Toxicology Exam I

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Causes deformation of limbs

thalidomide
Accound for most serious/fatal poisoning

suicide attempts
% ICU admission and % psych admissions due to poison
- 5% ICU
- 30% psych
Key points of diagnosis
- history
- physical exam
- laboratory values
Initial focus on the exam
- vital signs
- cardiopulmonary assessment
- neurologic assessment
Consumption of acids leads to

coagulation necrosis
consumption of bases leads to

liquifaction necrosis
Elevated ALT is a sign of

liver damage
Elevated lactate dehydrogenase is a sign of

heart attack
Guidelines for management of acute poisoning
- airway management
- breathing management
- circulation management
- (ABC)
Activated charcoal
- treatment of choice for most ingestions
- most effective when given w/in the 1st hour
Contraindications to activated charcoal
- pt with altered conscious state
- ethanol/glycols
- alkalis
- acids
- petrolum distilates
Examples of drugs that have specific antidotes
- Benzodiazepines
- alcohol
- methamphetamines
Alkali poisons result in
- liquifaction necrosis
- significant GI ulceration
Alkaline poisons
- drain cleaners
- oven cleaners
- dishwashing liquids/powders
- detergents
- ammonia
- portland cement
Liquid alkali producst are more likely to cause_____ than powders

esophageal burns
Antihistamine poisoning
- cough and cold preperations
- paracetamol may be in products
Psychostimulants
- dexamphetamine
- methylphenidate
Recreational drugs
- amphetamine
- cocaine
- ecstacy
Assesment of antihistamine poisoning (symptoms present)
- drowsiness
- restlessness
- tachycardia
- palpitations
- hypertension
Ephedrine may cause
- hypertensive crisis
- cerebral hemorrhage
Poisoning with slow release products
- beware of delayed onset of poisoning
- pt may require repeated doses of activated charcoal
Asymptomatic antihistamine poisoning

does not require treatment if dose is <3x the normal daily dose
Symptomatic antihistamine poisoning

charcoal 1g/kg unless altered conscious state
Symptoms of benzodiazepine poisoning
- CNS depression
- drowsiness
- coma
- respiratory depression
- hypotension
Management of BZD overdose
- charcoal is not usually beneficial
- flumazenil is antidote
- depresssion state = call EMS
Ethanol poisoning fatality occurs with blood levels ____ or breath level of _____.
- >86.8 mmol/L
- >0.4
Highest ethanol containing product
- mehtylated spirits (95%)
- does not contain methanol
Symptoms of EtOH poisoning
- n/v
- abd. pain
- hypoglycemia
Ethanol poisoning management
- charcoal is no benefit
- check bg in younger children
Petroleum distillates

gases/oils/fuels/white spirit
Main complication with petroleum distillate poisoning
- aspiration pneumonitis
- risk of aspiration during vomiting outweighs any benefit from removal of the substance
- CNS toxicity may be evident
Symptoms of petroleum distillate poison
- coughing
- choking
- respiratory distress
management of petroleum distillate poisoning

charcoal is contraindicated
Salicylate poisoning may result from
- aspirin
- oil of wintergreen
symptoms of salicylate poisoning
- tinnitus
- vomiting
- hyperventilation
- respiratory alkalosis
Patients requiring treatment for salicylate poisoning
- acute ingestion 150mg/kg
- all symptomatic pt
- ingestion of unknown qty
Labs for salicylate poisoning
- initial serum salicylate then q2h if symptomatic or extended release product was injested
- urea
- electrolytes
- creatinine
- acid/base
- glucose
Management of salicylate poisoning

symptomatic pt require urgent medical assesment

Author

Rx2013

66541

Card Set

Toxicology Exam I

Description

clinical toxicolgoy

Updated

2011-02-15T22:55:19Z

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