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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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Toxicology

  • 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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  • 54.
  • 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.