MD1TALK
Poisoning 🌟
Common reasons for ingestions:
I. Children <5 y: Unintentional
II. Teens: intentional (suicide attempt, drug abuse)
Historical findings:
1) History may not be accurate if intentional, unwitnessed,
2) Drug(s), dose, type (sustained release, enteric coated), time of
ingestion
Toxidrome: Signs and symptoms suggest specific poisoning
Sympathomimetic Toxidrome (MATHS) :
mydriasis(responses to light) , agitation, tachycardia, hypertension,
hyperthermia, sweating and seizure
Anticholinergics Toxidrome:
mydriasis (sluggish light response*cycloplegia*), agitation, tachycardia,
hypertension, hyperthermia, skin is dry , bowel inactive (dry
as stone and bowel run alone)✨
Opioids and barbiturates Toxidrome(CPR 3H):
coma - pin point pupil - respiratory depression - hypothermia -
hypotension - hyporeflexia.
Cholinergic toxidrome (DUMpLS BBB)
Lab according to clinical status;
1) Urine toxicology screen: mostly illicit drugs
2) Serum toxicology screen: acetaminophen, salicylate, ethanol
General Management
1) Supportive care (mainstay of therapy)
2) Specific therapy will depend on toxin.
3) Decontamination:
A. Activated charcoal :
- Does not adsorb (HACI.H) heavy metals, alcohols,
corrosives, hydrocarbons, inorganic ions.✨
, MD1TALK
B. bowel irrigation: large-volume NS *balanced* usually given by NGT
C. Syrup of ipecac, no longer recommended
4) Antidotes.
DISEASE SPECIFIC
Acetaminophen poisining :
Most commonly used analgesic and antipyretic in children.
Pharmacokinetics
1) Metabolized in liver, excreted by kidney
2) Toxic dose 150 mglkg (after liver stores of conjugating agent
glutathione are used up → NAPQI accumulate → toxicity in
organs)
Peak serum concentration: 4 hours after ingestion → then
decrease into half each 4h.
Clinical features:
Stage 1(1st 24h after ingestion):
Vomiting ,nausea, lethargy, or asymptomatic; normal labs.
Stage 2 (1-2 days):
Poisoning 🌟
Common reasons for ingestions:
I. Children <5 y: Unintentional
II. Teens: intentional (suicide attempt, drug abuse)
Historical findings:
1) History may not be accurate if intentional, unwitnessed,
2) Drug(s), dose, type (sustained release, enteric coated), time of
ingestion
Toxidrome: Signs and symptoms suggest specific poisoning
Sympathomimetic Toxidrome (MATHS) :
mydriasis(responses to light) , agitation, tachycardia, hypertension,
hyperthermia, sweating and seizure
Anticholinergics Toxidrome:
mydriasis (sluggish light response*cycloplegia*), agitation, tachycardia,
hypertension, hyperthermia, skin is dry , bowel inactive (dry
as stone and bowel run alone)✨
Opioids and barbiturates Toxidrome(CPR 3H):
coma - pin point pupil - respiratory depression - hypothermia -
hypotension - hyporeflexia.
Cholinergic toxidrome (DUMpLS BBB)
Lab according to clinical status;
1) Urine toxicology screen: mostly illicit drugs
2) Serum toxicology screen: acetaminophen, salicylate, ethanol
General Management
1) Supportive care (mainstay of therapy)
2) Specific therapy will depend on toxin.
3) Decontamination:
A. Activated charcoal :
- Does not adsorb (HACI.H) heavy metals, alcohols,
corrosives, hydrocarbons, inorganic ions.✨
, MD1TALK
B. bowel irrigation: large-volume NS *balanced* usually given by NGT
C. Syrup of ipecac, no longer recommended
4) Antidotes.
DISEASE SPECIFIC
Acetaminophen poisining :
Most commonly used analgesic and antipyretic in children.
Pharmacokinetics
1) Metabolized in liver, excreted by kidney
2) Toxic dose 150 mglkg (after liver stores of conjugating agent
glutathione are used up → NAPQI accumulate → toxicity in
organs)
Peak serum concentration: 4 hours after ingestion → then
decrease into half each 4h.
Clinical features:
Stage 1(1st 24h after ingestion):
Vomiting ,nausea, lethargy, or asymptomatic; normal labs.
Stage 2 (1-2 days):
