We'll describe several clinical toxicology syndromes, that are certainly
favored by the boards...they are the core questions on almost every
exam.
Q: Which acid-base disturbance is most likely in SALICYLATE overdose?
A: A MIXED DISORDER of respiratory alkalosis (due to tachypnea) and
metabolic acidosis (due to uncoupling of oxidative phosphorylation).
Q: What type of acid-base disorder does ingestion of ETHYLENE GLYCOL cause?
A: Severe ANION GAP (AG) METABOLIC ACIDOSIS.
Q: Which medication is used as an antidote for BETA BLOCKER poisoning?
A: GLUCAGON....as this drug will increase HEART RATE, stroke volume and thus
cardiac output. (It is especially useful in a HYPOTENSIVE B-Blocker O.D. patient).
Q What is the metabolic cause of ORGANOPHOSPHATE poisoning?
A: This pesticide used by farms/orchards causes inhibition of the
CHOLINESTERASE ENZYME. (Diarrhea/vomiting/excessive lacrimation/
salivation and brochospasm are typically seen).
Q: What is the treatment of NARCOTIC overdose.
A: NALOXONE (Narcan). 0.4-2.0 mg for adults. Pediatric dose is 0.01 mg/kg.
(There is NO toxic dose for this drug, as it is safe to administer in larger
amounts).
Q: What rate is ALCOHOL metabolized in an acutely ETOH intoxicated patient?
A: Rate of breakdown metabolism is 20mg/dl per HOUR.
Q: What is the treatment of choice of moderate to severe LITHIUM TOXICITY?
A: HEMODIALYSIS. Especially in serum level greater 4.0 mEq/l. (Lithium
is very toxic and the therapeutic-toxic "window" is quite narrow. Level
greater the 2.0 mEq/l is already considered mild toxicity).
Q: In which medication overdose is the RUMACK-MATTHEW
NOMOGRAM used?
A: ACETAMINOPHEN (Tylenol) oversode. Serum acetaminophen (apap)
is measured at exactly 4 HOURS POST INGESTION. If the level is greater
then 150 mg/ml....treatment is initiated. (with N-Acetylcysteine IV or PO).
It is most effective, if given in first 8 hours post ingestion.
Thanks for your time, again. We'll be back soon with more and more challenging topics.
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