Poisoning

Acetaminophen overdose
o Obtain level after 4 hrs of ingestion (can only be made after this time)
o Administer N-acetylcysteine 8 hrs after ingestion
Ethylene glycol poisoning / Methanol
o Metabolites such as glycolic acid injure the renal tubules while oxalic
acid binds calcium hypocalcemia and calcium oxalate crystal
deposition in the kidneys
Develop flank pain, hematuria, oliguria, acute renal failure,
anion gap metabolic acidosis
o Treatment: fomepizole/ ethanol to achieve ADH inhibition
Methanol poisoning vs Ethylene glycol
o Methanol causes vision loss/ coma/ blurred vision/ epigastric pain/
vomiting/ hyperemic optic disc
Cyanide poisoning
o Burning of rubber/ plastic
o Bitter almond breath (characteristic)
Methemoglobinemia
o CO poisoning
o Cyanosis and bluish discoloration of skin and mucous membranes
CO poisoning
o Headache, nausea, abdominal discomfort
o Pinkish-red skin hue confirm by carboxyhemoglobin level
TCA overdose
o Sodium bicarbonate narrows the QRS complex preventing the
development of arrhythmia by alleviating the cardio-depressant
action on sodium channels
o Causes dilated pupils, flushed and dry skin, intestinal ileus
o QRS prolongation ventricular arrhythmia
Lithium toxicity- tremor/hyperreflexia/ ataxia/ seizures
Opioid intoxication respiratory depression/ miosis
Phenytoin toxicity horizontal nystagmus/ cerebellar ataxia/ confusion
Diphenhydramine overdose anti-histamine effects including drowsiness/
confusion/ anticholinergic effects (dry mouth/ dilated pupils/ blurred
vision/ reduced bowel sounds/ urinary retention)
o Treatment: Physostigmine (cholinesterase inhibitor)
Iye ingestion
o Occurs instantaneously and effects esophagus (liquefactive necrosis)
o Efforts to neutralize the alkali, induce vomiting/ administer charcoal
do not improve outcomes
o Early upper GI contrast study / endoscopy critical for evaluating
damage
Acute iron intoxication
o 5 phases
GI phase: occurs 30 mins to 6 hrs after ingestion direct
mucosal damage
Patients experience nausea/vomiting/hematemesis/
melena/ abdominal pain
Latent phase occurs 6-24 hrs- asymptomatic
6-72 hrs post shock and metabolic acidosis
hepatoxicity occurs 12-96 hrs
bowel obstruction secondary to mucosal scarring develop
several weeks post-ingestion
o check serum iron concentration (levels >or equal 350 mcg/dL)
Organophosphate poisoning
o Bradycardia/ miosis/ bronchorrhea/ muscle fasciculations/
salivation/ lacrimation/ diarrhea/ urination
o Counteract effects atropine
o *equal importance immediate removal of the patients clothing to
prevent continued absorption of organophosphates through the skin
PCP intoxication
o Vertical nystagmus
o Dissociative feelings/ psychotic and violent behavior/ severe HTN/
hyperthermia
Acute iron poisoning
o Pre-natal vitamins radiopaque tablets on xray
o Abdominal pain/ hematemesis/ hypovolemic shock/ metabolic
acidosis
o Treatment: deferoxamine (binds ferric iron)
Caustic poisoning
o Damage of tissue lining the GI tract (necrosis/ edema/ scarring/
severe pain)
o White tongue, heavy salivation, dysphagia
o Severe esophageal and stomach ulceration may also occur
peritonitis/ mediastinitis
o Does not cause alteration in consciousness
Beta blocker overdose
o AV block/ bradycardia/ hypotension/ wheezing/ cardiogenic shock
o Atropine and IV fluids first line of therapy
o If not reversed glucagon
Antipsychotics
o Fluphenzaine high potency
Occasionally can cause hypothermia by disrupting
thermoregulation and bodys shivering mechanism
Patients should be advised to avoid prolonged exposure to
extreme temperatures
Marijuana intoxication
o Slowed reaction time, impaired short term memory, increased
appetite
o Conjunctival injection/ dry mouth/ HTN/ tachycardia