Quiz 4

activated charcoal

This patient requires no decontamination; however — can be administered in the setting of diuretic poisoning if the conditions are right (alert, early presenter).

benign

Adverse effects from chronic use or misuse (in sports or dieting) of diuretics is more common than acute poisoning. Overdoses are usually — and serious outcomes have not been reported.

• Dehydration

• Electroylte imbalance

• Hypokalemia

• Hypomagnesemia

• Hyponatremia

• Hypercalcemia

The major complications associated with diuretic overdose include

Diuretic overdose

Various dysrhythmias, weakness, hyporeflexia, tetany and lethergy may ensue if the electrolyte abnormalities are severe in what type of overdose?

• Nausea, vomiting and diarrhea are common after an acute overdose.

• An unusual complication which may occur is CNS depression.

True

True or false

• There are no antidotes for diuretic poisoning. Management should focus on stabilization of the airway, breathing and circulation. Particular attention should be paid to fluid and electrolyte correction.

• hypertonic saline

• osmotic demyelination syndrome

Furosemide overdose

• Rapid correction of hyponatremia in patients with seizure and coma can be performed with —;

• however correction of hyponatremia should be cautious in chronic abusers to avoid —

Clonidine

It is a centrally acting alpha-2 adrenergic receptor agonist. Stimulation of these receptors in the rostral ventrolateral medulla leads to decreased sympathetic outflow as manifested by reduced plasma norepinephrine.

• central nervous system depression

• bradycardia

• hypotension

• respiratory depression

• miosis

Overdose with clonidine may be life-threatening. The classic toxidrome includes —

opioid intoxication

Clonidine poisoninig

• Altered mental status is the most common finding. Other findings can include hypotonia, hyporeflexia, pallor, dry mucous membranes and hypothermia. These findings can mimic — and make distinction between the two conditions difficult

• Activated charcoal

Clonidine poisoning

• — is recommended to adsorb clonidine when the conditions are appropriate; however this patient does not have a secure airway at this time. It is recommended for use up to two hours post ingestion

naloxone

Clonidine poisoning

• No true antidote for clonidine poisoning exists; however — has been used with varying success.

• intravenous fluids

• Trendelenburg positioning

Clonidine poisoning

• Hypotension usually occurs within one to three hours after the ingestion and may persist for 24 hours. Initial therapy should include —.

• atropine

• Dopamine

Clonidine poisoning

• Bradycardia is usually mild but may respond to —.

• — may be beneficial if hypotension fails to respond to any of the previous

respiratory depression

The — seen in clonidine overdose may respond transiently to tactile stimulation and is one of the features of this condition that may distinguish it from opioid overdose.

• 2.5

• 5

• 7.5 mg

Clonidine patch preparations contain total doses of —, threefourths of which may remain after seven days of use.

• Hypotension

• Hyperkalemia

• Cough

• Rash angioedema

• Diarrhea

• Glomerulopathy

Overdoses of ACE inhibitors rarely produce severe toxicity. Symptoms of poisoning can include

• supine

ACE Inhibitor

• The hypotension should be managed with — positioning, intravenous fluids. Vasopressors are rarely required.

2-methyl propranolol-L-proline

All of the ACE inhibitors have a common — moiety which blocks the active site of angiotensin converting enzyme

• Nausea and vomiting

• Seizures

• Abdominal pain

• Generalized weakness

• Hepatorenal failure

Gyromitra esculenta

• The signs and symptoms of gyrometra esculenta poisoning begin approximately six to ten hours after ingestion and include —

• CNS

Gyromitra esculenta poisoning

• The primary site of toxicity is the —.

Pyridoxine 25 mg/kg

Hyromitra esculenta poisoning

• The mortality for this type of ingestion is 15-40%. What is the antidote for seizures?

Gyromitra esculenta

This particular mushroom, also known as the “false morel,” is unusual in that it is edible in the western United States, but poisonous in other areas. Certain cooking methods may eliminate the toxin, but inhalation of the fumes may result in poisoning.

• gyromitrin

• hydralazine

• pyridoxine

• pyridoxal phosphate-related

Gyromitra esculenta poisoning

• These types of mushrooms contain —, which through a variety of chemical reactions yields a — moiety. This moiety reacts with —, which results in inhibition of — enzymatic reactions.

Strychnos nux vomica

Strychnine is a naturally occurring chemical derived from the seeds inside the fruit of the tree —, also known as the Strychnine tree. It was first used as a rodenticide in 16th century Germany

• indigestion and constipation

Strychnine

• Medical uses in the United States included treatment of —; however due to the number of fatalities that resulted from its use, it was discontinued from over-thecounter medications in 1962.

• ten to 20 minutes

Strychnine poisoninig

• The signs and symptoms of strychnine poisoning usually occur within — of ingestion, but can be delayed if absorption occurs by another route (inhalation, injection, transdermal)

• Muscle twitching

• Extensor spasm

• Opisthotonus

Strychnine poisoninig

• Prodromal symptoms can include mydriasis, hypervigilance, anxiety, hyperreflexia, clonus, and stiffness of the facial and neck muscles. Later, CNS stimulatory effects, including — can occur, mimicking generalized tonic clonic seizure activity

Strychnine poisoning

Apparent seizure activity in what poisoning can be differentiated in that the patient retains a normal level of consciousness during the episode and lacks the characteristic post ictal period associated with true seizures.

generalized tetanus

Strychnine poisoning is the clinical condition that most closely mimics —.

• five hours

• Hyperthermia, severe lactic acidosis, rhabdomyolysis, compartment syndrome

Strychnine poisoning

• Prognosis is favorable if the patient survives the initial — of symptoms; however what states can occur

• rocuronium

Strychnine poisoninig

• Early interventions include skin decontamination and control of airway, breathing and circulation. Some sources suggest that non-depolarizing muscle relaxants, such as —, should be used preferentially to avoid the transient increased muscle tone associated succinylcholine.

• benzodiazepines

• phenobarbital

Any manipulation may trigger opisthotonos or muscle spasm activity; therefore, it is important to keep the patient in a calm environment. The extensor spasm, opisthotonos and seizures may be initially controlled with high-dose —, but may require —.

glycine

Strychnine competitively antagonizes —, an inhibitory neurotransmitter in the central nervous system, at the postsynaptic spinal cord motor neuron. There, it prevents the inhibitory mechanisms, leading to fierce muscle contractions.

Ciguatera

— fish poisoning is most common in the spring or summer and accounts for more than half of the fish-related food poisoning in the United States. It is commonly reported in Hawaii and Florida (90% of all cases)

• Gyromitra esculenta

• Ciguatera fish

What poisoning calls for public health notification

Ciguatera poisoning

Intravenous access should be obtained and attention paid to volume resuscitation and electrolyte repletion. Some series suggest that intravenous mannitol, if given within the first 48 hours, may be associated with a decrease in neurologic and muscular dysfunction;

What poisoning is this

• 72 hours

Iguatera poisoning

• Neurologic symptoms can occur as early as three hours after ingestion but onset can be delayed for as long as —.

reversal of temperature discrimination

A unique manifestation of ciguatera poisoning is — and is highly suggestive of ciguatera fish as the source of the illness.

• Heart block, hypotension, bradycardia and orthostatic hypotension have also been reported.

• Baraccuda

• Sea bass

• Parrot fish

• Red snapper

• Grouper

What large fishes become vectors of ciguatera poisoning after they ingest dinoflagellates that produce the toxin (either directly or via the consumption of smaller fish)?

True

True or false

• Because ciguatoxin is a heat-stable, acid resistant neurotoxin, there are no food preparation strategies (such as cooking, freezing, etc.) that will decrease transmission. Fish seem to be unaffected after consuming this toxin. There are also no physical characteristics of raw or cooked fish (such as unusual smell, taste, texture, color change, etc.) that might warn a person that it has been infected.

• Fish

• Nuts

• Alcohol

• Caffeine

One classic feature of ciguatera is return or worsening of symptoms after ingestion of —, which can recur for six months after poisoning. Patients should be counseled to refrain from consuming these things for six months. Additionally, symptoms associated with future attacks of ciguatera may be more severe.