TOXO clasani +} Metabolic acidosis with high anion gap: MUDPILES Methanol / Uremia / Diabetic ketoacidosis / Paraldehyde / Iron / Lactic acidosis / Ethylene glycol / Salicylates © Metabolic acidosis with normal anion gap: Any drug that increases chloride such as Ammonium chloride > Radio Opaque toxins: CHIPES Chloral hydrate/ Heavy metals/ Iron/ Phenothiazines/ Packets of cocaine or heroin/ Enteric-coated/ Sustained release preparations as Aspirin + Contraindications of Emesis: Poisons Patients T- Corrosives (fear of perforation) | I- Coma (Asphyxia Aspiration pneumonia 2 Kerosene (fear of chemical 2 Convulsions: Vomiting can stimulate convulsions pneumonitis) 3 Cardiac and elderly patients 3-_ Chronic Poisoning 4-_ Infants below 6 months (immature gag reflex) + Poisons f 5 : r fter 6 1 Salicylates (aspirin cake) Barbiturates (slow down stomach motility) Morphine (secreted in stomach) Anticholinergic toxidrome drugs+ Poisons for which charcoal is ineffective: CHARCOAL Corrosives, Cyanide/ Heavy metals/ Alcohols/ Rapid onset, absorption (cyanide, strychnine)/ Chlorine, iodine/ Others insoluble in water/ Aliphatic hydrocarbons/ Lithium + MDAC indications: SSS Show enterohepatic circulation (TCA, Digitalis & Barbiturates) Stick to the stomach (Salicylate) Slow gut motility (Barbiturates & Morphine) +} Whole bowel irrigation indications: PPP Poorly adsorbed drugs by Activated Charcoal Preparations which are slow release (Salicylates and CCB) Packets of illicit drugs (Cocaine or Heroin) + Poisons that affect cytochrome oxidase: Cyanide, HS / CO / Formic acid of methanol + Poisons causing non cardiogenic pulmonary edema: Barbiturates / CO Morphine / Salicylates / CCBs/ BBs / Hydrocarbons + Poisons causing rhabdomyolysis are those that cause any of the following: Severe convulsions Severe hyperthermia Deep coma like Barbiturates Direct toxic effect like COCauses of Red Asphyxia: COC Cold / CO / Cyanide, H2S + Poisons/ drugs causing methemoglobinemia: Carbolic acid, Nitrite, DMAP, Naphthalene + Therapeutic roles of vit B in toxo: B1 in coma cocktail B6 in ethanol ttt B12a in cyanide toxicity ttt + Two poisons are metabolized by the same enzyme and one of them is the antidote for the other one Ethanol and methanol + Poisons that are metabolized to more toxic metabolites. Paracetamol / Methanol / Naphthalene + Atropine is used as an antidote for: CCB / BB / Digoxin / Morphine / Organophosphorus empds + Silent killer toxin is CO > Rapid potent killer toxin is Cyanide+} Role of Sodium Bicarbonate: © Gastric lavage with salicylates, iron, ethanol, methanol © Antidote of TCA, diphenhydramine © Forced alkaline diuresis + Specific signs and symptoms Torsade’s de pointes Phenothiazine/ TCA/ Sotalol/ Bepridil Central Asphyxia Amphetamine/ Cocaine/ Barbiturates/ Ethanol Serotonin Syndrome Amphetamine/ Tramadol Wide ORS TCA/ Phenothiazines/ Diphenhydramine/ Cocaine/ Propranolol Respiratory Alkalosis Salicylates/ Carbolic acid/ Amphetamine/ Cocaine Metabolic Acidosis Sympathomimetic/ CCB, BB/ Acetaminophen/ Iron/ Salicylates/ Carbolic acid/ CO/ Cyanide/ Ethanol/ Methanol/ Organophosphatestipe eat YY —— Enhantd ekimnation fo \oG aU ¥ oho g Va 6istie + Toe, wlty Sy eu poy: 28 \BGluey beuets « A Ceamine phen2 For Fenal Forlure = Yetvac tory ACdoSis . electrolyte imbalenQ Amphetamin —o fer Yenal Relae 1D \ycte MS oy Toe: PO SaliGiees Qhe nol \ Treothyline es quanide @ =p Thanosa Wee A wee. 4, Seite Beso ‘* 25 9 10505 wy ae : ~ S s83 e sahet OM Sz PAD Find Cries Of 954 ay 42 : Orden String wine yizSa “> SulPurylureas digitokin Avg Palace Tw ce - hig: folis $y LVO,P}a WP my Ds re eS > -githewp, OY “oi Ss purrs, om?FA) Aioo ae etre Avotingo Ors Chulenagic a Weg. % are: EPS ope Woh Py binding 2 > RS ML Z \ow lioid Sobvble BBs (Aterlls sh, oO Chiminatisn Pee Gwe pice Gigs fo comet. 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Tekic Vae0~ ~Boo rcs mn) 2 Neth : PZec mes /ml Vee dese” Moms ie Aehld Re Slee Sinn ng aber sak, _ Mila 300 Mgldl : “Boo Mgld! Fadl ively Avo Aglds Tete dose > bo mg]ky LNethtelne OO ‘Fo Me dase! Abe - oa mg of Peete Se in21 ood age ust = Fa bel dos Fatal Pera; C1 1 db0P ¥ Ouca cy Boo M3 oF Ddbasvunn® Cyanide. 2 lominuhes 0, Ne WS iin Salts ep, : with Henn eect 3- Mehanei: ~- 3 Fetal dese ba. loont abu” =a \5 my Phidw blindnety Wb Few havesLevels Z doses Memo No. Date Treropatic 0-5 -2 smqiet Tonle 2-5 -Ynylnl serions 712 9 [ral @ Seumineihen |pdubs:- \Bo mg leg childs. Loomy Ky Thermpectic 5-20 moglml Toxic 120 =3a0mey|n) Aethal > 300 wea lm! 9 SAlichates | pate 7150 mgitcy (ina Single dese) + | chronic 7109 ng fy) 7\°? sity torer 2 days) gelron. 60.19 1k5 (oro) |Merpentic. 3-30 mq id} Tou 74.0 mg/d! \etnel 00 mg/dl Mild Joo Ag fay Sevias Goo Mg /d]al Antidotes J! JF ge ail! eto a oxo! at 1--Atropin --- > physastegmine 2. Anti-histaminics - --> physostegmine large dose of s+ vasdiee i diphenhydramine prolonged eS QRS! ut 3-TCA---» Na bicarbonate 4- Morphine --- > Naloxone de aS atropin gs Sars stimulation of Jats: afysal! vagus 5-CO---> Oxygen 6 Cyanide --- > cyanide kit /Vit 612 a/dicobalt EDTA/ DAMP 7- Hydrogen sulfied ---> fas cyanide) 8-8z--- sflumazenile Toxicity with bith a5 3) ation op Bz ond TCA 9 Digitalis --- » digt- bind (fab) 10- CCB --- > Calicium 11-BB--- > Glucagone/ Norepinephrine 12. potassium --- > insuline + 5% glucose 13- oral hypoglycemics -- glucose but sulfonylurea - octreotide 14-Fe---> deferroxamine 15- Inorganics corrosives Milk (local antidote) 16- Organic corrosives( pheno!) > Milk? egg white or--- > Ehtanal (local antidates) 17- Paracetamol ==» > Neacetyleystiene 18- OPP ---> Atropin ( for muscarenic R) of---> Oximes ( for Muscarenic and Necotenic R) 19+ Carbamates ---> as OPP 20- Methanol --- > Ethanol / 4-methyl pyrazole/ folinic acid folinic acid = oI tly As leucovorin eal Sb be tt i ghss pLue leucovoring! formic acid! Ja 70 4.602 J!