High-yield toxicology: essential facts for the critical care boards
Reilly, Eugene F. and Stawicki, S. Peter (2008) High-yield toxicology: essential facts for the critical care boards. OPUS 12 Scientist, 2 (1). pp. 33-38. ISSN 1940-8633
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Key points: (a) It is imperative that critical care practitioners are familiar with the most commonly encountered types of poisoning and toxicity – early recognition and appropriate intervention are crucial when approaching patients affected by toxins and poisons; (b) Acetaminophen toxicity has four distinct stages, predictable toxicity within 4 to 24 hours of exposure, and can be treated with N-acetylcysteine administration; (c) Anticholinergic toxicity is associated with characteristic signs and symptoms, including hyperthermia, dry skin, flushing, mydriasis and delirium; (d) Cyanide poisoning can be rapidly fatal – early recognition and treatment with thiosulfate, hydroxycobalamin, or amyl nitrate are essential; (e) Digitalis toxicity is associated with either increased drug level or increased sensitivity to the drug, and can produce a variety of symptoms (mostly non-specific) – cardiac arrhythmias constitute the most common cause of mortality; (f) Lithium toxicity can result in severe neurologic and cardiovascular symptoms – dialysis may be indicated in cases of severe toxicity or concurrent renal failure; (g) Organophosphate poisoning is characterized by muscarinic side effects, nicotinic side effects and central nervous system toxicity – muscarinic symptoms seen in acute organophosphate poisoning can be remembered by the use of the mnemonic DUMBELS (defecation, urination, miosis, bronchorrhea, bronchospasm, bradycardia, emesis, lacrimation, and salivation).
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