Studied by 2 people
"COINS" mnemonic:
(radiopaque on XR)
Calcium, Chlorinated hydrocarbons
Opium packets
Iron, other heavy metals
Neuroleptic agents (lithium, TCAs)
Sustain release or enteric coated agents (ASA/salicylates)
"HOBBIES" mnemonic:
(agents that cause hypoglycemia)
Hypoglycemic Oral agents
BBs
Insulin
Ethanol
Salicylates
"ME PIE" mnemonic:
(agents that cause inc. osmolar gap)
Methanol (adhesives, paints)
Ethanol
Propylene glycol (cosmetics)
Isopropyl alcohol (rubbing alcohol)
Ethylene glycol (antifreeze)
"MUDPILES" mnemonic:
(Agents that can inc. anion gap)
Methanol
Uremia
DKA
Phenols
Iron/INH
Lactate
Ethanol/ethylene glycol
Salicylates
An osmolar gap > _____ indicates unknown osmolar ingestion
10
High anion gap = anion gap > _____
12
What is the MC agent that causes an increased osmolar gap?
Ethanol
"DONT" mnemonic:
(Approach to unknown toxin exposure)
Dextrose
Oxygen
Naloxone
Thiamine
HR "FAST" mnemonic
(Substances that cause tachy)
Freebase cocaine
Anticholinergics
Sympathomimetics
Theophylline
HR "PACED" (slow) mnemonic:
(substances that cause brady)
Propranolol
Anticholinesterase drugs
Clonidine
Ethanol
Digoxin
"AAAS" mnemonic:
(Substances that cause mydriasis)
Antihistamine
Antidepressants
Anticholinergics
Sympathomimetics
"COPS" mnemonic:
(Substances that cause miosis)
Cholinergic, Clonidine
Opiates, Organophosphate
Phenothiazine, Pilocarpine
Sedatives (barbiturates)
"SOAP" mnemonic:
(Substances that cause diaphoresis)
Sympathomimetics
Organophosphates
ASA
PCP, Phencyclidine
Antidote for:
Acetaminophen
N-acetylcysteine
Antidote for:
Iron
IV Deferoxamine
Antidote for:
Pesticides
Atropine
Antidote for:
Narcotics
Naloxone (Narcan)
Antidote for:
Warfarin
Vitamin K
Antidote for:
Carbon monoxide
O2 by high flow mask immediately, Hyperbaric oxygen
Antidote for:
Cyanide
Cyanide antidote kit
Antidote for:
Benzodiazepines
Flumazenil
What is the MC agent for GI decontamination agent?
Activated charcoal
What is a non-prescription emetic that causes vomiting for 1-2 hours?
Ipecac
What are contraindications to activated charcoal?
Hydrocarbons, Corrosives, Ileus, Compromised airway
What are complications to activated charcoal?
Pulmonary aspiration, Emesis, Constipation
Gastric lavage can only be used how soon after a life-threatening ingestion?
3-60 minutes
What are complications of gastric lavage?
Pulmonary aspiration
What are contraindications to gastric lavage?
Hydrocarbons, Acids, Alkalis, Sharp ingestions, AMS
What agents are cathartics that decrease GI transit time?
Sorbitol, Magnesium citrate
What cathartic is commonly mixed with charcoal?
Sorbitol
What is the MC used analgesic in children?
Acetaminophen
What is the minimal toxic acetaminophen dose for a child?
150 mg/kg
What is the minimal toxic acetaminophen dose for an adult?
7.5 grams
When is a referral to ED warranted in an Acetaminophen OD?
200 mg/kg OR 10 g (whichever is less) is ingested
What occurs 0-24 hours after acetaminophen overdose?
GI irritation (N/V, normal LFTs)
What occurs 24-72 hours after acetaminophen overdose?
Latent period- asymptomatic, RUQ pain, LFTs may inc
What occurs 72-96 hours after acetaminophen overdose?
Hepatic failure -peak sx, AST > 20,000, prolong PT, death or coagulopathy
When does recovery or death of acetaminophen overdose occur?
4-14 days
When working up an Acetaminophen OD how often should you measure APAP levels?
4 hours from the last dose
When does peak acetaminophen concentration occur?
4 hours post-ingestion
When can activated charcoal be used for acetaminophen overdose?
within 4 of potentially toxic ingestion
When is Mucomyst (NAC) indicated for APAP OD?
- levels above the probable toxicity line
- suspected ingestion >150 mg/kg or 7.5 g regardless of wt in a pt whom APAP levels won’t be avail until > 8hrs post ingestion
**if time of ingestion is unknown or chronic consult toxicologist
What level of Ibuprofen indicates serious toxicity and death?
> 400 mg/kg
What is the tx for Ibuprofen overdose?
Activated charcoal, supportive care
What are anticholinergic agents?
Diphenhydramine, TCAs, Atropine, OTC antispasmodics, Mushrooms, Jimson weed, Deadly nightshade/Belladonna
When can asymptomatic patients with anticholinergic toxicity be observed and discharged?
sx free for 6 hours
What is the tx for anticholinergic toxicity?
Activated charcoal, Benzodiazepines
When can you use charcoal administration for Clonidine intoxication?
if ingested w/in 1-2 hours
What is the tx for Clonidine toxicity?
Atropine (bradycardia), Fluid bolus (hypotension), Dopamine (persistent hypotension)
When does Clonidine toxicity resolve?
w/in 24 hours
Cold medicines should not be used in what ages?
< 6 yo
What type of med is Guaifensesin?
Expectorant
What type of med is Pseudoephedrine & Phenylephrine?
Decongestant
What type of med is Dextromorphan?
Antitussive
What are the MC vitamins/herbs involved in toxicity?
Aloe, Echinacea, Garlic, St. John's Wort
What are the effects of iron toxicity?
corrosive to GI mucosa → N/V/D, abd pain
impairment of capillary permeability
mitochondrial cell dysfunction→ cellular death
direct vasodilation
Iron toxicity < _____ mg/kg = asymptomatic
20
Iron toxicity _____ mg/kg = moderate toxicity
20-60
Iron toxicity > _____ mg/kg = severe toxicity
60
What toxic stage would you expect 30 min-6 hours after iron ingestion?
GI stage
What toxic stage would you expect 6-12 hours after iron ingestion?
Stability
What toxic stage would you expect 12-72 hours after iron ingestion?
Systemic toxicity
What toxic stage would you expect 12-96 hours after iron ingestion?
Hepatic failure
What toxic stage would you expect 2-6 weeks after iron ingestion?
GI/Pyloric scarring
What is the tx for Iron toxicity?
IV Deferoxamine
What interventions should you NOT use in iron toxicity?
Ipecac, Activated charcoal, PO Bicarb, PO Deferoxamine
What are sx of Opiate poisoning?
Respiratory & CNS depression + pinpoint pupils
When can activated charcoal be given for opiate poisoning?
if alert and given within 1 hour of ingestion
What electrolyte abnormalities are associated with Salicylate toxicity?
Metabolic acidosis + Respiratory alkalosis
What do Oil of wintergreen & Antidiarrheal products (Pepto-Bismol) contain?
Salicylates
What are early symptoms of salicylate poisoning?
Tinnitus, vertigo, N/V/D
Salicylate level < _______ mg/kg = mild symptoms
300
Salicylate level _______ mg/kg = moderate symptoms
300-500
Salicylate level > _______ mg/kg = severe symptoms
500
How often should serum salicylates levels should be monitored?
every 3-4 hours
What procedure should you AVOID with salicylate poisoning because it can worsen acidosis?
Intubation
What is the tx for Salicylate poisoning in children?
Activated charcoal
How soon do sx of TCA poisoning symptoms usually occurs?
w/in 2 hours; major complications w/in 6 hrs
What EKG findings are associated with TCA poisoning?
Widened QRS, Prolonged QT
What are sx of TCA poisoning?
lethargy, agitation, seizures, coma, CV effects (tachycardia, HTN or hypotension)
Mnemonic for TCA posioning sx:
TriC Antidepressants
Coma
Convulsions
Cardiac dysrhthymias (wide QRS/prolong QT)
Acidosis
What is the tx for TCA poisoning?
ABCs, sodium bicarbonate, IVFs, activated charcoal (if w/in 2hrs), benzos for seizures, ECG monitoring
What does intoxication of Marijuana cause?
Euphoria, time distortion, increased talking, auditory/visual enhancements
What does intoxication of Cocaine cause?
CNS & PNS stimulant, local anesthetic activity, potent vasoconstrictor, feelings of pleasure, power/strength, and alertness & confidence
What are AE of cocaine?
seizures, cerebral hemorrhage, hyperactive reflexes, dilated pupils, tachycardia, dysrhythmias, MI
What does intoxication of Amphetamines cause?
Delirium/psychosis, seizures/cerebral hemorrhage, tachy/dysrhythmia/MI, dental caries, skin irritation "picking"
What are AE of MDMA (ecstasy)?
seizures (secondary to hyponatremia), tachycardia, HTN, “water loading” sweating, hyperthermia, SIADH → hyponatremic dehydration
What does Ecstasy intoxication cause?
stimulant, hallucinogenic effects
What is the "Date rape" drug?
GHB
What does intoxication of GHB?
Hypotension & bradycardia, respiratory depression, hypothermia
What does intoxication of Hallucinogens (LSD, PCP, Jimson weed, Mescaline) cause?
Muscle rigidity, brisk reflexes, "out of body experience", disorientation
What does intoxication of Anabolic steroids cause?
Acne, blood clots, increased LFTs, severe mood swings, testicular atrophy, increased muscle mass
Carbon monoxide (CO) poisoning causes the dissociation curve to shift to the (left/right)
Left
What are sx of Carbon monoxide?
Cherry red skin, HA, dizziness, nausea, malaise, visual changes, weakness, syncope, vomiting, ataxia, seizures, coma and death
What is the tx for CO poisoning?
O2 by high flow mask immediately
Which agents are Alkali?
Oven and drain cleaners, Hair relaxer, Bleach, Automatic dishwasher detergent
What agents are acidic?
Toilet bowl/grout cleaner, Rust remover, Metal cleaners
Alkali or Acidic:
Tasteless, Liquefaction necrosis --> mucosal perforation
Alkali
Alkali or Acidic:
Bitter, Coagulation necrosis --> superficial injury, Thick eschar formation
Acidic
What are sx of caustic ingestion?
drooling, refusal to drink, dysphagia
