MGT of a poisoned px

What are the 4 key pillars of supportive care in poisoning?

Respiratory failure, hypotension, seizures, supraventricular disturbances

What is the most common cause of death in poisoned patients?

Respiratory failure

What is the mechanism of respiratory failure in poisoning?

CNS depression or muscle paralysis

What is the first step in managing a poisoned patient?

Assess airway, breathing, circulation (ABCs)

What is included in the 'coma cocktail'?

Dextrose, oxygen, naloxone, thiamine

Why is naloxone given in poisoning?

To reverse opioid-induced respiratory depression

Why is thiamine given before glucose?

Prevent Wernicke encephalopathy

What is the main goal of toxicokinetics?

Understand ADME of toxins

What does toxicodynamics describe?

Effects of toxin on body

What is volume of distribution?

Apparent volume drug occupies

What does large Vd indicate?

Extensive tissue distribution

What does small Vd indicate?

Drug confined to plasma

What is total clearance?

Renal + hepatic elimination

How does overdose affect absorption?

Delayed gastric emptying

How does overdose affect metabolism?

Enzyme saturation

What happens when protein binding is saturated?

Increased free drug

What kinetics do overdoses follow?

Zero-order kinetics

What is extended therapeutic action?

Toxic effects differ from therapeutic effects

Which drugs cause anticholinergic toxicity?

TCAs, antihistamines

What is the 'red as a beet' sign?

Anticholinergic toxidrome

What causes pinpoint pupils?

Opioids

What causes dilated pupils?

Sympathomimetics

What toxin causes nystagmus?

Phenytoin, barbiturates

What does bitter almond odor suggest?

Cyanide

What causes diaphoresis?

Organophosphates

What causes dry skin?

Anticholinergics

What indicates metabolic acidosis with high anion gap?

Toxin ingestion

What is the anion gap formula?

Na - (Cl + HCO3)

What toxins increase osmolar gap?

Methanol, ethanol

What is activated charcoal used for?

GI decontamination

What toxins are NOT bound by charcoal?

Metals, alcohols, cyanide

What is whole bowel irrigation used for?

Drug packets ingestion

What enhances toxin elimination?

Hemodialysis

Which toxins are dialyzable?

Methanol, lithium, salicylates

What is urinary alkalinization used for?

Salicylate poisoning

What is the main fatal complication of poisoning?

Respiratory depression

What causes cardiac toxicity in poisoning?

Arrhythmias

Which drug causes wide QRS?

TCAs

What antidote is used for TCA overdose?

Sodium bicarbonate

What is the toxidrome of opioids?

Miosis, respiratory depression

What is the toxidrome of sympathomimetics?

Tachycardia, hypertension

What is serotonin syndrome sign?

Clonus, hyperthermia

What is cholinergic toxidrome mnemonic?

DUMBELS

What antidote treats organophosphate poisoning?

Atropine and pralidoxime

What is the mechanism of cyanide toxicity?

Inhibits cytochrome oxidase

What antidote is used for cyanide?

Hydroxocobalamin

What does methanol metabolize into?

Formic acid

What does ethylene glycol metabolize into?

Oxalic acid

What antidote treats methanol poisoning?

Fomepizole

What is the role of ethanol in poisoning?

Competitive inhibition of alcohol dehydrogenase

What causes hypoxia without cyanosis?

Carbon monoxide

What is treatment for CO poisoning?

100% oxygen

What is first-line for seizures in poisoning?

Benzodiazepines

What is treatment for beta-blocker overdose?

Glucagon

What is treatment for calcium channel blocker overdose?

Calcium, insulin

What is antidote for digoxin toxicity?

Digoxin Fab

What causes hyperthermia in toxicity?

Sympathomimetics

What causes hypothermia?

CNS depressants

What is common cause of metabolic acidosis in poisoning?

Salicylates

What is aspirin toxicity mechanism?

Uncouples oxidative phosphorylation

What is treatment for salicylate toxicity?

Alkalinization, dialysis

What is acetaminophen toxicity mechanism?

NAPQI accumulation

What antidote treats acetaminophen overdose?

N-acetylcysteine

What is early sign of acetaminophen toxicity?

Elevated AST/ALT

What is delayed organ damage in poisoning?

Liver failure

What is key principle in poisoning?

Treat patient, not toxin

What are the 4 key pillars of supportive care in poisoning?

Respiratory failure, hypotension, seizures, supraventricular disturbances

What is the most common cause of death in poisoned patients?

Respiratory failure

What is the mechanism of respiratory failure in poisoning?

CNS depression or muscle paralysis

What is the first step in managing a poisoned patient?

Assess airway, breathing, circulation (ABCs)

What is included in the 'coma cocktail'?

Dextrose, oxygen, naloxone, thiamine

Why is naloxone given in poisoning?

To reverse opioid-induced respiratory depression

Why is thiamine given before glucose?

Prevent Wernicke encephalopathy

What is the main goal of toxicokinetics?

Understand ADME of toxins

What does toxicodynamics describe?

Effects of toxin on body

What is volume of distribution?

Apparent volume drug occupies

What does large Vd indicate?

Extensive tissue distribution

What does small Vd indicate?

Drug confined to plasma

What is total clearance?

Renal + hepatic elimination

How does overdose affect absorption?

Delayed gastric emptying

How does overdose affect metabolism?

Enzyme saturation

What happens when protein binding is saturated?

Increased free drug

What kinetics do overdoses follow?

Zero-order kinetics

What is extended therapeutic action?

Toxic effects differ from therapeutic effects

Which drugs cause anticholinergic toxicity?

TCAs, antihistamines

What is the 'red as a beet' sign?

Anticholinergic toxidrome

What causes pinpoint pupils?

Opioids

What causes dilated pupils?

Sympathomimetics

What toxin causes nystagmus?

Phenytoin, barbiturates

What does bitter almond odor suggest?

Cyanide

What causes diaphoresis?

Organophosphates

What causes dry skin?

Anticholinergics

What indicates metabolic acidosis with high anion gap?

Toxin ingestion

What is the anion gap formula?

Na - (Cl + HCO3)

What toxins increase osmolar gap?

Methanol, ethanol

What is activated charcoal used for?

GI decontamination

What toxins are NOT bound by charcoal?

Metals, alcohols, cyanide

What is whole bowel irrigation used for?

Drug packets ingestion

What enhances toxin elimination?

Hemodialysis

Which toxins are dialyzable?

Methanol, lithium, salicylates