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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
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