Acetaminophen OD
Antidote: N-acetylcysteine (Acetadote, Mucomyst) |
Stg1 (<24h): asymp or a/n/v, malaise. Labs: (~12hr) Elevated LFTs (ALT, AST). |
Stg 2 (1-3d): a/n/v, RUQ pain; tachycardia, hypotension (fld loss). Labs: Elevated ALT, AST, PT, INR, bili, possible nephrotoxicity/renal function abn. |
Stg 3 (3-4d): n/v/pain, tender liver, coma; multi-organ failure; hepatic probs- jaundice, coagulopathy, hypoglycemia, hepatic enceph; possibly act renal failure & death. Labs: severe hepatotoxicity evident, hepatic necrosis (liver biopsy dx). |
Stg 4 (4d-3wk): Complete resolution of symptoms & hepatic dysfunction |
Anticholinergics
Antidote: Physostigmine |
Hyperthermia, tachycardia, wide pulse pressure, arrhy, circ collapse, resp distress |
Central: agitation, ataxia, auditory/visual hallucinations, cogn decline, come (late), confusion, delirium, diminished concentration, forgetfulness, fatigue, poor coordination, restlessness, sedation, seizures |
Decreased secretions: gastric & lacrimal, dry mouth, dry skin (no sweating) |
GI/GU: hypoactive bowel sounds, constipation, ileus, urinary ret |
Ocular: blurred vision, mydriasis, precip narrow-angle glauc |
SM: dysarthia, m twitching, diminished m tone (late) |
CCBs
Antidote: Calcium chloride/gluconate, Glucagon, Insulin/glucose |
Cholinergics
Antidote: Atropine, Pralidoxime |
Etiology: Physostigmine, Pilocarpine, Pyridostigmine |
DUMBELLSS: Dia, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Lethargy, Salivation, Seizures |
Complications: resp failure (rapid onset), seizure, dehydration, neurological sequlae |
Killer B's: Bradycardia, Bronchorrhea, Bronchospasm (wheezing) |
n/v/cramps, increased secretions; conduction abn (AVB, cardiac arrest) |
Tx: |
Cyanide Poisoning
Antidote: Methylene blue, Cyanide antidote kit (Liliy Kit), Hydroxycobalamin (Cyanokit), Amyl nitrite, Sodium nitrite, Sodium thiosulfite |
Early: HA, anxiety, confusion, tachypnea, tachycardia |
Late: Alt LOC, seizures, hypoventilation, hypotension, dysrhy (AVB, VF, SVT) |
Nursing |
Monitor methemoglobin levels (shouldn't exceed 20%) |
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Digoxin Toxicity
Therapeutic Dose: 0.8-2.0 |
Antidote: Digoxin FAB (Digibind) |
GI/GU: a/n/v/d, abd pain (late sign), excessive nocturia |
Neuro: HA, fatigue, weakness, confusion, delirium |
Visual: green-yellow halos around images/lights, alt color perception, blurred or double vision, seeing spots, photophobia |
CV: irreg pulse, palps; |
EKG: ST seg dpr, inverted T, sinus brady; VT/F/flutter; Paroxysmal atrial tach; Sinoatrial, bundle branch, or AV block |
Other Tx: Lidocaine, Atropine (bradycardia), Dilantin |
Heavy Metal Poisoning
(Arsenic, Copper, Lead, Mercury) |
Antidote: EDTA, Succimer (DMSA), Dimercaprol, Penicillamine |
Lead Poisoning
Antidote: Edetate disodium (EDTA), Dimercaprol (BAL), Succimer (CHEMET) |
HA. ataxia, tremors, convulsions, vertigo, hearing loss, delusions, insomnia, irritability, aggressive behavior, attention probs |
Distal neuropathy, paresthesia, reduced sensation, muscle weakness |
Poor appetite, abd pain, constipation, anemia |
Delayed growth, reduced IQ, loss of developmental skills |
Lithium Toxicity
Therapeutic range: 0.6-1.0 |
Etiology: OD, volume depletion, reduced GFR, med interactions (ACEIs, NSAIDs, Thiazide diuretics) |
Mild (<1.6): n/v/d, apathy, irritability, impaired memory, lethargy, proximal muscle weakness |
Mod (<2.5): (neurotox) confusion, drowsiness, blurred vision, slurred speech, progressing tremor, unsteady gait, incont |
tremors, fasciculations, clonus, ataxia, dysarthria, hyperreflexia; stupor, coma, seizures |
Severe (>2.5): (nephrotox) nocturia, distal tubular acidosis, seizure, coma, (cardiotox) ST changes, QT prolong, flat T, hypotension, conduction delay, dysrhy (VT), CV collapse, |
SILENT (syndrome of irreversible lithium-effectuate neurotoxicity): after d/c lithium >2min; truncal ataxia, ataxic gait, scanning speech, incoordination |
Tx: Li levels q2-4h, IV fluids (bolus + 1.5-2x maintenance), bowel irrigation w/PEG for severe acute ingestion; Hemodialysis if severe tox, renal insuff + Li >2.5, Li >4 |
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Heparin Overdose
Antidote: Protamine Sulfate |
Ethylene glycol
Antidote: Fomepizole (Antizol) |
Benzodiazepine Overdose
Antidote: Flumazenil 0.1 mg/min infusion to 1 mg |
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