L3. Intoxication

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Questions and Answers

Which laboratory assessment is crucial for evaluating the cardiovascular status of a patient who has ingested poison?

Urinalysis for renal function evaluation

Liver function tests for toxicity indication

Blood pressure and heart rate monitoring (correct)

Complete blood count for infection signs

What is a possible complication of gastric lavage in a poisoned patient?

Aspiration pneumonia (correct)

Enhanced drug absorption

Increased stomach motility

Electrolyte imbalance correction

Which decontamination method is recommended for a victim with poison on the skin?

Cover the area with a sterile dressing

Massage the poisoned area to increase blood flow

Apply ointment immediately after exposure

Flood the area with water for 10 minutes (correct)

What is the primary technique for gastric decontamination in cases of acute poisoning?

Gastric lavage with saline solution Signup and view all the answers

In the event of inhaled poisons, what is the recommended initial emergency response?

Provide supplemental oxygen to ensure ventilation Signup and view all the answers

Which aspect of the diagnostic assessment is significant for identifying poisoning effects?

Evaluating neurological function and symptoms Signup and view all the answers

What should be avoided when treating a patient exposed to ocular poison?

Using contact lenses during treatment Signup and view all the answers

Which of the following drugs is critical for the treatment of suspected opioid poisoning?

Naloxone Signup and view all the answers

What should be prioritized while providing initial care for a patient who has swallowed poison?

Establishing airway, breathing, and circulation Signup and view all the answers

What is a common symptom to evaluate during a cardiopulmonary examination for poisoning?

Chest pain or discomfort Signup and view all the answers

Which laboratory assessments are routinely conducted after a patient is stabilized following exposure to a toxic agent?

CBC, serum electrolytes, BUN, Scr, and blood glucose Signup and view all the answers

What is the primary purpose of skin decontamination in cases of toxic exposure?

To prevent further absorption of toxic agents Signup and view all the answers

Which of the following conditions contraindicates gastric lavage?

Ingestion of a corrosive strong acid Signup and view all the answers

What is a reason why Ipecac syrup is no longer recommended for gastric decontamination?

It is dangerous for patients with corrosive ingestion Signup and view all the answers

What step should be taken immediately if a person has inhaled a poisonous substance?

Get the person to fresh air Signup and view all the answers

What does whole bowel irrigation (WBI) involve in the context of gastric decontamination?

Flushing the entire gastrointestinal tract to remove toxins Signup and view all the answers

What is a critical precaution when performing gastric lavage on an unconscious patient?

Ensure the patient is intubated to prevent aspiration Signup and view all the answers

What action should NOT be taken during skin decontamination of a toxic substance?

Attempt chemical neutralization of the toxin Signup and view all the answers

Which method is indicated for gastric decontamination if a toxin has been ingested within 1 hour?

Single-dose activated charcoal Signup and view all the answers

When is artificial respiration necessary in the case of inhaled poison?

If the patient is not breathing Signup and view all the answers

Which complication is specifically associated with gastric lavage?

Laryngospasm Signup and view all the answers

What is the primary action of activated charcoal in gastrointestinal decontamination?

Adsorbs the drug Signup and view all the answers

What is the recommended method to perform gastric lavage in adults?

Instill small volumes until return is clear Signup and view all the answers

Which of the following is not effectively treated with activated charcoal?

Cyanide poisoning Signup and view all the answers

During gastric lavage, what fluid temperature is recommended for instillation?

Warm, approximately 37°C to 38°C Signup and view all the answers

What is a key factor in determining the effectiveness of activated charcoal?

Timing of administration Signup and view all the answers

Which method is often combined with activated charcoal during gastric decontamination?

Laxative administration Signup and view all the answers

What is the typical volume of fluid instilled during gastric lavage in pediatric patients?

50-100 ml at a time Signup and view all the answers

Which of the following is a sign of the aspiration pneumonitis complication?

Breathing difficulties Signup and view all the answers

What volume of activated charcoal is typically recommended for adults during an overdose?

25-100 g Signup and view all the answers

What is typically the first action taken in the emergency response to a patient exposed to inhaled poisons?

Start artificial respiration if the victim is unconscious Signup and view all the answers

Which of the following complications is associated with gastric lavage?

Aspiration pneumonia Signup and view all the answers

What is the primary purpose of decontamination methods in treating poisoning?

To eliminate toxins before they can be absorbed systemically Signup and view all the answers

Which gastric decontamination technique is often used in an acute setting to prevent toxin absorption?

Activated charcoal administration Signup and view all the answers

Which of the following is a key consideration when evaluating routine laboratory assessments for poisoning?

Measurement of liver function tests and electrolytes Signup and view all the answers

What technique enhances the elimination of poisons by altering urine pH?

Urinary alkalinization Signup and view all the answers

Which symptom would most likely indicate severe cases of poisoning requiring intensive medical intervention?

Severe respiratory distress Signup and view all the answers

Which factor is NOT considered in the initial stabilization process during intoxication management?

Immediate administration of antidotes Signup and view all the answers

In which scenario would a clinician most likely utilize hemoperfusion?

In cases of severe overdose of certain drugs that are less amenable to dialysis Signup and view all the answers

Which of the following strategies is least effective immediately after toxin ingestion?

Wait for spontaneous elimination and monitor symptoms Signup and view all the answers

Study Notes

General Approach to Management of Intoxication

Poisoning is an adverse effect from a chemical, drug, or xenobiotic taken in excessive amounts.
The body can tolerate or detoxify a certain dose of a chemical; exceeding the threshold causes toxicity.
Poisoning can cause minor local effects (treatable) or systemic life-threatening effects needing intensive medical intervention.
Clinical toxicology studies the pathophysiological changes, symptoms, and management of intoxicated persons.

Objectives

Understanding the principles of treating and managing poisonings (clinical toxicology).
Describing supportive care measures for severely intoxicated patients.
Identifying and comparing strategies for decreasing poison absorption (e.g., GI decontamination).
Discussing techniques for enhancing poison elimination (e.g., dialysis, hemoperfusion).
Recognizing the basic toxicology features and treatment for poisonings by various agents (e.g., carbon monoxide, cyanide, alcohols, acetaminophen, salicylates).

Introduction to Poisoning

Poisoning is an adverse effect from a chemical, drug, or xenobiotic taken in excessive amounts, overwhelming the body's tolerance or detoxification capacity.
Body tolerates a certain dose of a chemical; exceeding it leads to toxicity.

Case Study (Example)

A 16-year-old female arrives at the emergency department (ED) after being found in an intoxicated state.
Empty pill bottles were scattered around the room.
The patient was given 1.5 g/kg of oral activated charcoal.
Liver transaminase values were elevated to approximately three times the upper limit of normal.

Principles of Poisoning Treatment and Management

Initial stabilization (ABCD approach)
Diagnostic assessment and laboratory evaluation
Decontamination
Enhancing elimination of poisons
Administration of specific antidotes

Pre-Hospital Care: First Aid for Poison Exposures

Inhaled poison: Immediately move the person to fresh air, avoid breathing fumes.
Poison on skin: Remove contaminated clothing and flood skin with water for 10 minutes. Wash gently with soap and water.
Poison in the eye: Flood the eye with water for 10-15 minutes.
Swallowed poison: Provide supportive care.

Diagnostic Assessment and Laboratory Evaluation

Obtain exposure history (substance ingested, quantity, route, duration, signs, & symptoms, prior illness).
Perform physical examination (neurological, cardiopulmonary, GI).
Conduct past medical history (medications, allergies, alcohol & drug abuse, pregnancy, social history).
Implement routine laboratory assessment (blood tests, urine analysis, ECG, x-rays).

Decontamination (Preventing Absorption)

Skin decontamination: Perform when percutaneous absorption may result in systemic effect or local toxic effect. Irrigate with large quantities of water.
Inhaled poison: Immediately move the person to fresh air.
Gastric decontamination: Emesis (with ipecac syrup), gastric lavage, single-dose activated charcoal, or cathartics.

Gastric Decontamination

Gastric lavage(stomach wash)- Considered only if ingestion happened 1 hour prior.
Avoid in unconscious patients (risk of aspiration)

Enhancement of Poison Elimination

Forced diuresis: Increase urine output to enhance excretion of certain chemicals by altering urine pH.
Dialysis (hemodialysis): Used for patients unresponsive to other decontamination methods. Can remove water-soluble toxins.
Hemoperfusion: Removes toxins bound to proteins using a filter with activated charcoal or resin.

Administration of Specific Antidotes

Administer specific antidotes as needed based on the identified toxin.

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Description

This quiz focuses on the clinical approach to managing intoxication and poisoning, exploring the principles of treatment and supportive care. It covers strategies for reducing poison absorption and enhancing elimination, as well as the toxicology of various agents. Test your knowledge on the critical aspects of toxicology in medical practice.