Notes in L10 Classic & Common Culprits in Intentional Self-Poisining

To Subscribe, use this Key

Status	Last Update	Fields
Published	06/22/2023	Acetaminophen (APAP) comes in different strengths and formulations • There are {{c4::immediate- and extended-release}} formulations. IR  …
Published	06/22/2023	Acute vs. Chronic APAP Ingestion • Acute overdose is arbitrarily defined as an {{c1::entire ingestion within a single 8-hour period.}} • Ch…
Published	06/22/2023	e919b5bca1db4137ad419c8ed0a0e04d-oa-1
Published	06/22/2023	e919b5bca1db4137ad419c8ed0a0e04d-oa-2
Published	06/22/2023	e919b5bca1db4137ad419c8ed0a0e04d-oa-3
Published	06/22/2023	e919b5bca1db4137ad419c8ed0a0e04d-oa-4
Published	06/22/2023	Analgesic Nephropathy from 5 oxoproline (pyroglutamic acid){{c1::Anion gap metabolic acidosis}} often develops in patients with acute acetaminophen he…
Published	06/22/2023	Analgesic Nephropathy from 5 oxoproline (pyroglutamic acid)The {{c1::ATP futile 5-oxoproline cycle}} causes nephrotoxicity
Published	06/22/2023	For acetaminophen the major target is your {{c1::liver.}}
Published	06/22/2023	Getting APAP LevelsPre-4 hour vs 4-hour levelGetting an APAP level 1 to 4 hours after ingestion may be helpful only to exclude ingestion of APAP (that…
Published	06/22/2023	What is the Rumack-Matthew Nomogram?The Rumack-Matthew nomogram is used to determine the risk of APAP-induced hepatoxicity after a {{c1::single ac…
Published	06/22/2023	What do serum concentrations above the treatment line on the Rumack-Matthew Nomogram indicate? It indicates the need for {{c1::N-acetylcysteine (N…
Published	06/22/2023	When is the APAP Rumack-Matthew Nomogram not applicable?If {{c1::time of ingestion is unknown}} or if {{c1::ingestion spans more than 24 hours}}
Published	06/22/2023	How do we determine Hepatotoxicity Risk if Nomogram isnt applicable? We screen with labs (APAP concentration, hepatic function tests, renal funct…
Published	06/22/2023	Laboratory Assessment for APAP  (Tylenol) intoxication:  • {{c1::APAP}} Levels • Assess Labs for {{c2::Hepatic Injury}}   &nbsp…
Published	06/22/2023	How do we administer APAP treatment? • GI decontamination:Generally not useful due to rapid APAP absorption Activated charcoal may be useful i…
Published	06/22/2023	What is N-Acetyl Cysteine (NAC) Therapy? Mechanism of Action: • The non-toxic route of APAP metabolism gets saturated in overdoses, which leads to …
Published	06/22/2023	NAC has a hepatoprotective effect. NAC augments {{c1::sulfation}} NAC is a {{c2::glutathione (GSH}}) precursor NAC is a {{c3::glutathione…
Published	06/22/2023	NAC Administration: • Treatment should begin within {{c1::8 hours of ingestion}} or as soon as possible after ingestion. The two possible routes a…
Published	06/22/2023	Oral (Mucomyst®) NAC Administration: • {{c1::72-hour}} regimen: Consists of 18 doses (1 loading dose and 17 maintenance doses) • Repeat dose if …
Published	06/22/2023	• IV (Acetadote ®) NAC Administration: • {{c1::21-hour regimen}}: Consists of 3 components Loading dose over 1 hour Second dose over 4 hour…
Published	06/22/2023	WHat criteria do we abide by for predicting the need for hepatic transplant?{{c1::King's College Criteria}}
Published	06/22/2023	King’s College Criteria for predicting the need for hepatic transplant: • PERSISTENT {{c1::LACTIC ACIDODIS}} • Serum pH {{c2::<}} 7.3 or lac…
Published	06/22/2023	{{c1::5oxoproline}} depletes your ATP in locations where it's metabolized
Published	06/22/2023	What are free radicals?  {{c1::Unpaired electrons}}, so they like to bind to charged particles.  Many charged particles are in your DNA, so …
Published	06/22/2023	WHat did the UK revision of the Normogram result in? Following an exhaustive review process, the MHRA recommended a revised use of the nomogram, no…
Published	06/22/2023	• For patients with acute APAP overdoses, use the {{c1::Rumack-Matthew Nomogram}}.        • Plot a {{c2::single [APAP]}} onto…
Published	06/22/2023	For patients with chronic APAP overdoses (repeated supratherapeutic ingestions), treat with NAC if:             &n…
Published	06/22/2023	NAC shouldn’t be given as a set length protocol. An informed decision should be made when stopping NAC, which requires assessing that th…
Published	06/22/2023	Aspirin is widely available over the counter and found in many medications and formulations • Examples: Oil of {{c1::Wintergreen}}, Bismuth Subs…
Published	06/22/2023	What is the Mechanism of Action for salicylates (aspirin)? • Analgesic, antipyretic, anti-inflammatory properties due to {{c1::inhibition of cycloo…
Published	06/22/2023	When considering ASA (aspirin) history what do we ask? • Consider {{c1::co-ingestions}}, and ask patient about any other pills/drugs taken• Ask abo…
Published	06/22/2023	What is the ASA  (aspirin) exam? • In acute ingestions early symptoms of toxicity include: t{{c1::innitus, tachypnea, hearing loss, dizziness,…
Published	06/22/2023	What is Chronic Toxicity History from ASA? Important to ask patients (especially elderly) about {{c1::chronic/repeated salicylate ingestion}} as …
Published	06/22/2023	What is the ASA poisining differential?We consider {{c1::toxicologic and non-toxicologic}} causes of ASA poisining
Published	06/22/2023	What do Lab ASA diagnostics look like? • Salicylate Serum Concentration         • Acute Ingestion:        …
Published	06/22/2023	How does imaging work for ASA diagnostics? • {{c1::Chest X-Ray}}        • Obtain if any clinical signs pulmonary edema • …
Published	06/22/2023	What is the treatment for Salicylate Poisoning? • ABCD      1.• {{c1::Airway/Breathing}}     • Avoid intubation …
Published	06/22/2023	What is the Mechanism of Action for Plasma and Urinary Alkalinization for Salicylate Elimination? Mechanism of Action • ASA is a {{c1::weak acid …
Published	06/22/2023	Hemodialysis • Standard of care for those patients who are {{c1::critically ill, altered mental status, have renal failure, or pulmonary edema&n…
Published	06/22/2023	A TCA is also known as a {{c1::Tricyclic Antidepressant}}
Published	06/22/2023	What are TCA's Mechanism of Toxicity • TCAs alter the conformation of the {{c1::sodium channel}} and slow the {{c1::rate of rise of the action pote…
Published	06/22/2023	What are the Toxic Effects of TCA poisoning? Acute overdose of most TCAs cause {{c1::cardiovascular and CNS}} toxicity. Signs of acute cardiov…
Published	06/22/2023	WHat do TCA's mainly do?TCAs are mainly {{c1::sodium channel}} blockers but they also act on youracetylcholine receptors and alpha receptors.The main …
Published	06/22/2023	What is the General Treatment Approach to TCA Poisoning: If the decision is made to intubate, avoid apnea, pretreat w {{c1::benzos}} to raise sei…
Published	06/22/2023	TCAs are {{c1::sodium channel blockers}} and primary treatment of TCA poisoning is {{c2::sodium bicarb}}. The EKG abnormalities lik…
Published	06/22/2023	Physostigmine, is what we use to treat, what? It's used to treat {{c1::anticholinergic}} poisoning.
Published	06/22/2023	Physostigmine like most things that end in stigmine are{{c1::tertiary}} compounds where they have three things bound to it'snitrogen versus neostigmin…
Published	06/22/2023	Physostigmine, a Tertiary Cholinesterase Inhibitor Causes Cholinergic effects and Can Reverse Anticholinergic Delirium • Cholinergic Effects: •…
Published	06/22/2023	The below list are all examples of Absolute Contraindications for {{c1::Administering Physostigmine}} • Salicylate allergy (depending on the …
Published	06/22/2023	In 1980, a case series of {{c1::two}} patients experiencing catastrophic complications after receiving physo for TCA poisoning was published …
Published	06/22/2023	Reversing the Physostigmine Dogma:In the decades since the 2 cases regarding Phystostigmine causes a stigma surrounding utilizing it for treatment, no…
Published	06/22/2023	If TCA delirium is the most major issue for your patient, {{c1::physostigmine}} is likely the correct treatment.
Published	06/22/2023	Prioritizing the Treatments for TCA and Anticholinergic Poisoned Patients  If you have a critically ill patient, priorities are i{{c1::ntu…
Published	06/22/2023	Treat the Clinical Picture Not Necessarily the Specific Drug If a patient comes into the ED with hypotension, a wide QRS, and seizures, whethe…
Published	06/22/2023	Treat the Clinical Picture Not Necessarily the Specific Drug • If a patient arrives with mumbled speech, a normal blood pressure, carphologia, and …
Published	06/22/2023	WHat is Libby Zion Associated with?{{c1::Seratonin}} Syndrome
Status	Last Update	Fields