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ABIM NEP INTOXICANTS
ABIM NEP Intoxicants & Poisonings
| Question | Answer |
|---|---|
| Initial eval of pt with suspected intoxication/poisoning? | ABG, co-oximetry carboxyhemoglobin & methemoglobinemia, lytes (need AG), lactate and ketone levels, serum osmolality, tox screen |
| Charcoal lavage is useful for? | salicylates, phenobarbital, Theophylline, digoxin, phenytoin, carbamazepine, SR meds, drugs and slow G.I. motility (anti-cholinergics)… NOT for TCA. |
| Alkalinizing urine help intoxication by? | Best for salicylate and barbiturates. Promotes elimination of weak acid. Usu done with forced diuresis resulting in higher urine flow rate and reduced drug concentration that lowers gradient for reabsorption. |
| Useful antidote for acetaminophen? | - n-acetylcysteine |
| Useful antidote for carbon monoxide? | hyperbaric oxygen |
| Useful antidote for cyanide? | sodium thiosulfate |
| Useful antidote for digoxin? | Fab fragment |
| Useful antidote for methanol or ethylene glycol? | |
| Useful antidote for benzodiazepines? | flumazenil |
| Useful antidote for opiates? | naloxone |
| RRT vs HD for drug clearance? | HD is first line d/t higher clearance, but often us CRRT later to prevent rebound. |
| When is plasma exchange useful for drug clearance? | remove toxins from plasma only: amanita mushroom, digoxin, snake venom, cisplatin, biologics, cholinesterase with organophosphate poisoning. BUT does not affect acid-base or lytes. |
| Indications for dialysis in Lithium intoxication? | level > 4mmol/L; < 4 assoc w/ severe CNS symptoms, Low GFR, hemodynamic instability, level not falling in 12 hours. Level < 2.5 requires HD if lithium level rising for ESRD. |
| Dialysis prescription for lithium intoxication? | HD x 4 hrs (use pressers if needed), expect rebound and either dialyze again or start CRRT |
| Changes in the putamen assoc with _______ intoxication? | methanol |
| Renal effects of long term anabolic steroids? | FSGS |
| Drug associated with ANCA-vasculitis? | cocaine cut w levamisole. (usu MPO-ANCA ++ but half also PR3 +). Often develop low level auto immune ag. |
| Metformin causes ___ acidosis. | type B lactic acidosis, pH usu 6.75 and LA lvl 19!. Biguanides cause LA by impairing hepatic mitochondrial fcn. |
| Treatment of metformin induced lactic acidosis? | Rapidly reversed with iHD then CRRT to prevent rebound. Poorly protein bound. Alkalinization + loop diuretic useful for mild cases. |
| treatment of dabigatran OD? | Idarucizumab (Praxbind) is specific reversal agent, humanized Fab fragment. iHD partially useful followed by CRRT to manage rebound.. |
| Melamine and the kidney | An organic nitrogenous compound deliberately added to milk to falsely elevate protein content, resulting in radiolucent stones, impaired renal function and growth |
| Environmental toxins causing albuminuria? | phthalates, bisphenol (BPA), dioxins, polychlorinated biphenyls (PCBs). |
| Toluene aka glue sniffing renal effects? | RTA, hypoK,hypophos, AKI, hematuria, sterile pyuria, proteinuria. |
Created by:
ka1usg
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