Poisoning

Acetaminophen overdoseo Obtain level after 4 hrs of ingestion (can only be made after this time) o Administer N-acetylcysteine 8 hrs after ingestion

Ethylene glycol poisoning / Methanol o Metabolites such as glycolic acid injure the renal tubules while oxalic

acid binds calcium hypocalcemia and calcium oxalate crystal deposition in the kidneys

Develop flank pain, hematuria, oliguria, acute renal failure, anion gap metabolic acidosis

o Treatment: fomepizole/ ethanol to achieve ADH inhibition Methanol poisoning vs Ethylene glycol

o Methanol causes vision loss/ coma/ blurred vision/ epigastric pain/ vomiting/ hyperemic optic disc

Cyanide poisoning o Burning of rubber/ plastico Bitter almond breath (characteristic)

Methemoglobinemia o CO poisoning o Cyanosis and bluish discoloration of skin and mucous membranes

CO poisoning o Headache, nausea, abdominal discomforto Pinkish-red skin hue confirm by carboxyhemoglobin level

TCA overdoseo Sodium bicarbonate narrows the QRS complex preventing the

development of arrhythmia by alleviating the cardio-depressant action on sodium channels

o Causes dilated pupils, flushed and dry skin, intestinal ileuso QRS prolongation ventricular arrhythmia

Lithium toxicity- tremor/hyperreflexia/ ataxia/ seizures Opioid intoxication – respiratory depression/ miosis Phenytoin toxicity – horizontal nystagmus/ cerebellar ataxia/ confusion Diphenhydramine overdose anti-histamine effects including drowsiness/

confusion/ anticholinergic effects (dry mouth/ dilated pupils/ blurred vision/ reduced bowel sounds/ urinary retention)

o Treatment: Physostigmine (cholinesterase inhibitor) Iye ingestion

o Occurs instantaneously and effects esophagus (liquefactive necrosis) o Efforts to neutralize the alkali, induce vomiting/ administer charcoal

do not improve outcomes o Early upper GI contrast study / endoscopy – critical for evaluating

damage Acute iron intoxication

o 5 phases GI phase: occurs 30 mins to 6 hrs after ingestion direct

mucosal damage Patients experience nausea/vomiting/hematemesis/

melena/ abdominal pain Latent phase occurs 6-24 hrs- asymptomatic 6-72 hrs post – shock and metabolic acidosis hepatoxicity occurs 12-96 hrs bowel obstruction secondary to mucosal scarring develop

several weeks post-ingestion o check serum iron concentration (levels >or equal 350 mcg/dL)

Organophosphate poisoning o Bradycardia/ miosis/ bronchorrhea/ muscle fasciculations/

salivation/ lacrimation/ diarrhea/ urination o Counteract effects atropine o *equal importance immediate removal of the patient’s clothing to

prevent continued absorption of organophosphates through the skin PCP intoxication

o Vertical nystagmuso Dissociative feelings/ psychotic and violent behavior/ severe HTN/

hyperthermia Acute iron poisoning

o Pre-natal vitamins radiopaque tablets on xray o Abdominal pain/ hematemesis/ hypovolemic shock/ metabolic

acidosis o Treatment: deferoxamine (binds ferric iron)

Caustic poisoningo Damage of tissue lining the GI tract (necrosis/ edema/ scarring/

severe pain) o White tongue, heavy salivation, dysphagia o Severe esophageal and stomach ulceration may also occur

peritonitis/ mediastinitis o Does not cause alteration in consciousness

Beta blocker overdoseo AV block/ bradycardia/ hypotension/ wheezing/ cardiogenic shock o Atropine and IV fluids first line of therapyo If not reversed glucagon

Antipsychoticso Fluphenzaine – high potency

Occasionally can cause hypothermia by disrupting thermoregulation and body’s shivering mechanism

Patients should be advised to avoid prolonged exposure to extreme temperatures

Marijuana intoxication

o Slowed reaction time, impaired short term memory, increased appetite

o Conjunctival injection/ dry mouth/ HTN/ tachycardia