1Ingestions are most commonly seen in children _____ y.o, but _____ y.o are the highest risk age group for ingestions.
- < 3
- < 5
2Ingestions in the Pre-adolescent age group- ____ y.o; are more commonly _____
- < 12 y.o
- Males
3Ingestions in the adolescent age group are more commonly _____
- Females
4Activated Charcoal dose in children up to 1 y.o= _____. can be repeated _____
- 1 g/kg/dose (10-25 grams)
- q4-6 hours
5Activated Charcoal dose in children 1-12 y.o= ______. can be repeated
- 1-2g/kg/dose (25 to 50 grams)
- q4-6 hours
6Activated Charcoal dose in children >12 y.o= _____ to _____ grams PO
- 50 to 100 grams
7Activated Charcoal is most helpful within _____ of ingestion
- 1 hour
8Contraindications for activated charcoal= ______, _______, & ______
- Mental status, timing, substance
9Toxic exposure substances with high risk of death include ______, ______, ______, _____, & ______
- Analgesics
- Sedative-hypnotics
- Alcohols
- Gases & fumes
- Cleaning substances
10Tylenol antidote (oral & IV)
- N Acetylcysteine (IV)
- Mucomyst (Oral)
11Antidote for Anticholinergics
Physostigmine
12Antidote for Beta Blockers
Glucagon, Catecholamine
13Antidote for Carbon Monoxide
Oxygen
14Antidote for Cyanide
- Amyl Nitrate
- Na Nitrate
- Na Thiosulfate
15Antidote for Ethylene Glycol
- Dialysis
- Fomepizole
- Ethanol
16Antidote for Iron
Desoferoxamine
17Antidote for Isonizad
Pyridoxine
18Antidote for Lead/Heavy Metals
- DMSA
- BAL
- EDTA
19Antidote for Methemoglobin producing agents
Methylene blue
20Antidote for Organophosphates
Atropine
21Antidote for Phenothiazines
Benadryl
22What triggers would lead you to think ingestion?
- At risk age group: < 6 y.o
- acute AMS, arrhythmias, hypotension w/ no other signs of shock, metabolic acidosis
23_____ hrs after Acetaminophen ingestion is when we see _____
- Elevated liver function tests (AST, ALT, & GGTs)
24Peak toxicity for acetaminophen ingestion is seen at ______ & presents as ______, ______, & ______
- 72 hrs
- Encephalopathy, liver failure and Coagulopathy
25Ethylene glycol is used in _______ & has a _______ that makes it attractive to small children.
- Antifreeze
- Sweet taste
26The 2nd stage of iron toxicity is called the _____ phase and occurs ____ to _____ after ingestion. In this phase the pt will have ______ s/s initially and then ______ but can _____
- Latent
- 6 to 24 hours
- GI s/s
- Improve
- Deteriorate
27Ethylene Glycol poisoning presentation includes ________, ________, severe ________, and _______ on urinalysis
- decreased sensorium
- obtunded
- severe metabolic acidosis
- calcium oxalate crystals
28Mild Iron toxicity = _____ μg/dL
< 300 μg/dL
29Moderate Iron toxicity = _____ μg/dL
300‐500 μg/dL
30Sever Iron toxicity = _____ μg/dL
> 500 μg/dL
31The third stage of iron toxicity usually occurs ____ to _____ hours post-ingestion. S/S seen in this stage include ______, ______, _____, & ______
- 12 to 48
- Coagulopathy, Hepatic dysfunction, cardiomyopathy, and renal failure
32_______ & _______ are treatments for coagulopathy caused by iron toxicity
- Vitamin K and fresh frozen plasma
33Hydrocarbon ingestions can lead to ________ or __________ due to the high volatility and low viscosity of these substances.
- chemical pneumonitis or acute respiratory distress syndrome
34Radiographic pulmonary findings of hydrocarbon aspiration can be delayed, a chest x-ray may be recommended after ________
- 4 - 6 hours of observation
35After alkali ingestion (bleach) have the child....
drink water or milk to dilute the ingested bleach within 4 to 5 minutes of ingestion
36A tylenol level _____ μg/mL at 4 hours from ingestion is considered toxic
>140 μg/mL
37The most likely presentation after an overdose of TCAs is _______. During the early phase, one may develop ______, _____, & even ______
- seizures
- chest pain, palpitations, and even hypotension.
38The physical exam for TCA toxicity should focus on _______. The patient may have ______, ______, _____, _____, & ______
- Cardiotoxicity
- altered mental status, hypotension, ileus, rigidity, and dry skin.
39 The most characteristic acid-base abnormality seen in salicylate toxicity is _______ w/ _______. This occurs d/t......
- respiratory alkalosis with metabolic acidosis.
- Respiratory alkalosis occurs because of an increased respiratory rate.
- Metabolic acidosis occurs because of increased lactic acid production.
40Definitive management for salicylate toxicity is _______
- sodium bicarbonate infusion
41What is the most common cause of death following TCA ingestion?
Arrhythmia
42The most prominent electrocardiographic manifestation of TCA toxicity is the _________
widening of the QRS
43The immediate management of TCA overdose is to get a ______
- 12-lead EKG
44_______ should be given for TCA overdose to ______ patients, patients with ______, and _______ of more than _____. This med is given as a ______, followed by _____
- Sodium bicarbonate
- hemodynamically unstable
- seizures
- QRS prolongation of more than 100 msec.
- 1 meq/kg bolus
- Sodium bicarb MIVF
45Acute Tylenol tox dose in young kids = _____; adult/adolescents= _____
-150-200 mg/kg ingestion in young kids
->7.5 gm in adult/adolescents
461. A child presents to the ED lethargic and hypotensive and is suspected to have consumed antifreeze. What treatment would likely be indicated?
- Fomepizole is indicated for known or suspected ethylene glycol or methyl alcohol intoxication to inhibit alcohol dehydrogenase production
47Antifreeze is most likely an ethylene glycol exposure and is often ingested by toddlers because of its
attractive color and sweet taste.
48Ethanol intoxication can cause profound
hypoglycemia, and is often delayed in presentation.
49The peak toxicity for an acetaminophen overdose occurs at
72 hours postingestion. In severe cases, encephalopathy, liver failure, coagulopathy, and even death may occur.
50Discontinuing the gingko biloba prior to surgery is recommended due to which of the following risks associated with its use?
Inc. bleeding risk
51Which of the following factors can increase the incidence of lactic acidosis with metformin overdose?
Preexisting renal insufficiency
52Which of the following laboratory studies is needed to evaluate a patient with a metformin overdose?
Lactic acid level and pH level
53What are the most common symptoms associated with a calcium channel blocker ingestion?
- Hypotension, bradycardia, altered mental status.
- Other: bradydysrhythmias, ileus, seizure, coma, and noncardiogenic pulmonary edema
54Ingestion of metoprolol, a β-blocker antihypertensive agent, is commonly associated with
hypotension, bradycardia, bronchospasm, and death
55Muscarinic symptoms of cholinergic excess include
salivation, lacrimation, urination, defecation, GI cramps, and emesis (mnemonic = SLUDGE)
56What symptoms can be anticipated when a child experiences an accidental clonidine ingestion?
bradycardia, hypotension, CNS depression, and respiratory depression.
57Due to its stimulant effects, it is recommended that _____ not be combined with caffeine.
ginseng
58Which of the following antidotes used for organophosphate poisoning will prevent aging of cholinesterase?
c. Pralidoxime.