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These drugs/classes cause miosis
- COPS
- Cholinergics, clonidine
- Opiates, organophosphates
- Phencyclidine, phenothiazine, pilocarpine
- Sedatives (barbiturates)
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These drugs/classes cause mydriasis
- AAAS
- Anticholinergics (atropine)
- Antihistamines
- Antidepressants (cyclic)
- Simpathomimetics (amphetamine, cocaine, LSD)
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These drugs/classes cause diaphoresis
- SOAP (if you're sweaty you need to SOAP up)
- Simpathomimetics
- Organophosphates
- Aspirin (salicylates)
- PCP
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Causes of blue skin
- methemoglobinemia
- cyanosis
-
Activated charcoal is ineffective or contraindicated in the following
- CHEMICAL CamP
- Caustics
- Hydrocarbons (and most water soluble compounds)
- Electrolytes
- Metals
- Iron
- Cyanide
- Alcohols
- Lithium
- Camphor
- Phosphorus
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How do you treat acetaminophen ingestion?
- activated charcoal
- check APAP level 4 hours after ingestion
- compare to Rumack-Matthew nomogram
- if toxicity possible, IV NAC or PO acetylcysteine within 8 hours of ingestion
- follow AST/ALT/PT/PTT (not APAP levels)
- consider coingestions
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Signs/symptoms of anticholinergic ingestion
- dry as a bone (decreased sweating and urine output)
- red as a beet
- blind as a bat (mydriasis)
- mad as a hatter (agitation, seizure)
- hot as a hare (hyperthermia)
-
treatment of anticholinergic ingestion
- activated charcoal
- physostigmine is contraversial
-
treatment of carbamazapine ingestion
- activated charcoal and supportive care
- ideally check levels 2-4 hours post ingestion
- follow levels and renal function (delayed peak 24-72 hours)
-
What does clonidine ingestion mimic?
How is it treated?
- Mimics opioid toxicity
- activated charcoal and whole bowel irrigation
- Serial ECGs and blood gases to dictate supportive measures
- resolves in 24 hours
-
what doses of ibuprofen are/aren't toxic?
treatement?
- <100mg/kg not toxic
- >400mg/kg causes seizures and coma
- Rx: activated charcoal and supportive care
-
toxic dose of iron
stages of toxicity
treatment
- >60mg/kg of elemental iron is severe
- 1. GI stage (30min-6hr)
- 2. stability (6-24hr)
- 3. systemic toxicity (w/in 48 hours) (remember AG met acidosis)
- 4. hepoatotoxicity (2-3 days)
- 5. GI/pyloric scarring (2-6 weeks)
- treat levels greater than 500mcg/ml (drawn ideally at 4 hours) with IV deferoxamine
- PO deferoxamine and activated charcoal do not work
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How do you treat phenothiazine ingestion
What type of symptoms will be seen
- Activated charcoal
- All symptoms dose dependent
- mild: anticholinergic, disruption of CNS, temp, BP
- mod: cogwheel rigidity
- sev: cardiac conduction abnormalities
- Also dose dependent dystonic reaction
- Treat with IV/IM diphenhydramine
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What topical analgesic ingrediant can cause salicylate poisoning?
oil of wintergreen
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a few points on Dx and Rx of salicylate ingestion
- respiratory alkalosis
- AG met acidosis
- low glucose, low K, dehydration
- Ferric chloride plus any salicylate turns urine purple/brown
- activated charcoal (surgery if tablet bezoar)
- alkalinize urine with bicarb to enhance elimination
- consider dialysis
-
laboratory signs of theophylline ingestion and treatment
- hyperglycemia
- hypercalcemia
- hypokalemia
- hypophosphatemia
- met acidosis
- treat with repeated activated charcoal and consider dialysis
-
Pneumonic for tricyclic ingestion signs
- TriC A (CCCA)
- Coma
- Convulsions
- Cardiac dysrhythmias
- Acidosis
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Cardiac effects of tricyclics
- tachycardia, including VT
- hyper/hypotension
- widened QRS
- prolonged QT
-
Treatment of TCA ingestion
- NaHCO3 to alkalinize serum/prevent dysrhythmias
- Lidocaine if dysrhythmias occur
- Activated charcoal
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symptoms of CO poisoning and clinical actions
- headache, malaise, nausea
- cherry red skin/lips
- check serum CO because pulse ox can be falsely normal
-
Triad seen in methanol ingestion
treatment
- visual complaints (snowstorm)
- abdominal pain
- metabolic acidosis (high AG without lactica acidosis or ketonuria)
- Rx: NaCO3, ethanol or fomepizole (to competitively inhibit alcohol dehydrogenase), folate (for formic acid metabolism), dialysis if needed.
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What is ethylene glycol metabolized to?
glycolic and oxalic acids
oxalic acid chelates calcium leading to Ca-oxalate crystals in urine (urine may flouresce with Woods lamp)
-
signs/symptoms of ethylene glycol ingestion
- appears drunk: N/V, drowsiness, slurred speech
- AG met acidosis
- high osmolal gap
- possible hypocalcemia
-
Treatment for ethylene glycol ingestion
- IV ethanol or fomepizole (competitively inhibits alcohol dehydrogenase)
- thiamine and pyridoxine to shunt metabolism to less toxic metabolites
- hemodialysis if needed
- treat hypocalcemia if present
-
organophospate exposure signs/symptoms
(cholinesterase inhibiters --> cholinergic toxidrome)
- DUMBELS
- diarrhea
- urination
- miosis
- bronchospasm/bronchorrhea
- emesis
- lacrimation
- salivation
- (miosis + all bodily fluids)
-
confirmatory test and Rx for organophosphate poisoning
- decreased RBC cholinesterase activity confirms Dx (don't wait for test result)
- wear protective clothing
- decontaminate child
- ATROPINE
- Pralidoxime (2-PAM)
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