Sodium Thiosulfate
- Nitrites (induces methemoglobinemia)
empircally treat smoke inhalation pts!
cp for lead toxicity - 2
- GI distress
- Neuro distress ( stocking glove neuropathy, memory ⬇︎)
Remember that lead toxicity impairs heme synthesis –> microcytic Sideroblastic Anemia
Toxicity of which compound causes Bitter Almond Breath?
Cyanide toxicity
will also have pink skin like carbon monoxide toxicity
