0071643192.pdf

TOXICOLOGY DIAGNOSIS ■ Usually obvious from patient’s history and exam ■ Serum levels are readily available in most EDs. ■ The c ...

TOXICOLOGY ■ Folate:Improves the metabolism of formic acid. ■ Urinary alkalinization: Improves renal clearance of formic acid. ■ ...

TOXICOLOGY Unlike methanol and ethylene glycol, isopropanol is notmetabolized to an organic acid. It is converted directly to ac ...

TOXICOLOGY Examples include: ■ Amitriptyline (Elavil) ■ Nortriptyline (Aventyl) ■ Imipramine (Tofranil) MECHANISM/TOXICITY TCAs ...

TOXICOLOGY ■ Seizuresare typically self-limited, but are associated with acidosis, which in turn worsens the Na++channel blockad ...

TOXICOLOGY ■ Benzodiazepines for seizures ■ Sodium bicarbonate is notindicated for seizures (seizures are not due to Na++channel ...

TOXICOLOGY ■ Benzodiazepines for agitation and seizures ■ Sodium bicarbonate for QRS widening >100 msec ■ Antidote = cyprohep ...

TOXICOLOGY ■ Sodium nitroprusside or phentolamine, if severely hypertensive ■ Avoid: ■ β-Blockers (→unopposedα-adrenergic stimul ...

TOXICOLOGY SYMPTOMS/EXAM ■ Nausea and vomiting ■ Slurred speech, ataxia, depressed mental status, and seizures ■ The classic pre ...

TOXICOLOGY A 23-year-old male with a history of depression presents to the ED via EMS for altered mentation. On presentation he ...

TOXICOLOGY ■ Hypertension ■ Diminished bowel sounds, decreased defecation ■ Urinary retention DIFFERENTIAL ■ Encephalitis ■ Neur ...

TOXICOLOGY DIAGNOSIS ■ Clinical diagnosis is based on exposure history and physical exam. ■ RBC cholinesterase levels may be ind ...

TOXICOLOGY SYMPTOMS/EXAM ■ Bleeding—may be spontaneous or related to trauma DIFFERENTIAL ■ Other “warfarin-like” anticoagulants, ...

TOXICOLOGY ■ Fresh frozen plasma ■ 10–15mg/kg will restore factor levels to ≥30% of normal. ■ Prothrombin complex concentrate an ...

TOXICOLOGY ANTICONVULSANTS Anticonvulsant medications were developed for the treatment of seizures, but they are also used for t ...

TOXICOLOGY COMPLICATIONS ■ Hypersensitivity reactionsmay occur 1–6 weeks after starting phenytoin therapy, eg, SLE, TEN, erythem ...

TOXICOLOGY Selegiline ■ Limited data, may see classic MAOI toxicity DIAGNOSIS ■ Clinical diagnosis is based on history and exami ...

TOXICOLOGY ■ Muscarinic receptor antagonism →anticholinergic symptoms. ■ Histamine receptor antagonism →sedation. ■ Cardiac K+ch ...

TOXICOLOGY ■ Activated charcoal: For large ingestions within 1–2 hours (with airway pro- tection as needed) ■ Norepinephrine: Fo ...

TOXICOLOGY b-Blockers Normal function of β-adrenergic receptors: ■ β-1: Heart (increases rate, contractility, conduction), kidne ...