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:

L-lactic acid produced by animals

Henna chemical = para-phenylenediamine