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Critical Care Toxicology Lecture Overview

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Andrew Ferguson

1) The document discusses various toxidromes including anticholinergic, cholinergic, sympathomimetic, narcotic, and serotonergic toxidromes. 2) It outlines the essential investigations for potential drug overdoses including calculating the anion gap, serum osmolality, and osmolar gap. 3) The management of common overdoses is discussed, including toxic alcohols, acetaminophen, TCAs, and serotonin syndrome. Some overdoses may require dialysis.

Santé & Médecine
1  sur  56
Toxicology Dalhousie Critical Care Lecture Series
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Overdose ,[object Object],[object Object],[object Object],[object Object],[object Object]
Overdose ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis - History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis - PE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Increased Osmolal Gap ,[object Object],[object Object],[object Object],[object Object]
Toxicology Critical Care Lecture Series
What is a toxidrome? ,[object Object],[object Object],[object Object]
Anticholinergic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anticholinergic Toxidrome - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cholinergic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cholinergic Toxidrome - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sympathomimetic (adrenergic) toxidrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cocaine, MDMA (“ecstasy”), Amphetamines, Phencyclidine (PCP), Theophylline, Decongestants ( Ephedrine Pseudoephedrine Phenylpropanolamine), Caffeine (very large doses)
Adrenergic Toxidrome - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Narcotic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid-Narcotic Toxidrome - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Serotoninergic Toxidrome Eg. SSRI’s, MAOI’s, ecstasy Diarrhoea, trismus, myoclonus, tremor, rhabdo Other Normal/decreased (SIADH possible) Urination Increased Bowel sounds Increased Reflexes Normal/flushed/sweating Skin Normal Mucous membranes Normal/unreactive Pupils Agitated/irritable Mental status Physical examination Normal/decreased Blood pressure Increased Temperature Increased Heart rate Normal/increased Respiratory rate Vital Signs
Serotoninergic Toxidrome - Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sternbach H. The serotonin syndrome. Am J Psychiatry 1991;148:705-13 Mills KC. Serotonin syndrome. Am Fam Physician 1995;52:1475-82
Serotoninergic Toxidrome - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis - Investigation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Activated Charcoal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Activated Charcoal ,[object Object]
Activated Charcoal ,[object Object],[object Object],[object Object],[object Object]
AC: problem ,[object Object],[object Object]
Drugs and Extracorporeal Removal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Urinary Alkalinisation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Specific Ingestions
Acetaminophen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acetaminophen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acetaminophen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acetaminophen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alcohols ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ethylene Glycol ,[object Object],[object Object],[object Object],[object Object],Ethylene glycol ETOH dehydrogenase Oxalic acid
Ethylene Glycol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methanol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methanol ETOH dehydrogenase Formic Acid
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Isopropanol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Isopropanol ETOH dehydrogenasez Acetone
Salicylate Intoxication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Salicylate Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Salicylate Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TCA Intoxication ,[object Object],[object Object],[object Object],[object Object]
TCA - Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TCA - Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
B-Blocker Overdose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 -blocker Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ca channel Blocker OD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ca Channel Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CO poisoning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CO poisoning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CO poisoning - Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CO Poisoning - Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antidotes Naloxone Opioids Atropine, pralidoxime Organophosphates Methylene blue Methaemoglobinaemia Ethanol/fomepizole, folate Methanol Pyridoxine Isoniazid Deferoxamine Iron Dextrose, glucagon, ocreotide Hypoglycaemic agents Dimercaprol, EDTA, penicillamine Arsenic, copper, gold, lead, mercury Ethanol/fomepizole, thiamine, pyridoxine Ethylene Glycol Digoxin-specific antibodies Digoxin Amyl nitrite/sodium nitrite/thiosulphate ( Taylor Cyanide Antidote Package) hydroxycobalamin Cyanide Oxygen Carbon Monoxide Flumazenil Benzodiazepines Atropine Anticholinesterases Physostigmine Anticholinergics N-acetylcysteine Acetaminophen Antidote Toxin/effect
Summary ,[object Object],[object Object],[object Object],[object Object]

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Critical Care Toxicology Lecture Overview

  • 1. Toxicology Dalhousie Critical Care Lecture Series
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  • 8. Toxicology Critical Care Lecture Series
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  • 18. Serotoninergic Toxidrome Eg. SSRI’s, MAOI’s, ecstasy Diarrhoea, trismus, myoclonus, tremor, rhabdo Other Normal/decreased (SIADH possible) Urination Increased Bowel sounds Increased Reflexes Normal/flushed/sweating Skin Normal Mucous membranes Normal/unreactive Pupils Agitated/irritable Mental status Physical examination Normal/decreased Blood pressure Increased Temperature Increased Heart rate Normal/increased Respiratory rate Vital Signs
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  • 55. Antidotes Naloxone Opioids Atropine, pralidoxime Organophosphates Methylene blue Methaemoglobinaemia Ethanol/fomepizole, folate Methanol Pyridoxine Isoniazid Deferoxamine Iron Dextrose, glucagon, ocreotide Hypoglycaemic agents Dimercaprol, EDTA, penicillamine Arsenic, copper, gold, lead, mercury Ethanol/fomepizole, thiamine, pyridoxine Ethylene Glycol Digoxin-specific antibodies Digoxin Amyl nitrite/sodium nitrite/thiosulphate ( Taylor Cyanide Antidote Package) hydroxycobalamin Cyanide Oxygen Carbon Monoxide Flumazenil Benzodiazepines Atropine Anticholinesterases Physostigmine Anticholinergics N-acetylcysteine Acetaminophen Antidote Toxin/effect
  • 56.