Term
• On average over two million human exposures reported
– Unintentional ~ 75%
• Unintentional general ~56%
• Therapeutic error ~ 13%- double dosing • Unintentional misuse ~ 6% |
|
Definition
|
|
Term
• 50% of ALL exposures <5 years old
• 86% of all pediatric exposures <5 years
– 99% of these exposures in <5 year olds are unintentional
• After 9 years of age, suicidal intent and substance abuse emerge
• Of 13-19 year olds 50% intend self harm |
|
Definition
| Toddler vs. Adolescent/Adult |
|
|
Term
1) No suicidal intent
2) Single agent exposure
3) Small amount ingested
4) Usually non-toxic
5) Typically obtain medical care immediately 6) Typically know precise time of exposure |
|
Definition
|
|
Term
• Simultaneous treatment & diagnosis
• Immediate action:
– ABC(D) , IV / O2 / monitor
• Thinking:
– Is this a toxicology problem?
– If yes, are there complicating factors?
• Gotdrunkandfelldown,nowwithheadinjury?
• You’ve considered a differential and you think it is a toxicologic issue
• Immediate action:
– Supportive therapy (airway etc.) – Decontamination
• Thinking:
– Toxidrome present?
– What more information do I need?
• Definitive Management
– Is there an antidote or specific treatment?
• History
– May be unreliable
• Source important –reliable source? – friend, family, EMS
• What? How Much? When/Time? Why? What else? (significant number of intentional ingestions involve more than one substance, including ETOH)
• Who, What, When, Where, How...Why is mostly pertinent in adolescent and adult ingestions
• What was the substance?
• GET CONTAINER or SUBSTANCE
• When was the exposure?
• How exposure occurred?
• Who witnessed exposure or found patient?
• Symptoms subsequent to exposure
• Environmental clues such as drug paraphernalia, empty pill bottles, odors, suicide notes
• Review hospital records for recent prescriptions, psychiatric history, previous suicide attempts
• Look for loose pills with imprint codes |
|
Definition
| Approach to Toxicology Patient |
|
|
Term
• Disrobepatient-becarefulforlooseitemssuchas needles or chemicals
• Reviewvitalsigns
• Comprehensivephysicalexamination
• Levelofconsciousness
• Pupilsize
• Mucousmembranes
• Respiratoryrate
• Breathsounds
• Bowelsounds
• Skintemperature
• Muscletone |
|
Definition
|
|
Term
| • The presence of a combination of findings may suggest a specific toxidrome |
|
Definition
|
|
Term
• Toxidromes are a cluster of signs & symptoms that together are specific and pathognomonic for a specific ingestion
• Knowing these toxidromes will guide you to your diagnosis!!!
• Toxic + Syndrome= Toxidrome |
|
Definition
|
|
Term
• Narcotic
• Sympathomimetic • Anticholinergic
• Cholinergic |
|
Definition
|
|
Term
• Opioids, cocaine, methamphetamines, and other stimulants
• Hallucinogens-LSD, psilocybin, mescaline, ecstasy (MDMA), phencyclidine (PCP, angel dust) |
|
Definition
|
|
Term
• Natural & synthetic compounds which mimic endogenous endorphins
• Heroin, Morphine, Dilaudid, Demerol, Vicodin, Methadone, Fentanyl (China White), Oxycontin
• Different pharmacologic parameters
• Common drugs of abuse
• Street drugs – adulterated (mixed OD) |
|
Definition
|
|
Term
• Bradycardia
• CNS depression, stupor, slurred speech
• Hypotension
• Miosis (pinpoint pupils)
• Respiratory depression, apnea
• Results from heroin, codeine, methadone, morphine, meperidine may differ
• Antidote is naloxone 0.05 mg-2 mg |
|
Definition
| Opioid Toxicity/Toxidrome |
|
|
Term
• Supportive care/ABCs
• Narcan 2mg IV q2min until effect
– Comes in 0.4mg vials
• Can require massive doses
• IV/IM/SQ/ETroutes
• Short acting & may require repeat doses or IV drip |
|
Definition
|
|
Term
• Fightorflightsystem
• Drugactivates adrenergic nervous system
• Cross-activationof dopaminergic à euphoria & hallucinations
• Common sympathomimetics
– Cocaine
– Caffeine
– Ephedrine
– MDMA (ecstasy)
– LSD (prominent hallucinations)
– Pseudoephedrine (Sudafed) |
|
Definition
|
|
Term
• ABCs
• Supportivecare/time
• Treatmentissymptomatic, may use benzodiazepines, Ca+ channel blocker,
• Cocaine–avoidB-blockers
• BBlockersare contraindicated due to unopposed alpha receptor stimulation |
|
Definition
| Sympathomimetics Treatment |
|
|
Term
Mydriasis Tachy
Anxiety Muscle tension
Treatment:
Supportive Benzos Haldol |
|
Definition
|
|
Term
Mydriasis Tachy
Muscle tension N&V
Treatment:
Supportive Benzos |
|
Definition
|
|
Term
Mydriasis Abdominal Pain N&V Dizziness Nystagmus Ataxia
Treatment: Supportive Benzos |
|
Definition
|
|
Term
Mydriasis Bruxism Jaw Tension Ataxia
Dry Mouth Nausea
Treatment:
Benzos Hydration Active Cooling Serotonin antagonist |
|
Definition
|
|
Term
Small or mid- sized pupils Nystagmus Muscle Rigidity Hypersalivation Agitation Catatonia
Treatment:
Benzos Hydration Active Cooling |
|
Definition
|
|
Term
Tachycardia Conjunctival injection
Treatment:
Supportive Benzos |
|
Definition
|
|
Term
• Synthetic cathinones, more commonly known as "bath salts," are drugs that contain one or more human-made chemicals related to cathinone, a stimulant found in the khat plant.
• Marketed as cheap substitutes for other stimulants such as methamphetamine and cocaine. Products sold as Molly (MDMA) may contain instead.
• People typically swallow, snort, smoke, or inject
• Much is still unknown about how the chemicals affect the human brain.
• Intoxication has resulted in death.
• May be addictive.
• Behavioral therapy may be used to treat addiction
• No medications are currently available to treat addiction |
|
Definition
|
|
Term
• paranoia
• increased sociability
• increased sex drive
• hallucinations
• panic attacks |
|
Definition
| Synthetic cathinones can cause: |
|
|
Term
• Antagonism of the cholinergic nervous system (parasympathetic)
• Sympathetic disinhibition & loss of parasympathetic functions
• Common medication side- effect
• Less commonly abused class of drugs
“Can’t see, can’t pee, can’t s—t, can’t spit” |
|
Definition
|
|
Term
• Agents such as Benadryl (Antihistamines), Scopolamine, Atropine, Jimsonweed (Datura), Belladonna, prochlorperazine, ipratropium, Phenothiazines (antiemetics), Tricyclic antidepressants
• Common Findings: AMS, mydriasis (dilated pupils), dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mucous membranes
• Seizures, dysrhythmias, rhabdomyolysis, |
|
Definition
| Anticholinergic Toxidrome |
|
|
Term
• Supportive Care: ABC’s, IV, EKG, treat seizures, activated charcoal, urinary drainage
• Antidote is Physostigmine- USE WITH CAUTION
– derived from Physostigma venenosum
– inhibits acetylcholine metabolism |
|
Definition
| Anticholinergic Toxicity Treatment |
|
|
Term
• These toxins include scopolamine and hyoscyamine which cause a bizarre delirium and hallucinations, and are also used as pharmaceutical anticholinergics. The drug atropine is derived from the plant.
• Poison-tipped arrows
• ”Beautiful woman" because the herb was used in eye-drops by women to dilate the pupils of the eyes to make them appear seductive |
|
Definition
| Belladonna-Deadly Nightshade |
|
|
Term
Increased acetylcholine activity
• Nicotinic NS: increased nerve transmission and muscle activation
• Muscarinic NS: liquid management
• Rarely abused
• Occupational exposures - insecticides
• Muscarinicacetylcholineexcesspredominates“wet” patient due to increased secretory overdrive: salivation, lacrimation, urination, defecation(diarrhea), bronchial secretion, vomiting
• Muscarinic Effects--DumBBBels Defecation
Urination
Miosis
Bradycardia, Bronchospasm, Bronchorrhea Emesis
Lacrimation
Salivation
***Also known as “SLUDGE” (salivation, lacrimation, urination, diarrhea/defecation, GI cramps, emesis) |
|
Definition
|
|
Term
• Nicotiniceffects—MTWHF Miosis
Tachycardia
Weakness (nerve transmissions can’t get through)/respiratory depression/paralysis
Hyperglycemia, Hypertension
Fasciculations
• Sympatheticgangliaexcess |
|
Definition
|
|
Term
• Usually insecticide or rodenticide (organophosphates)
• Chemical warfare agents (i.e. Sarin)
• Myasthenia gravis meds
• “Green tobacco sickness”
– Nicotine poisoning during harvest
Treatment:
• DECONTAMINATE
• Cardiopulmonary support
• Antidotes
– Atropine 2mg q 5 mins until secretions are gone
– Pralidoxime (2-PAM) x 3 auto-injectors or 30mg/kg IV (if organophosphates) |
|
Definition
| Cholinergic Toxidrome Treatment |
|
|
Term
|
Definition
|
|
Term
| • Cyclic antidepressants, atypical antidepressants, SSRI, Serotonin syndrome, Trazadone, Bupropion, Mirtazapine, Serotonin/Norepinephrine Reuptake Inhibitors, MAOI’s, Antipsychotics, Lithium |
|
Definition
| Psychopharmacologic Agents |
|
|
Term
• Potentially life-threatening adverse reaction to serotoninergic medications
• Any drug or drug combination that can increase central serotonin neurotransmission, most commonly antidepressants
• Altered mental status
• Hyperthermia
• Seizures
• Increased muscle tone-myoclonus
• Common causes: fluoxetine, sertraline, trazadone
• Treatment: ET tube, benzos, discontinue serotonergic drugs |
|
Definition
|
|
Term
• Depression, sleep, & pain disorders
• Less common due to SSRI prevalence • High toxicity in overdose
• Anticholinergic toxidrome plus
• Cardiac Dysrhythmias
– Quinidine-like (Ia) effects on Na channels – Sinus tach, Vfib, Vtach
• Seizures |
|
Definition
| Tricyclic Antidepressants |
|
|
Term
• EKG CLASSIC
– Sinus Tachycardia
– PR, QRS, QT Prolongation
– Classic Findings - QRS Prolongation, Rightward Axis,
“Brugada pattern” in AVR (Terminal R Wave) |
|
Definition
|
|
Term
• ABCs
• Bicarbonate drip
– Reduces cardiac effects
• Control seizures
– Benzodiazepines
– Phenobarbital
– Avoid phenytoin – risk of dysrhythmias |
|
Definition
| Tricyclic Antidepressants- Treatment |
|
|
Term
| • Barbs, Benzos, Nonbenzodiazepine Sedative Hyptonics-Chloral Hydrate |
|
Definition
|
|
Term
• Somnolence, obtunded • Nystagmus
• Hallucinations
• Slurred Speech
• Ataxia
• Weakness/Hypotonia
• Paradoxical Excitation • Hypotension
• Respiratory Depression |
|
Definition
|
|
Term
• Addiction
• Withdrawal –anxiety, irritability, insomnia, nausea, tremor, disorientation and seizures
• Flumazenil selective antagonist –may precipitate seizures-use for respiratory depression following procedural sedation with Benzos |
|
Definition
|
|
Term
| • Ethanol, Isopropanol, Methanol and Ethylene Glycol |
|
Definition
|
|
Term
• Signs and symptoms: slurred speech, disinhibited behavior, CNS depression, altered coordination
• Remember: manifestations of serious head injury or hypoglycemia may be identical to, or clouded by ethanol ingestion
• Nystagmus and odor of ethanol may be observed
• Always check a bedside glucose
• Electrolytes
• LFT’s
• Serum ethanol levels
• Treatment: observe, hydrate, Banana Bag- Thiamine 100 mg/Folate 1mg/MVI 10 ml mixed in 1L of NS
• More recent studies abandoning the BB |
|
Definition
|
|
Term
• Isopropanol-lastslonger,deeperCNSdepression, smells fruity odor of ketones, may have coma, respiratory depression, hypotension, hemorrhagic gastritis
• Treat:IVF,treatbleeding,mayneedhemodialysis
• Methanol-antifreeze,windshieldwashingfluid
• Ethyleneglycol–coolants,polishes,detergents
• Symptomsmaynotappearfor12-24hr.
• CNSdepression,visualdisturbances(snowstorm), abdominal pain, nausea, vomiting, fundoscopic exam may reveal retinal edema or hyperemia of the optic disk |
|
Definition
|
|
Term
• First12hours-patientappearsintoxicated
• 12-24hours:cardiopulmonaryeffectspredominate: elevated heart rate, respiratory rate, and blood pressure, congestive heart failure, respiratory distress syndrome, and circulatory collapse
• 24-72hoursrenaleffects;flankpain,CVAtenderness, acute tubular necrosis, hypocalcemia may lead to tetany and ECG change
• Treatmentformethanolandethyleneglycol:Fomepizole– potent inhibitor of alcohol dehydrogenase; may use 80 proof liquor, dialysis |
|
Definition
| Ethylene Glycol Poisoning |
|
|
Term
| • Aspirin and Salicylates, Acetaminophen, NSAIDS |
|
Definition
|
|
Term
• Common “cry for help”
• Ubiquitous
–Accidental OD’s – “multi-symptom cold meds” –Common co-ingestant
• Initially asymptomatic or mild GI upset
• Quiescent period of a few days after intoxication (LFTs may be elevated)
• Delayed & sometimes fatal liver toxicity
• Metabolism
–Metabolite toxic to hepatocytes causing hepatic necrosis
–At therapeutic doses, glutathione neutralizes metabolite and prevents toxicity
–At high doses glutathione depleted and toxicity results |
|
Definition
|
|
Term
•Slow death, good choice for hidden suicide
•No obvious toxidrome
•Contained in many medications cause “accidental” overdose
•All suspected overdoses/ suicide attempts should have a level sent and nomogram documented! This is based on the serum level and approximate time of ingestion |
|
Definition
| The Hidden Danger....Acetaminophen |
|
|
Term
• APAP toxicity is initially clinically “silent”
• 1/500 ingestions will have a toxic APAP level without History
• APAP level indications:
Any ingestion with intent of self-harm Ingestion of APAP, acute or chronic
• Plotting on the Rumack-Matthews should be routine |
|
Definition
|
|
Term
•The rule of 140
–Toxic dose is 140 mg/kg
–Toxic level at 4 hours is 140 mcg/ml
–First dose of NAC is 140 mg/kg po (subsequent 17 doses are 70mg/kg) |
|
Definition
|
|
Term
• Antidote: N-acetylcysteine
• Replenishes glutathione in the liver
• Tastes AWFUL
– May require NGT administration – IV form (Acetadote) |
|
Definition
|
|
Term
• ASA, Peptobismol (salicylic acid)
• Oil of wintergreen
–1 tsp = 7gm salicylate (peds lethal dose)
• Symptoms onset within 1 hour
• Enteric-coated delays absorption
• Gastric bezoars also delay absorption • Renal clearance
• Symptoms
–Vomiting, tinnitus, hyperpnea, fever (mild) –Acidosis, AMS, seizures and shock (severe) –**Metabolic acidosis w/ respiratory alkalosis
• Toxicity begins at 50mg/kg (acute) |
|
Definition
|
|
Term
• Generalguidelinesforseverity
– Mild <300 mg /kg ingested
– Moderate 300-500 mg/kg
– Severe / potentially lethal > 500 mg/kg
• Serumlevel>30mg/dlat6hrs–toxic
– Serum level not predictive of degree of toxicity
• Increased elimination in urine
– Urine alkalization
• 3ampsofbicarbin1LofD5W
• Hemodialysis indicated if
• Coma, seizure
• Renal, hepatic, or pulmonary failure • Pulmonary edema
• Severe acid-base imbalance
• Deterioration in condition• Confusion • Dyspnea • N/V/D
• Headache • Amnesia
• Agnosia • Apraxia |
|
Definition
|
|
Term
• Confusion • Dyspnea • N/V/D
• Headache • Amnesia
• Agnosia • Apraxia
• Tachycardia
• Hyper/Hypotension
• Hyperthermia
• Pallor
• Bright red retinal veins with papilledema
• Brisk reflexes
Although Cherry Red skin/mucous membranes
are often associated “when
you’re
dead”
you’re
cherry red |
|
Definition
|
|
Term
• Comawithnormalvitalsigns=benzodiazepines
• HTNwithreflexivebradycardia=pseudoephedrine, phenylephrine/phenylpropanolamine (decongestant removed from US market but still used in veterinary medicine-because of increased risk of stroke)
• Extreme hypotension with normal mental status= Ca+ channel blocker
• Sympathomimetictoxidromewithwidepulsepressure = theophylline (rarely used today)
• Apresumedalcoholintoxicationwith“snowblindness” = methanol |
|
Definition
| Some Telltale Signs & Symptoms for Specific Ingestions |
|
|
Term
• Sympathomimetics and other drugs cause dramatic tachycardia and HTN
• These symptoms can be non-specific result of stress
• Hypotension can be end stage result from most any severe toxicity |
|
Definition
| Tachycardia, Hypertension, Hypotension |
|
|
Term
• Chloral hydrate (OTC sedative for insomnia no longer available in US)
• Cholinergics
• Clonidine
• Nicotine
• Opioids |
|
Definition
|
|
Term
• Amphetamines • Antihistamines • Anticholinergics • Atropine
• Cocaine |
|
Definition
|
|
Term
• Carbamazepine
• Dextromethorphan • Ethanol
• Ketamine
• PCP
• Phenytoin |
|
Definition
|
|
Term
• Acetone= isopropyl, ethanol, DKA
• Almond= cyanide
• Garlic= arsenic, thallium, malathion
• Hay= phosgene gas
• Mothballs= napthalene, paradichlorobenzene,camphor
• Peanuts= Vacor
• Pears= chloral hydrate
• Rotten eggs= hydrogen sulfide, N-acetylcysteine (NAC)
• Wintergreen= methyl salicylate
• Shoe polish= aniline dye
• New shower curtain= ethylchlorvinyl |
|
Definition
| Scents/Odors –aroma of the poison |
|
|
Term
• Heartblock(possiblelithiumOD)
• QRSchanges/QT(prolongedintricyclic(TCA)(OD)
• Torsades(veryprolongedQTantihistamines: astemizole/terfenadine, with macrolides, antifungals, grapefruit juice or certain antiarrhythmics-taken off US market)
• STchanges(Digoxin)
• Digoxincanmimicmanydysrhythmiasbutoftenshows increased PR, decreased QT intervals |
|
Definition
| EKG changes-poisoning of the heart |
|
|
Term
M-methanol, metformin
Uremia
DKA, ETOH, starvation ketoacidosis
Paraldehyde, Phenformin, Propylene glycol
Iron, INH
Lactic acidosis
Ethanol, Ethylene glycol
Salicylates, Solvents |
|
Definition
| Metabolic Acidosis with anion gap "MUDPILES" |
|
|
Term
• Alcohol
• Epilepsy, Endocrine, Exocrine, Electrolytes
• Insulin, Infection
• Overdose, oxygen deprivation
• Uremia
• Trauma, Temperature
• Psychosis, Porphyria, Poison
• Stroke, Sepsis, Shock, space occupying lesion, Seizure, SAH |
|
Definition
| AEIOU TIPS- Useful for AMS |
|
|
Term
• ABCDE
Protect the airway, are they somnolent?
How is the oxygen saturation, do they need suctioned due to secretions?
Fluid resuscitation/blood pressure support. Are they hypovolemic and dry?
Do they have any neurologic deficit
Is the exposure on the skin (organophosphate) and they require decontamination?
• Identify (if possible) substances
• Reduce absorption
• Enhance elimination: gastrointestinal decontamination/removal of substance prior to absorption
• Neutralization of poison/reversal of effect antidote |
|
Definition
| Goals in the Treatment of the Poisoned Patient |
|
|
Term
• Supportivecare
• Maintainvitalsigns
• Preventharm!!!!!!
• Useindicatedantidotesandtherapies
• Treatseizureswithbenzodiazepines,pyridoxine, barbiturates, NOT phenytoin
• CALLPOISONCONTROL....theyaretheexpertsand will guide you through the treatment of any poisoning or suspected poisoning, they are your biggest asset in the treatment of your patient, additionally they will follow your patient after discharge and keep records of poisonings in your area |
|
Definition
|
|
Term
• Bloodglucose,metabolicpanel
• EKG
• Screeningserumtoxicology(acetaminophen,salicylate)
• Focusedserumtoxicology;digoxin,theophylline,anti- convulsants
• Drugofabusescreeningisrarelyindicated |
|
Definition
|
|
Term
• Acetaminophen
• Anticonvulsants (carbamazepine, phenytoin,Valproic acid)
• Barbiturates
• Caffeine
• Carbonmonoxide (COHb)
• Digoxin
• Ethanol
• Ethyleneglycol
• Lead
• Iron
• Lithium
• Methanol
• Methemoglobinemia • Methotrexate
• Salicylate
• Theophylline |
|
Definition
|
|
Term
• Thereisnostandarddefinitionof“toxicologyscreening” • Thisisasenselesstermthatyoushouldavoidusing
• Someinstitutionscanscreenforhundredsofdrugs
• Generallymeansqualitativedetectionofspecificdrugs • Mostfrequentlyintendedtomeandrugofabusetesting
• OSHA5
– Amphetamine
– Benzoylecgonine(cocaine)
– Morphine(opioids)
– Phencyclidine
– Tetrahydrocannibol(marijuana) |
|
Definition
|
|
Term
• Remember Lab Medicine when you order tests
• Neither comprehensive TS nor drug of abuse screening improves patient management
• Comprehensive screening costs $2,315 per patient |
|
Definition
| Toxicology Screen Literature |
|
|
Term
• GI exposure
– Most common route (75% of toxic exposures) – Prevent absorption
• Topical exposures – Remove clothing – Wash skin
• Enhance elimination – Whole bowel irrigation – Sorbitol
– Diuresis / ion trapping – Hemodialysis |
|
Definition
|
|
Term
• Indicatedforasubstancethatcanpotentiallyharm the patient
• Thebenefitofdecontaminationmustoutweighthe risk and unpleasantness
• Itispreferabletopreventthetoxicitythantotreatthe poisoned patient
– Activated charcoal
– Gastric lavage
– Whole bowel irrigation – Ipecac |
|
Definition
| Gastrointestinal Decontamination |
|
|
Term
• Absorbs most drugs well/ Absorbs up to 60% of ingestant
• 1 gm/kg +/- Sorbitol
• Maximal effect if given early (<1 hr)
• Optimal 10:1 concentration AC:drug
• Will not bind metals, poorly binds hydrocarbons, alcohols, electrolytes, or acids
• Can cause vomiting, aspiration, constipation, GI obstruction
• Also enhances clearance from blood
• Possible aspiration/ poor patient compliance due to “gritty” taste
• Contraindications
• Depressed MS – Intubate to avoid aspiration • Bowel obstruction / perforation
• Acid/ alkali ingestion |
|
Definition
|
|
Term
• “Pumping the stomach”
• Early presentation of potentially lethal OD
• tricyclics, iron, CCBs, B-blockers
• Substance must be potentially harmful, particularly life threatening
• Substance must pass through oral-gastric tube
• Protect airway
• High Risk – aspiration / perforation / airway compromise |
|
Definition
|
|
Term
• Used for
• Lifethreateningingestion
• Bodypackers
• Poorlyabsorbedortoomassivedosefor charcoal binding (lithium, calcium channel blocker, iron)
• Polyethylene glycol solution (Golytely) • Role is not fully defined |
|
Definition
|
|
Term
• Induces vomiting & eliminates less than charcoal
• Cardiomyopathy risk |
|
Definition
|
|
Term
• ABC’s
• Identify (if possible) substances
• Reduce absorption
• Enhance elimination
• Specific antidotes (if possible)
– Relatively few but important to know
• Supportive care |
|
Definition
| Treatment Goals with Overdose |
|
|
Term
|
Definition
|
|
Term
| Anti-cholinergics antidote |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Ca channel blockers antidote |
|
Definition
| Glucagon, Insulin + dextrose, Calcium |
|
|
Term
|
Definition
| Digoxin antibodies, digibind |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Oral hypoglycemics antidote |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Methemoglobinemia antidote |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Digoxin, colchicine, crotalid antidote |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Tricyclic antidepressants and other sodium-channel blockers antidote |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Insulin reaction antidote |
|
Definition
|
|
Term
| neuromuscular blockage/paralytics antidote |
|
Definition
| anticholinesterase agents |
|
|
Term
• Substances that may be lethal to a child/elderly adult in a single or small dose
• A small quantity may be a large dose due to the child or elderly adult’s small mass
• Any suspected exposure to these substances should be managed with caution |
|
Definition
|
|
Term
• Preventing toxicity is preferable to treating it
• History and Physical Exam are key
• GI decontamination (prevent toxicity)
• Occasionally lab tests are indicated
• Usually only supportive care is necessary
• Occasionally, specific antidote/therapy is indicated |
|
Definition
|
|
Term
• Know your local number!
• Aid in management
• Educate public
• Educate health care providers • Monitor trends |
|
Definition
|
|
