Toxicology

Symptoms of Ach-esterase inhibitor poisoning? What commonly causes poisoning?

Commonly due to
organophosphates
, Malathion and parathion in particular
-DUMBELSS
-Diarrhea, Urination, miosis, Broncho-constriction, bradycardia, Excitation, lacrimation, salivation, sweating

What is unique about the sweating/skeletal muscle excitation response in organophosphate poisoning?

They are both
nicotinic receptor responses

What is the treatment for organophosphate toxicity?

Atropine + pralidoxime
Respiratory support

Effects of atropine/other Muscarinic blocker toxicity?

Tachycardia
High BP
Dellusions/delerium
Hyperthermia/ flushed skin
Dry mouth
Cycloplegia
Mydriasis
Hallucinations

Treatment of atropine toxicity?

Physostigmine to increase Ach levels
Control heart rate and temperature

CO toxicity symptoms?

Dyspnea
Nausea vomiting
Mydriasis
Vertigo
Decreased BP, syncope, increased HR and
Headache
causes a left shift of O2 dissociation curve

Treatment of CO toxicity?

100% hyperbaric O2

Signs of amphetamine overdose?

High BP, High heart rate
warm sweaty skin
Hyperthermia
Dellusion, psychosis , anxiety
Mydriasis

Treatment of amphetamine overdose?

Treat HR and Bp and hyperthermia
Give anti-psychotics

Opiod overdose symptoms?

Lethargy/sedation
Low BP and heart rate
Pupil constriction
Respiratory failure

Treatment of Opiod overdose?

Naldoxone
respiratory support

Aspirin overdose symptoms?

Confusion and lethargy
Tinnitus
Dehydration
Hyper ventilation
Hyperthermia
Acidosis
Hypokalemia

Treatment of aspirin overdose?

Correct acidosis
Balance electrolytes
Alkalize urine
Hemodialysis

Ethanol/ benzodiazepene overdose?

Nystagmus
Ataxia
stupor
Hypothermia
Respiratory failure
coma
lethargy

Treatment of ethanol/BNZ overdose?

Flumazenil
Ventilatory support

Symptoms of seratonin syndrome?

Muscle rigidity
Confusion, hallucination
Hyperthermia
Increased heart rate and BP
Seizures

Treatment of seratonin syndrome?

Cyproheptadine (5HT3 antagonist)
Control hyperthermia and heart rate

Tricyclic anti-depressant toxicity symptoms? What receptors are being blocked?

Coma, cardiotoxicity and convulsions
Hyperthermia with hot
dry
flushed skin
Mydriasis
M1 and A1 receptor block

Treatment of TAC toxicity?

Treat hyperthermia and correct acidosis
Treat seizures

Symptoms and pathophysiology of CN poisoning?

Binds Fe3+ in cyctochrome C in ETC
Binds Fe3+ in hemoglobin
(methemoglobinmeia)

Treatment of CN poisoning?

- First Sodium nitrite initially to extract from ETC and
increase methemoglobin
-Then Thiosulfate to increase liver processing

Symptoms of methanol poisoning?

Metabolic acidosis
Visual disturbances
GI disturbances
Vertigo, lethargy, respiratory depression

Mechanism of action of methanol poisoning?

Metabolized to formic acid/ formaldehyde
formic acid accumulates
Inhibits
cytochrome oxidase
Can cause blindness in the eye

Where is ethylene glycol found? Who is commonly affected?

Anti-freeze, and coolants
Children ingesting it

What is Ethylene glycol metabolized to?

Glycolic acid which is further metabolized to
oxalate

What organs does ethylene glycol affect?

CNS and Kidneys
Oxalate can form kidney stone with calcium

Symptoms of ethylene glycol poisoning?

CNS depression
Nausea, vomiting
Major acidosis with
anion gap

What is used to treat ethyele glycol, methanol and ethanol toxicity?

Gastric lavage if under 60 min
-
Fomepizole
Inhibits alcohol dehydrogenase
-Bicarbonate for acidosis
-Thiamine and B vitamins