therapy toxic Quiz

Toxicology and Overdose Management

• Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
• Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
• Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
• Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
• Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
• Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
• Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
• Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
• Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
• Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
• Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
• Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

Poison Ingestion Treatment Methods

• Gastric lavage is a method of rinsing the stomach with water or saline solution via a tube inserted through the mouth or nose, and it is effective within 1 hour of ingestion of poison.
• Contraindications for gastric lavage include corrosive ingestion, hydrocarbons, comatose patients, patients experiencing seizures, and those with hemorrhage in the esophagus or stomach.
• Specific lavage fluids include thiosulfate solution for CN, calcium gluconate solution for oxalic acid, and deferioxamine solution for iron.
• Activated charcoal is used as an adsorbent to prevent toxin absorption into the bloodstream, with a typical dose of 10:1 charcoal to toxin ratio or 1 gm/kg b.wt.
• Multiple dose activated charcoal (MDAC) is useful for overdose of theophylline, phenobarbital, quinine, dapsone, and carbamazepine.
• Whole bowel irrigation (WBI) involves flushing the entire GI tract with polyethylene glycol (PEG) and an added electrolyte lavage solution (ELS) to reduce transit time and limit toxin absorption.
• WBI is valuable for sustained-release drugs, foreign bodies, and toxins not removed by charcoal, and it must be employed soon after toxin exposure.
• Acid or base load can change the urinary pH, affecting the charge status of substances in the blood, a technique known as ion trapping.
• Alkaline urine enhances the elimination of acids such as salicylates, phenobarbital, chlorpropamide, and others, while acidic urine can speed up the excretion of basic drugs like tricyclic antidepressants or phencyclidine.
• Cathartics, including laxatives and rapid watery evacuation promoters, can draw water into the gut by establishing an osmotic gradient, and are used for intestinal evacuation.
• Saline cathartics such as magnesium citrate and magnesium sulfate and sorbitol are usually employed for this purpose.
• Each method has specific indications, contraindications, and mechanisms, and should be used according to the specific characteristics of the poisoning and the patient's condition.

Toxicology and Overdose Management

• Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
• Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
• Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
• Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
• Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
• Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
• Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
• Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
• Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
• Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
• Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
• Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

Toxicology and Overdose Management

• Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
• Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
• Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
• Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
• Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
• Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
• Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
• Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
• Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
• Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
• Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
• Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

Toxicology and Antidotes Overview

• Increased water retention leads to increased intestinal pressure and motility
• Adverse effects of cathartics are dehydration and electrolyte disturbances
• Contraindications for cathartics include intestinal obstruction and renal insufficiency
• Dialysis involves blood circulated through a semi-permeable membrane
• Factors affecting dialysis effectiveness include tissue binding, volume of distribution, and molecular weight
• Examples of substances responding well to dialysis are lithium, methanol, and salicylates
• Hemoperfusion involves blood pumped through an external cartridge containing charcoal or adsorbent
• Symptomatic treatment for poisoning is based on functional antagonism
• Antidotes are specific medicinal interventions effective for particular toxins
• Antidotes can be classified into chemical, receptor, dispositional, and functional classes
• Examples of clinically useful antidotes include N-acetylcysteine for acetaminophen and naloxone for opiates
• Diagnostic clues for poisoning include colored emesis, stool, urine, nails, and odors associated with specific toxins

Test your knowledge on the use of gastric lavage in advanced pregnancy and foreign material ingestion cases. Learn about the challenges and indications of this medical procedure.