Toxicology
Hydroxocobalamin dose (cyanide toxicity) = 5 grams
Physostigmine for anticholinergic toxicity
When giving physo, pts need to be on a monitor, with pulse oxymetry, and with frequent auscultations after each dosing listening for bronchospasm, while having atropine at your side. Dilute the 1mg/mL of physo 1:10 so that you only give 0.1mg (1mL of the dilute sol.) at a time. This will prevent the possibility of acute seizures, bradycardia/ AV blocks or sialorrhea/ bronchospasm. If after 1mg of physo given the patient is still anticholinergic you've made a diagnosis of anticholinergic toxicity. They should have become cholinergic after that dose. You need to give more physo until the MS is OK/ or anticholinergic symptoms are gone. This depends on how much, and when the patient overdosed, etc. Titrating this takes time at the bedside and keen clinical observation. -Reuben Olmedo
Physostigmine for quetiapine overdose (Am J Emerg Med 2011 July 28)
Anion Gap Acidoses
MUDPILES --> KULT
Methanol Toxin (formate)
Uremia Uremia (sulphates, phosphates, etc.)
DKA Ketoacids (beta-hydroxybutyrate, acetoacetate)
Paracetamol Toxin (5-oxoproline = pyroglutamate) (alt. paraldehyde -> acetate)
Isoniazid (INH) Lactate (from seizures)
Lactate Lactate*
Ethylene Glycol Toxin (oxalate)
Salicylates Toxin (salicylate, + lactate, ketoacids)
*Other causes of lactic acidosis: Cyanide, Carbon Monoxide, Metformin, Didanosine, Stavudine, Strychnine, Emtriva, Rotenone (Fish Poison), NaAzide (Lab Workers), Apap (if Liver Fx), Phospine (rodenticide), NaMonofluoroacetate (Coyote Poison‐Give Etoh as antidote), INH (if patient Seizes), Hemlock, Depakote, Hydrogen Sulfide, Nitroprusside (If cyanide toxic), Ricin, Propofol, & Jequerty Bean
Serum Osmolarity: 2(Na) + glucose/18 + BUN/2.8 + etoh/4.6
Henna chemical = para-phenylenediamine (can cause allergic reaction)
Urushiol = allergenic oil found in Anacardiaceae family plants, including poison ivy, poison sumac, as well as mangoes, and cashews (before they are heat-treated, as they usually are before sold to consumers)
