Toxicology

Carbon-Monoxide Detector With Snooze Button Recalled

www.theonion.com

EBMedicine.net

Hydroxocobalamin dose = 5 grams


Physostigmine for anticholinergic toxicity
When giving physo, pts need to be on a monitor, with pulse oxymetry, and with frequent auscultations after each dosing listening for bronchospasm, while having atropine at your side.  Dilute the 1mg/mL of physo 1:10 so that you only give 0.1mg (1mL of the dilute sol.) at a time.  This will prevent the possibility of acute seizures, bradycardia/ AV blocks or sialorrhea/ bronchospasm.  If after 1mg of physo given the patient is still anticholinergic you've made a diagnosis of anticholinergic toxicity. They should have become cholinergic after that dose.  You need to give more physo until the MS is OK/ or anticholinergic symptoms are gone. This depends on how much, and when the patient overdosed, etc. Titrating this takes time at the bedside and keen clinical observation.  -Reuben Olmedo
 
Physostigmine for quetiapine overdose (Am J Emerg Med 2011 July 28)

Anion Gap Acidoses

MUDPILES --> KULT

Methanol                  Toxin (formate)
Uremia                      Uremia
DKA                          Ketoacids
Propylene Glycol     Toxin (glycolate)
Isoniazid                   Lactate
Lactate                     Lactate
Ethylene Glycol       Toxin (glycolate, oxalate)
Salicylates               Toxin (salicylate --> lactate + ketoacids)

Ketones: acetone, beta-hydroxy butyrate
Uremia: phosphates, sulfates, organic acids
Lactic Acidosis: Cyanide, Carbon Monoxide, Metformin, Didanosine, Stavudine, Strychnine, Emtriva, Rotenone (fish poison), NaAzide (lab workers), APAP (if liver fx or very high dose), Phospine (rodenticide), NaMonofluoroacetate (coyote poison‐give etOH as antidote), INH (if patient seizes), Hemlock, Depakote, Hydrogen Sulfide, Nitroprusside (If cyanide toxic), Ricin, Propylene glycol (Glycolate interferes with lactate assay), Propofol, & Jequerty bean
Toxins: formic acid, oxalic acid, salicylic acid, citric acid (blood product admin, esp FFP)
 
 

Serum Osmolarity: 2(Na) + glucose/18 + BUN/2.8 + etoh/4.6
 

Lactic acid:File:Lactic-acid-skeletal.svg

L-lactic acid produced by animals
 

 
Henna chemical = para-phenylenediamine



 
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Weingart's Acid-Base Algorithm  250k v. 1 Mar 2, 2011, 3:22 PM Kit Tainter