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Toxic Ingestion (Alcohols (EtOH (Isopropyl (Ethylene Glycol (Methanol…

- - - - Ethylene Glycol
        
        Methanol
        
        Real redneck self made booze. Not available in stores.
        
        blindness :dark_sunglasses:
        
        :check:
        
        :check:
        
        Fomepizole
        
        EtOH infusion
        
        Antifreeze
        
        Tastes sweet :candy:
        
        :baby::skin-tone-3:peds accidental ingestion
        
        poor person who's looking for booze
        
        Renal failure
        
        contains flouricein dye, so can see glowing eyes :eyes: w/ Wood's lamp (pathognomonic)
        
        :check:
        
        :check:
        
        Fomepizole
        
        EtOH infusion
      - Rubbing alcohol: cleaner
        
        trying to get drunk, but can't get booze
        
        teenagers, poor people
        
        no
        
        :check:
        
        supportive
    - - no
        
        :check:
        
        supportive
- - - - :pencil2:Chronic max dose: 2g /day
        Acute max does: 3g /day
      - Dx: AST, ALT > 1000
        
        :warning:reflexively order acetaminophen drug screen
        
        complete at 4hr and 16hr from ingestion; compare to nomogram
        
        Above nomogram line?
        Tx: N-acetylcysteine
        
        Below nomogram line
        Tx: Observe :eyes:
        
        F/u: if develop fulminant hepatic failure = transplant :hocho: (not for intentional OD)
  - - - Path: ASA
        
        hard to unintentionally OD
        
        Early phase:
        
        Tinnitus
        
        nausea/vom
        
        Vertigo
        
        1º Respiratory Alkalosis
        
        (binds medulla, causes deep breaths)
        
        Late phase: AG Acidosis
        
        obdunded
        
        ±Hyperpyrexia:
        
        paradoxically high fever :fire::fire:
        
        Dx: Salicylate level
        
        Tx: Goal-get ASA out of body
        
        Bicarb! Alkalization of the urine.
        
        basic pharm, traps salicylate in urine
        
        Then Forced diuresis
    - - Path: Smoke inhalation :cloud:
        
        Pt: high Hb affinity >> O2
        
        SpO2 (pulse ox) = 100%
        :warning: Pt is hypoxemic
        
        HA,
        
        nausea/vomiting,
        
        delirium
        
        Dx: ABG
        
        measure carboxyhemoglobin
        
        Tx: Let carboxyhemoglobin wear off (takes 5hrs)
        
        decrease half-life by giving 100% FiO2
        
        possible role for hyperbaric chamber (unproven)
      - Cyanide :cloud:
        
        Path:
        
        Fires/smoke :fire::cloud:inhalation = #1 cause
        
        sodium nitroprusside is a rare academic consideration
        
        Consider CN- & CO for smoke, initial presentation cannot differentiate
        
        Pt: SAS, aerobic metabolism impaired.
        
        Lactic acidosis (really really ill)
        
        Obtunded
        
        Cherry red skin :cherries:
        
        Cherry red blood :cherries: on ABG
        
        Dx: Clinical
        
        Tx: Thiosulfate
        
        :warning: Avoid Amylnitrate. Amylnitrate is technically ok, but bad if CO poisoning too.. Most common cause of CN toxicity is smoke inhalation. Resultant methhemoglominemia worsens carboxyhemoglobinemia (CO poisoning)
        
        Organophosphate poisoning :tractor::male-farmer:
        
        Path: unintentional contact w/ pesticides
        
        or MG treatment (-stigmines)
        
        Blocks acetylcholine esterase, ACh always active at endplate
        
        later: irreversible inhibition of acetylcholine esterase
        
        Everything that can secrete, does
        
        Pt: SLUDGE
        
        Salivation :sweat_drops:
        
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