-
Toxic alcohol ingestion
- will see serum osmolal gap first
- anion gap happens once the alcohol is metabolized
- thus, early in ingestion, may not see anion gap but should see osmolal gap
- no osmolal gap and normal anion gap rules out a toxic alcohol ingestion
Posted 10/05/16 11:00:46 AM by Anna Krigel
-
Narcan (naloxone)
- used for opiate toxicity reversal
- typical starting dose is 0.4mg, but it is a good idea to start even lower at 0.04mg and then titrate up as needed
Posted 10/05/16 11:33:40 AM by Anna Krigel
-
Activated charcoal
- used for tablet ingestions
- not good for toxic alcohol or organophosphate ingestion as these are absorbed too quickly
- should not be used in patients with poor mental status who cannot protect their airway (significant aspiration risk)
Posted 10/05/16 11:36:08 AM by Anna Krigel
-
- potent cholinesterase inhibitors (bind to acetylcholinesterase and render the enzyme non-functional)
- cause increased acetylcholine levels leading to severe cholinergic toxicity following cutaneous exposure, inhalation, or ingestion
- organophosphate = permanent inhibitor, carbamate = transient inhibitor, thus carbamate toxicity tends to be of shorter duration
- Muscarinic signs of cholinergic excess (DUMBELS)
- D - defecation
- U - urination
- M - miosis
- B - bronchorrhea/bronchospasm/bradycardia
- E - emesis
- L - lacrimation
- S - salivation
- Found in many pesticides and insecticides
- rodent killer containing carbamate from the Dominican Republic called "Tres Pasitos" can be found in the US, especially in the Washington Heights neighborhood
Posted 10/05/16 11:56:18 AM by Anna Krigel
-
Organophosphate and carbamate toxicity management
- Atropine - reverses cholinergic symptoms, start with 1mg and double the dose every 5 minutes until secretions dry up
- look out for delirium with atropine
- Pralidoxime (2-PAM) - cholinesterase reactivating agent, used as a weight-based continuous infusion (30mg/kg)
- has poor CNS penetration, thus must be used with atropine
Posted 10/05/16 02:24:43 PM by Anna Krigel
-
For further reading...
Posted 10/05/16 02:31:59 PM by Anna Krigel
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.