Sympathomimetics
Sxs:
Agitation
Seizures
Mydriasis
Tachycardia
Hypertension
Diaphoresis
Pallor
Cool skin
Fever
Agents:
Albuterol/ Terbutaline
Amphetamines
Cocaine
Methamphetamines
PCP
Theophylline
Caffeine
Catecholamines
Ketamine
Cholinergics
Sxs:
(DUMBBELS)
Diarrhea
Urination
Miosis
Bradycardia
Bronchorrhea
Emesis
Lacrimation
Salivation
Agents:
Organophosphates
Pesticides
Carbamates
Nerve agents
Opiods
Sxs:
Respiratory depression
Coma
Miosis
Bradycardia
Hypotension
Constipation
Agents:
Morphine
Methadone
Codeine
Anticholinergics
Sxs:
Agitation
Delirium
Coma
Mydriasis
Dry mouth
Flushed skin
Tachycardia
Hypertension
Fever
Urinary retention
Agents:
Antihistamines
Atropine
Carbamazepine
Cyclic antidepressants
Jimson weed
Oxybutynin
Phenothiazines
Scopolamine
Important Antidotes
Drug
Benzos
Iron
Opiates
Organophosphates
Phenothiazines
Insulin
Isoniazid
B-Blocker, CCB
Method of Removal
Dialysis
Urinary alkalinization w/ Na Bicarbonate
Antidote
Flumazenil
Deferoxamine
Naloxone
Atropine
Benadryl
Dextrose
Pyridoxine
Glucagon
Indication
Toxic alcohols, salicylates, Theophylline, Atenolol, Lithium Valproic acid
Methotrexate, chlorpropamide, Salicylates, phenobarb
Tylenol, salicylate, iron ingestions
**Call poison control for all ingestions. They will fax important information to you re: symptoms and treatment.
Consider ingestions in all cases of altered mental status.
Calculate anion and osmolar gap for all suspected ingestions.
Tylenol ingestion
Toxic range: 200 mg/kg or 10 g
- Obtain levels and LFTs – do not wait to treat until levels return if concerning amount of drug was ingested. Continue to monitor frequently.
- Plot on Rumack-Matthew nomogram to determine potential for toxicity.
- N-acetylcysteine (NAC) therapy administered over 20 hours. Give 150 mg/kg loading dose over 15 minutes, then 50 mg/kg over 4 hours, followed by 100 mg/kg over remaining 16 hours.
- Know the stages of toxicity
- Stage I (12-24 hrs) – N/V or asymptomatic
- Stage II (> 24 hrs) – Transaminase elevation occurs
- Stage III (48-72 hrs) – Liver fxn abnormalities peak, N/V/anorexia return
- Stage IV- Recovery phase
Salicylate ingestion
Toxic range: >150 mg/kg (Symptoms more important than level)
Sx: Respiratory alkalosis, N/V, tinnitus, lethargy, coma
- Obtain and monitor levels.
- Alkalinize the urine to enhance elimination.
- Consider dialysis if needed.
Iron ingestion
Toxic range: 60 mg/kg elemental iron
- Monitor levels and watch for symptoms. If > 6 hrs Goes by w/o sxs, unlikely to become toxic. Watch for metabolic acidosis.
- Consider deferoxamine if level > 500 mcg/dL or if CV collapse, otherwise supportive cares.
- Know phases of iron toxicity.
- Stage I (w/in 30 mins) – N/V/D, hematemesis or hematochezia
- Stage II- GI sxs resolve, nonspecific malaise. Tachycardia and acidosis may develop.
- Stage III (>12 hrs) – Hemodynamic instability & shock
- Stage IV – Liver failure
Metabolic Acidosis (anion gap >12)
- Methanol
- Uremia
- DKA
- Paraldehyde
- Isoniazid / iron
- Lactic acidosis
- Ethanol / ethylene glycol
- Salicylates
Agents not absorbed by charcoal
- “Charcoal PHAILS”
- Pesticides
- Hydrocarbons
- Acids/ alkalis/ alcohols
- Iron
- Lithium
- Solvents