Toxicological

Rapid Review

• Background
  • Acetaminophen overdose occurs at doses of 150mg/kg within 24 hours,  causing delayed onset of severe liver injury and potentially liver failure due to the production of NAPQI from the parent compound. 
• Signs/Symptoms
  • Symptoms: Nausea/vomiting at first, progresses to RUQ pain
  • Signs: jaundice, tachycardia, hypotension
• Diagnosis
  • Acetaminophen (APAP) level; compare with Rumack-Matthew Nomagram
  • Liver function tests
• Treatment
  • N-acetylcysteine (most beneficial if given within 8 hours of ingestion)
  • Supportive care (IV fluids, antiemetics)

Pearls

Deep Dive

• Acetaminophen Toxicity (EMCRIT)

Rapid Review

• Background
  •  Beta-blockers inhibit epinephrine and norepinephrine adrenergic stimulation on beta receptors; overdose can cause bradycardia, hypotension, and ultimately cardiovascular collapse. 
• Signs/Symptoms
  • Symptoms: Fatigue, nausea, weakness
  • Signs: (+) Hypotension, (+) bradycardia
• Diagnosis
  • Clinical diagnosis based on history and clinical features
  • Routine drug screens not usually helpful
• Treatment
  • Maintain hemodynamics (IV fluids, vasopressors)
  • Consider glucagon and atropine

Pearls

Deep Dive

• Beta Blocker Toxicity (NUEM Blog)

Rapid Review

• Background
  • Lithium is used primarily to treat bipolar disorder. Toxicity can cause GI, neurologic, and renal manifestations.
• Signs/Symptoms
  • Predominantly GI symptoms initially (nausea, vomiting, cramping, diarrhea)
  • Progression of toxicity can cause dystonia, ataxia, hyperreflexia, and cardiac dysrhythmias.
• Diagnosis
  • Lithium level (may not correlate with clinical symptoms)
  • Consider testing for coingestants (ex. Acetaminophen)
• Treatment
  • GI decontamination (whole bowel irrigation, gastric lavage)
  • Enhanced elimination (IV fluids, diuretics, hemodialysis)

Pearls

Deep Dive

• Lithium Intoxication (EMCRIT)