Tox

Question 1

Correction factor for ETOH when correcting Osmolar Gap

Answer 1

ETOH X 1.25

Question 2

Classic CO-Hgb SpO2 reading

Answer 2

85%

Question 3

Opioid toxicity toxidrome

Answer 3

Respiratory and mental status depression, analgesia, miosis, orthostatic hypotension, nausea and vomiting (especially in opioid-naïve patients), histamine release resulting in localized urticaria and bronchospasm, ileus, and urinary retention secondary to increased vesical sphincter tone.

Question 4

Naloxone onset

Answer 4

1-2 minutes

Question 5

Naloxone duration of action

Answer 5

20-90 minutes

Question 6

Naloxone dosing

Answer 6

• * mild decrease LOC, minimal resp depression: 0.05-0.4 mg IV increments
  * apnea/near-apnea/cyanosis: 2 mg IV —> 4 mg IV —> 8 mg IV Q3min, max 12 mg if no response
  * infusion (if responded to bolus, and required repeat dosing): 2/3 of “wake-up dose” per hour

Question 7

Opioid withdrawal syndrome

Answer 7

• Hours: anxiety, yawning, craving, lacrimation, rhinorrhea, diaphoresis, myalgias
• 12 hours: irritability, tremor, piloerection, mydriasis
• 24-36 hours: insomnia, muscle spasms, abdo pain, nxvxdx
• peak on day 3, resolve by day 5/6

Question 8

Opioid withdrawal treatment

Answer 8

• see Evernote “Opioid Overdose”

Question 9

ETOH Withdrawal, Delerium Tremens

Answer 9

Read Evernote “ETOH”

Question 10

Acetaminophen Toxicity

Answer 10

Review Evernote

Question 11

Isoniazid Overdose

Answer 11

• nx, LOC, ataxia
• seizures, metabolic acidosis, protracted coma
• seizures refractory to usual therapy, occur from vitamin B6 (pyridoxine) depletion
  
  • tx with benzo’s +
  • pyridoxine (gram for gram equivalent to isoniazid ingested)
    
    • for unknown, give 5 g IV (70 mg/kg peds) @ 1 g Q2-3 min until sz stop or 5 g dose reached
      
      • after sz stop give rest of dose over 4-6 hours

Question 12

Anticholinergic Toxidrome

Answer 12

• Dry as a bone
• Red as a beet
• Hot as a hare
• Blind as a bat
• dilated pupils may not appear for 12-24h
• Mad as a hatter
• Stuffed as a pipe

Question 13

Anticholinergic Toxicity

Answer 13

Review Evernote

Question 14

Anticonvulsant Overdose

Answer 14

Review Evernote

Question 15

Antihypertensive Overdose

Answer 15

Review Evernote

Question 16

Neuroleptic Malignant Syndrome Tetrad

How to differentiate from Serotonin Syndrome

Answer 16

• usually shortly after starting/adjusting dose
• not usually from OD
• tetrad
  
  • fever
  • lead-pipe/cogwheel rigidity
  • autonomic dysfunction
  • altered LOC
  • develops over 1-3 days
• *NMS vs SS
  
  • SS usually no multiorgan failure
  • NMS usually no diarrhea, myoclonus, hyperreflexia, or mydriasis

Question 17

Antipsychotic Overdose/Side-effects

Answer 17

Review Evernote

Question 18

Benzo Overdose

Answer 18

Review Evernote

Question 19

Beta Blocker Overdose

Answer 19

Review Evernote

Question 20

Calcium Channel Blocker Overdose

Answer 20

Review Evernote

Question 21

Caustic Ingestions

Answer 21

Review Evernote

Question 22

Cocaine/Amphetamine Overdose

Answer 22

Review Evernote

Question 23

Cyclinc Antidepressant Overdose

Answer 23

Review Evernote

Question 24

Digitalis Toxicity

Answer 24

Review Evernote

Question 25

Dyshemoglobinemias

Answer 25

Review Evernote

Question 26

Gastric Lavage

Answer 26

* 36-40F adult * 22-24F children * OG insertion from chin to xiphoid * Left lateral decubitus, HOB tilted down 20 degrees * Small amounts 200-300 mL adult, 10 mL/kg children to avoid pushing into duodenum * Warm/room temp saline or tap water * Continue until clear * Instill charcoal if indicated, before removing tube * Usually only helpful within 1 h ingestion of life-threatening toxins

Question 27

Dose of Activated Charcoal

Answer 27

* Benefit within 1 h of ingestion, but possibly longer * Dose is 10:1 ratio of charcoal to drug or 1 g/kg, whichever is larger * Multidose: for substances that have prolonger absorption. 1 g/kg then 0.25-0.50 g/kg x 1-3 times Q 1-4 hours

Question 28

Whole Bowel Irrigation

Answer 28

* PEG through NG or PO 1.5-2 L/h adult, 1L/h children 6-12, 0.5 L/h children \<6 until clear rectal effluent. * May be useful for toxic substances not known to adsorb well to charcoal. No evidence. * Give Zofran or Maxeran to relieve nausea from gastric distension

Question 29

Urinary Alkalanization

Answer 29

* Common: ASA, phenobarb * correct hypo K+ * 1-2 mEq/kg sodium bicarb IV bolus over 1 hour * may need to repeat * infusion of 100 mEq bicarb/1L D5W @ 250 mL/h * add 20-40 K+ to solution as needed * Check urine pH q15-30 min, target 7.5-8.5 * check lytes Q 2-4h * Keep serum pH \<7.55, correct hypokalemia

Question 30

Hallucinogen Overdose

Answer 30

Review Evernote

Question 31

Hydrocarbon Toxicity

Answer 31

Review Evernote

Question 32

Industrial Toxin Overdose

Answer 32

Review Evernote

Question 33

Iron Overdose

Answer 33

Review Evernote

Question 34

Lithium Overdose

Answer 34

Review Evernote

Question 35

Marine & Diving Injuries

Answer 35

Review Evernote

Question 36

Metals & Metalloid Overdose

Answer 36

Review Evernote

Question 37

MAOI Overdose

Answer 37

Review Evernote

Question 38

NSAID Overdose

Answer 38

Review Evernote

Question 39

Cholinergic Syndrome

Answer 39

* **D**efecation * **U**rination * **M**uslcle weakness/fasciculations, miosis * **B**radycardia, bronchorrhea, bronchospasm * **E**mesis * **L**acrimation * **S**alivation, seizures

Question 40

Pesticide Poisoning

Answer 40

See Evernote

Question 41

Salicylate Overdose

Answer 41

Review Evernote

Question 42

SSRI & Atypical Antidepressant Overdose

Answer 42

Review Evernote

Question 43

Elimination rate of ETOH, legal limit

Answer 43

* legal limit = 17 mmol/L * Zero Order elimination * ~4 mmol/L/h in naive to 6 mmol/L/h in habituated drinkers

Question 44

Toxic Alcohol Poisoning

Answer 44

Review Evernote

Question 45

Antibioticl Overdose/Toxicity

Answer 45

Review Evernote

Question 46

Carbon Monoxide Poisoning

Answer 46

Review Evernote