Rosh Tox
Dose of NAC - ANS-Loading dose 140 mg/kg PO
70 mg/kg PO Q4h for 17 doses
Indication for NAC - ANS-Serum APAP level at or above 150 at 4 hours post ingestion
AMS
Unclear history
Indications for hyperbaric O2 in CO poisoning - ANS-Syncope, AMS, seizures, coma,
focal neuro deficit, COHb >15% in pregnancy, COHb >25% in other patients
Evidence of end organ damage
Risk factors for poor outcome in CO poisoning - ANS-<6 mo old
Pregnant
>60yo old
CAD
First line Treatment of anticholinergic toxicity - ANS-sodium bicarb
Treatment for agitation in anticholinergic toxicity - ANS-Physostigmine (if no QRS
widening)
Presentation of Isopropyl alcohol - ANS-Nausea and vomiting
CNS effects inebriation to coma
Tachycardia common
Hypotension rare
Metabolic derangements in isopropyl alcohol ingestion - ANS-Osmolar gap
Ketosis
No metabolic acidosis
Treatment of isopropyl alcohol ingestion - ANS-Supportive care
Dextromethorphan toxic ingestion - ANS-AMS
Dilated pupils
Rotary nystagmus
Tachycardia
Opioid with similar structure to PCP, less respiratory depression
, What toxidrome can dextromethorphan precipitate? - ANS-serotonin syndrome
Hydrocarbon toxicity - ANS-Mild CNS depression
Coughing can lead to aspiration and hydrocarbon pneumonitis
Hydrocarbon pneumonitis - ANS-Mild symptoms or progress rapidly to ARDS
Bilateraly patchy infiltrates on CXR within 6 hours
Treatment is supportive
What urinary abnormality found in antifreeze ingestion? - ANS-calcium oxalate crystals
in urine
Colchicine poisoning - ANS-1. severe GI distress, dehydration, leukocytosis
2. pancytopenia, multisystem organ failure, sudden cardiac death over next 1-7 days
Patients who survive colchicine poisoning may develop what? - ANS-Alopecia
Myopathy
Neuropathy
Metabolism of colchicine - ANS-liver and kidney
Renal or liver disease can potentiate toxicity at therapeutic doses
Clinical presentation of cyanide poisoning - ANS-Initial hypotension, bradycardia,
hyperventilation
dyspnea, LOC, seizures, cardiac dysrhythmias
Coma, cardiovascular collapse, death may occur immediately from high exposure
Sources of cyanide - ANS-Cyanide salt
Smoke inhalation
Manufacturing exposure (jewelry, fumigation pesticide control)
Food - cassava, prunis pits (apricots, peaches, bitter almond, cherry)
Cigarette smoke
Acetonitrile
Treatment of cyanide poisoning - ANS-hydroxocobalamin or
amyl nitrite and sodium thiosulfate
Indications for defuroxamine - ANS-Iron level >500 mcg/dL
Shock
Dose of NAC - ANS-Loading dose 140 mg/kg PO
70 mg/kg PO Q4h for 17 doses
Indication for NAC - ANS-Serum APAP level at or above 150 at 4 hours post ingestion
AMS
Unclear history
Indications for hyperbaric O2 in CO poisoning - ANS-Syncope, AMS, seizures, coma,
focal neuro deficit, COHb >15% in pregnancy, COHb >25% in other patients
Evidence of end organ damage
Risk factors for poor outcome in CO poisoning - ANS-<6 mo old
Pregnant
>60yo old
CAD
First line Treatment of anticholinergic toxicity - ANS-sodium bicarb
Treatment for agitation in anticholinergic toxicity - ANS-Physostigmine (if no QRS
widening)
Presentation of Isopropyl alcohol - ANS-Nausea and vomiting
CNS effects inebriation to coma
Tachycardia common
Hypotension rare
Metabolic derangements in isopropyl alcohol ingestion - ANS-Osmolar gap
Ketosis
No metabolic acidosis
Treatment of isopropyl alcohol ingestion - ANS-Supportive care
Dextromethorphan toxic ingestion - ANS-AMS
Dilated pupils
Rotary nystagmus
Tachycardia
Opioid with similar structure to PCP, less respiratory depression
, What toxidrome can dextromethorphan precipitate? - ANS-serotonin syndrome
Hydrocarbon toxicity - ANS-Mild CNS depression
Coughing can lead to aspiration and hydrocarbon pneumonitis
Hydrocarbon pneumonitis - ANS-Mild symptoms or progress rapidly to ARDS
Bilateraly patchy infiltrates on CXR within 6 hours
Treatment is supportive
What urinary abnormality found in antifreeze ingestion? - ANS-calcium oxalate crystals
in urine
Colchicine poisoning - ANS-1. severe GI distress, dehydration, leukocytosis
2. pancytopenia, multisystem organ failure, sudden cardiac death over next 1-7 days
Patients who survive colchicine poisoning may develop what? - ANS-Alopecia
Myopathy
Neuropathy
Metabolism of colchicine - ANS-liver and kidney
Renal or liver disease can potentiate toxicity at therapeutic doses
Clinical presentation of cyanide poisoning - ANS-Initial hypotension, bradycardia,
hyperventilation
dyspnea, LOC, seizures, cardiac dysrhythmias
Coma, cardiovascular collapse, death may occur immediately from high exposure
Sources of cyanide - ANS-Cyanide salt
Smoke inhalation
Manufacturing exposure (jewelry, fumigation pesticide control)
Food - cassava, prunis pits (apricots, peaches, bitter almond, cherry)
Cigarette smoke
Acetonitrile
Treatment of cyanide poisoning - ANS-hydroxocobalamin or
amyl nitrite and sodium thiosulfate
Indications for defuroxamine - ANS-Iron level >500 mcg/dL
Shock
