poisonings.txt

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Author:
jmeglin
ID:
29041
Filename:
poisonings.txt
Updated:
2010-08-05 21:59:28
Tags:
Pediatric Boards ingestion poisonings
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Description:
Peds Board poisonings
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  1. These drugs/classes cause miosis
    • COPS
    • Cholinergics, clonidine
    • Opiates, organophosphates
    • Phencyclidine, phenothiazine, pilocarpine
    • Sedatives (barbiturates)
  2. These drugs/classes cause mydriasis
    • AAAS
    • Anticholinergics (atropine)
    • Antihistamines
    • Antidepressants (cyclic)
    • Simpathomimetics (amphetamine, cocaine, LSD)
  3. These drugs/classes cause diaphoresis
    • SOAP (if you're sweaty you need to SOAP up)
    • Simpathomimetics
    • Organophosphates
    • Aspirin (salicylates)
    • PCP
  4. Causes of red skin
    • CO
    • boric acid
  5. Causes of blue skin
    • methemoglobinemia
    • cyanosis
  6. Activated charcoal is ineffective or contraindicated in the following
    • CHEMICAL CamP
    • Caustics
    • Hydrocarbons (and most water soluble compounds)
    • Electrolytes
    • Metals
    • Iron
    • Cyanide
    • Alcohols
    • Lithium
    • Camphor
    • Phosphorus
  7. How do you treat acetaminophen ingestion?
    • activated charcoal
    • check APAP level 4 hours after ingestion
    • compare to Rumack-Matthew nomogram
    • if toxicity possible, IV NAC or PO acetylcysteine within 8 hours of ingestion
    • follow AST/ALT/PT/PTT (not APAP levels)
    • consider coingestions
  8. Signs/symptoms of anticholinergic ingestion
    • dry as a bone (decreased sweating and urine output)
    • red as a beet
    • blind as a bat (mydriasis)
    • mad as a hatter (agitation, seizure)
    • hot as a hare (hyperthermia)
  9. treatment of anticholinergic ingestion
    • activated charcoal
    • physostigmine is contraversial
  10. treatment of carbamazapine ingestion
    • activated charcoal and supportive care
    • ideally check levels 2-4 hours post ingestion
    • follow levels and renal function (delayed peak 24-72 hours)
  11. What does clonidine ingestion mimic?
    How is it treated?
    • Mimics opioid toxicity
    • activated charcoal and whole bowel irrigation
    • Serial ECGs and blood gases to dictate supportive measures
    • resolves in 24 hours
  12. what doses of ibuprofen are/aren't toxic?
    treatement?
    • <100mg/kg not toxic
    • >400mg/kg causes seizures and coma
    • Rx: activated charcoal and supportive care
  13. toxic dose of iron
    stages of toxicity
    treatment
    • >60mg/kg of elemental iron is severe
    • 1. GI stage (30min-6hr)
    • 2. stability (6-24hr)
    • 3. systemic toxicity (w/in 48 hours) (remember AG met acidosis)
    • 4. hepoatotoxicity (2-3 days)
    • 5. GI/pyloric scarring (2-6 weeks)
    • treat levels greater than 500mcg/ml (drawn ideally at 4 hours) with IV deferoxamine
    • PO deferoxamine and activated charcoal do not work
  14. How do you treat phenothiazine ingestion
    What type of symptoms will be seen
    • Activated charcoal
    • All symptoms dose dependent
    • mild: anticholinergic, disruption of CNS, temp, BP
    • mod: cogwheel rigidity
    • sev: cardiac conduction abnormalities
    • Also dose dependent dystonic reaction
    • Treat with IV/IM diphenhydramine
  15. What topical analgesic ingrediant can cause salicylate poisoning?
    oil of wintergreen
  16. a few points on Dx and Rx of salicylate ingestion
    • respiratory alkalosis
    • AG met acidosis
    • low glucose, low K, dehydration
    • Ferric chloride plus any salicylate turns urine purple/brown
    • activated charcoal (surgery if tablet bezoar)
    • alkalinize urine with bicarb to enhance elimination
    • consider dialysis
  17. laboratory signs of theophylline ingestion and treatment
    • hyperglycemia
    • hypercalcemia
    • hypokalemia
    • hypophosphatemia
    • met acidosis
    • treat with repeated activated charcoal and consider dialysis
  18. Pneumonic for tricyclic ingestion signs
    • TriC A (CCCA)
    • Coma
    • Convulsions
    • Cardiac dysrhythmias
    • Acidosis
  19. Cardiac effects of tricyclics
    • tachycardia, including VT
    • hyper/hypotension
    • widened QRS
    • prolonged QT
  20. Treatment of TCA ingestion
    • NaHCO3 to alkalinize serum/prevent dysrhythmias
    • Lidocaine if dysrhythmias occur
    • Activated charcoal
  21. symptoms of CO poisoning and clinical actions
    • headache, malaise, nausea
    • cherry red skin/lips
    • check serum CO because pulse ox can be falsely normal
  22. Triad seen in methanol ingestion
    treatment
    • visual complaints (snowstorm)
    • abdominal pain
    • metabolic acidosis (high AG without lactica acidosis or ketonuria)
    • Rx: NaCO3, ethanol or fomepizole (to competitively inhibit alcohol dehydrogenase), folate (for formic acid metabolism), dialysis if needed.
  23. What is ethylene glycol metabolized to?
    glycolic and oxalic acids

    oxalic acid chelates calcium leading to Ca-oxalate crystals in urine (urine may flouresce with Woods lamp)
  24. signs/symptoms of ethylene glycol ingestion
    • appears drunk: N/V, drowsiness, slurred speech
    • AG met acidosis
    • high osmolal gap
    • possible hypocalcemia
  25. Treatment for ethylene glycol ingestion
    • IV ethanol or fomepizole (competitively inhibits alcohol dehydrogenase)
    • thiamine and pyridoxine to shunt metabolism to less toxic metabolites
    • hemodialysis if needed
    • treat hypocalcemia if present
  26. organophospate exposure signs/symptoms
    (cholinesterase inhibiters --> cholinergic toxidrome)
    • DUMBELS
    • diarrhea
    • urination
    • miosis
    • bronchospasm/bronchorrhea
    • emesis
    • lacrimation
    • salivation
    • (miosis + all bodily fluids)
  27. confirmatory test and Rx for organophosphate poisoning
    • decreased RBC cholinesterase activity confirms Dx (don't wait for test result)
    • wear protective clothing
    • decontaminate child
    • ATROPINE
    • Pralidoxime (2-PAM)

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