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Toxicology /B

Miosis with clonidine, barbiturates, opiates, cholinergics, pontine stroke
Mydriasis with sympathomimetics, anticholinergics
Dry skin with anticholinergics
Wet skin with cholinergics, sympathomimetics
Blisters with barbiturates, carbon monoxide poisoning
Cholinergics/ Anticholinergics/ Sympatomimetics/ serotonine and Malignant Neuroleptic Syndrome prime presentations? Cholinergics: BM Sludge/ Anticholinergics: Hot-Crazy-Dry/ Sympathomimetics: Hot-Crazy-Wet/ Serotonine and MNS: Hot-Crazy-Rigid
Cholinergics features/ killers/ examples/ treatment? High acetylcholine: hollow end organ hypersecretion (water from all orifices)/ bradycardia and bronchospasm/ Pesticides (organophosphates), nerve gas (Sarin)/ Rx: atropine and pralidoxime
Mechanism of action of atropine in cholinergics management? competes at muscarinic sites to decrease acetylcholine activity
Mechanism of action of pralidoxime in cholinergics management? restores cholinesterase activity i.e. separates toxin from enzyme
Anticholinergics presentation? And treatment? Flushed, mydriatic, dry, hyperactive, agitated hallucinations + hot; symptomatic, physostigmine for severe cases
Anticholinergics causes? All anti's (antidepressants, antipsychotics, antihistamines, antiemetics, antispasmodics, antiparkinsonians; alkaloids, atropin, belladonna
How to differentiate anticholinergics from: sympathomimetics, MOAi/Li, serotonine syndrome, NMS and malignant hyperthermia? Sympathomimetics (sweaty); MAOi/Li (miosis); serotonin Sx (tremor), NMS/malignant hyperthermia (rigidity)
Sympathomimetics presentation and treatment? CNS excitation till seizures, sympathetic overactivity and diaphoresis and N/V; Rx: symptomatic
Serotonine syndrome presentation? All like sympathomimetics but with myoclonus muscle tremors and hyperreflexia
Causes of serotonine syndrome? SSRI , SNRI, TCA, MAOi, cough medicine and ecstasy (MDMA)
Mnemonics for toxicology: X-ray investigation (CHIPES); Charcoal not indicated (HEMI); Multidose charcoal (AABCD); Gastric lavage (FACT); Bowel irrigation (PM LIFE); Urine alkalinization (TARL); Hrmodialysis (HEMODYALIS)
Activated charcoal dose/ not indications/ contraindication? 10 g for 1 g toxin; < 1 hr not indicated for HEMI(HCs, Ethanol and other alcoholes, Metals and Ions); C/ind in caustics, aspiration, ileus, perforation
Multidose activated charcoal indications? AABCD: Aminophylline (theophylline and ethylenediamine ) , Antimalarias, Barbiturates, Carbamazepine, Dapson (leprosy) ± digoxin
Whole bowel irrigation indication and compound used? PM LiFe; Packers, heavy Metals, Li and Fe; polyethelen glycole or Mg sulfate
Gastric lavage indications? FACT: Fe (and other metals), ASA, Colchicine, TCA
Urine alkalinization indication? Major ones are: TARL: TCA, ASA, Rhabdomyolysis, Lead
Emergency dialysis indication? HEMODIALYS: HTN; Electrolytes (K, H, Mg, Ca, …); Mediastinum (pericarditis); Overload (pulmonary edema); Drugs: INH, Alcohol, Lithium, theophYlline, Salicylates
Indications for CXR? CHIPES: Ca, chlorinated hydrocarbons, Heavy metals (lead, mercury), Iron, Iodine, Phenothiazines, potassium, Enteric coated pills, Solvents (halogenated)
Toxicity levels for iron, vit A, acetaminophen and ASA? Iron: 30 mg/kg (multivitamins contain 12 mg); Vit A: > 300,000 IU (multivitamins contain 3000 IU): increase ICP; Acetaminophen: 100 mg/kg (severe: 140 mg/kg); ASA: 200-300 mg/kg (45 tab)
Presentation may be with seizures: INH, TCA, anticholinergics, cholinergics, sympathomimetics, propranolol, stimulants, bupropion (anxiolytic and used for smoking quit)
Two common medications with no role in toxicology? Phenytoin in control of seizures as it is Na channel blocker; antipyretics as almos all hyperthermia are peripheral (muscle contractions) and not central
Methanol and ethelene glycole toxicity and treatment? Methanol: formic acid and direct retinal injury; EG: renal failure; Rx for both is fomepizole + thiamine and folic acid
Antidots for Thallium? Perussian blue
Mercury poisoning features? Mercurial behaviour (shy and then angry outbursts); Minamata disease (ataxia and tremor); toxicity: elemental via respiration and organic via ingestion
Tallium toxicity? painful ascending peripheral neuropathy, hair loss, Mee’s lines (also with arsenic and in renal failure)
Created by: Bijan39