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ABIM NEP Intoxicants & Poisonings

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