Toxicology

OBJECTIVE 9: TOXICOLOGY: Describe the general approach to the poisoned patient.

The Toxicology portion of the curriculum will be performed online. Watch the videos or refer to the Toxicology section on the CDEMcurriculum website. This provides just an introduction to discipline of Toxicology.

Introduction

Remember the phone number for the Illinois Poison Control Center: 1-800-222-1222. This video reviews the following:

  • How do you assess the primary survey
  • What initial actions should you complete
  • How can you get history

The solution to pollution is dilution.

Toxidromes

Your physical exam can be focused around toxic syndromes. What are the components of the following toxidromes?

  • Anticholinergic
  • Sympathimimetics
  • Sedative-Hypnotics
  • Opiates
  • Cholinergics
  • Serotonin Syndrome

Testing

Which tests do you order in your poisoned patients?

  • CBC, CMP, VBG, serum osmolarity
  • Urine drug screen?
  • Tylenol and aspirin level
  • Alcohols
  • EKG
  • x-rays: COINS

And don’t forget your calculations:

  • Anion Gap = Na – Cl – HCO3 :: (nl 8-12) → MUDPILES
  • Delta Gap = (AnionGap – 23) – (HCO3 – 24) :: (nl -6 to 6)
  • Calculated Osmoles = 2Na + BUN/2.8 + Glu/18 + EtOH/4.6 + Methanol/3.2 + EthyleneGlycol/6.2 + Isopropanol/6.0
  • Osmolar Gap = MeasuredOsmoles – CalculatedOsmoles :: (nl < 10)

Decontamination

Remember the following treatments:

  • Skin and eye decontamination
  • GI decontamination
  • Antidotes
  • Enhanced Elimination
  • Disposition

Quiz

Test your knowledge with an optional quiz.

References:

(1) Tobin DG, et al. CCJM 2016 Mar;83(3):207-215.
(2) Saitman A, et al. J Anal Toxicol 2014;38(7):387-96.