Study Set Content:
Vinyl
Ethchlorvynol
Wintergreen
Methylsalicylate
Number of agents or which detection is possible in the rapid-turnaround clinical setting is extremely() compared with the number of possible agents that can poison patients.
limited
This further emphasizes the importance of recognizing clinical syndromes or poisoning and or the clinical toxicologist to initiate general treatment and supportive care or the patient with poisoning from an
unknown substance
Predictive relationships of drug plasma concentration and clinical outcome and/or suggested concentrations that require () are available or several agents including salicylates, lithium, digoxin, iron, phenobarbital, and theophylline. Some authors have identified “action levels” or toxic threshold values or the measured plasma concentrations of various drugs or chemicals.
therapeutic interventions
difference between the serum Na ion concentration and the sum of the serum Cl, and HCO3 ion concentrations. A normal anion gap is < 12. When there is laboratory evidence of metabolic acidosis, the finding of an elevated anion gap would suggest systemic toxicity from a relatively limited number of agents. (for example alcohol and iron).
Anion gap
numerical difference between the measured serum osmolality and the serum osmolarity calculated from the clinical chemistry measurements of the serum sodium ion, glucose, and blood urea nitrogen (BUN) concentrations. The normal osmol gap is < 10 mOsm. An elevated osmol gap suggests the presence of an osmotically active substance (methanol, ethanol, ethylene glycol, and isopropanol) in the plasma that is not accounted for by the sodium ion, glucose, or BUN concentration.
Osmol gap
Limited due to lack of radiopacity. Generally, plain radiographs can detect a significant amount of ingested oral medication containing ferrous or potassium salts. In addition, certain formulations that have an enteric coating or certain types of sustained release products are radiopaque as well.
Radiographic Examination
The most useful radiographs ordered in a case of overdose or poisoning include the:
o Chest radiograph o Abdominal radiog
Four primary methods to prevent continued absorption of an oral poison are:
Induction of emesis with syrup of ipecac
Gastric lavage
Oral administration of activated charcoal
Whole bowel irrigation
Use or induction of emesis in the treatment of a potentially toxic ingestion has declined due to risk of cardio- and neurotoxicity and lower effectiveness at removing the toxicant than desired limit its use
Induction of emesis with syrup of ipecac
- involves placing an orogastric tube into the stomach and aspirating fluid, and then cyclically instilling fluid and aspirating until the effluent is clear, is limited by the risk of aspiration during the lavage procedure and evidence of limited effectiveness.
Gastric lavage
Results in enhancement of the renal clearance of weak acids. The basic principle is to increase the pH of urinary filtrate to a level sufficient to ionize the weak acid and prevent renal tubule () o the molecule (ion trapping)
reabsorption
Method is not used because acute renal failure and acid– base and electrolyte disturbances are associated with
acidification
Cannot pass through the dialysis membrane; others are distributed mainly to the tissues and so are not concentrated in the blood, making dialysis impractical.
Hemodialysis
Similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. Direct contact with adsorptive material (usually activated charcoal).
Hemoperfusion
Hemoperfusion
Thrombocytopenia, hypocalcemia, and leukopenia.
Ultrafiltrate of plasma is removed by hydrostatic pressure from the blood side of the membrane. The perfusion pressure or the technique is generated either by the patient’s blood pressure (for arteriovenous hemofiltration) or by a blood pump (for venovenous hemofiltration).
Hemofiltration
Removal of ()and replacement with frozen donor plasma, albumin, or both with intravenous fluid.
plasma
Mostly confined to inadvertent drug overdose in a
neonate or premature infant.
