Toxicology /B
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| Miosis with | clonidine, barbiturates, opiates, cholinergics, pontine stroke
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| Mydriasis with | sympathomimetics, anticholinergics
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| Dry skin with | anticholinergics
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| Wet skin with | cholinergics, sympathomimetics
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| Blisters with | barbiturates, carbon monoxide poisoning
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| 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
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| 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
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| Mechanism of action of atropine in cholinergics management? | competes at muscarinic sites to decrease acetylcholine activity
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| Mechanism of action of pralidoxime in cholinergics management? | restores cholinesterase activity i.e. separates toxin from enzyme
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| Anticholinergics presentation? And treatment? | Flushed, mydriatic, dry, hyperactive, agitated hallucinations + hot; symptomatic, physostigmine for severe cases
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| Anticholinergics causes? | All anti's (antidepressants, antipsychotics, antihistamines, antiemetics, antispasmodics, antiparkinsonians; alkaloids, atropin, belladonna
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| 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)
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| Sympathomimetics presentation and treatment? | CNS excitation till seizures, sympathetic overactivity and diaphoresis and N/V; Rx: symptomatic
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| Serotonine syndrome presentation? | All like sympathomimetics but with myoclonus muscle tremors and hyperreflexia
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| Causes of serotonine syndrome? | SSRI , SNRI, TCA, MAOi, cough medicine and ecstasy (MDMA)
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| 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)
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| 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
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| Multidose activated charcoal indications? | AABCD: Aminophylline (theophylline and ethylenediamine ) , Antimalarias, Barbiturates, Carbamazepine, Dapson (leprosy) ± digoxin
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| Whole bowel irrigation indication and compound used? | PM LiFe; Packers, heavy Metals, Li and Fe; polyethelen glycole or Mg sulfate
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| Gastric lavage indications? | FACT: Fe (and other metals), ASA, Colchicine, TCA
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| Urine alkalinization indication? | Major ones are: TARL: TCA, ASA, Rhabdomyolysis, Lead
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| Emergency dialysis indication? | HEMODIALYS: HTN; Electrolytes (K, H, Mg, Ca, …); Mediastinum (pericarditis); Overload (pulmonary edema); Drugs: INH, Alcohol, Lithium, theophYlline, Salicylates
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| Indications for CXR? | CHIPES: Ca, chlorinated hydrocarbons, Heavy metals (lead, mercury), Iron, Iodine, Phenothiazines, potassium, Enteric coated pills, Solvents (halogenated)
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| 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)
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| Presentation may be with seizures: | INH, TCA, anticholinergics, cholinergics, sympathomimetics, propranolol, stimulants, bupropion (anxiolytic and used for smoking quit)
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| 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
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| 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
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| Antidots for Thallium? | Perussian blue
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| Mercury poisoning features? | Mercurial behaviour (shy and then angry outbursts); Minamata disease (ataxia and tremor); toxicity: elemental via respiration and organic via ingestion
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| Tallium toxicity? | painful ascending peripheral neuropathy, hair loss, Mee’s lines (also with arsenic and in renal failure)
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