General Approach ABC’s of Toxicology
A-Antidotes and alter absorption  (in some instances prior to airway-decontamination with organophosphates to protect others, cyanide toxicity where antidotes are lifesaving)
B-Basics; ABC’s
C-Change metabolism (NAC, ethanol)
D-Distribute differently (calcium gluconate, O2)
E-Elimination (diuresis, dialysis, hemoperfusion)

TOXIDROMES
A.Introduction
1.“Physiologic fingerprints” that occur in the form of syndromes or groups of symptoms which are observed to occur together in response to exposure to one of a pharmacologically similar group of agents
2.Useful in determining the class of agents involved in an unknown poisoning
3.Result of receptor interaction or neurotransmitter release leading to stimulation or inhibition of the different divisions of the autonomic nervous system

Sympathetic or sympathomimetic
Presentation: mydriasis, tachycardia, hypertension, hyperthermia, diaphoresis, seizure, central nervous system (CNS) excitation
Similar to withdrawal toxidrome
Similar to anticholinergic toxidrome except:
Diaphoresis and normal bowel sounds with sympathomimetic toxidrome
Dry skin and absent bowel sounds with anticholinergic toxidrome

Cholinergic-Toxidrome (Muscarinic)
Presentation: DUMBBELS
D-Diarrhea U-Urination M-Miosis B-Bronchorrhea B-Bradycardia E-Emesis L-Lacrimation S-Salivation

Anticholinergic Toxidrome
Presentation: “red as a beet (flushing), dry as a bone (dry skin), mad as a hatter (delirium, hallucinations), hot as Hades (hyperthermia), blind as a bat (mydriasis).” Also see hypertension, tachycardia, urinary retention, absent bowel sounds, seizures

Withdrawal Toxidrome
Presentation: diarrhea, piloerection, lacrimation, crampy abdominal pain, hallucinations, mydriasis, tachycardia, hypertension, yawning, seizure (ethanol, benzodiazepine, barbiturate). Similar to sympathetic toxidrome

METHODS OF EMPTYING
Gastric lavage
Large bore orogastric tube (36 - 40 F) Place patient in left lateral decubitus position
Infuse 250 cc aliquots of saline, drain, repeat until clear (at least 2 liters)
Remember airway protection
Complications: aspiration, esophageal rupture, epistaxis, hypothermia

Charcoal-now procedure of choice if appropriate substance. Major risk is aspiration.
May use NG/OG tube or give orally.  If giving orally, assure patient is awake and airway protected.

whole bowel irrigation
Polyethylene glycol electrolyte solution is instilled at a rate of 2 L/hr until the rectal effluent is clear. Often requires nasogastric (NG) placement for administration...

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