Toxicology table L

hrhodes's version from 2015-10-12 00:40


Question Answer Column 3 Column 4 Column 5 Column 6
LeadRare to be acute unless occupational
>4.8mcmol/L severe confusion, GIT, coma
Acute: abdo pain, vomiting, seizures, cerebral oedema Chronic: Vague lethargy, weight loss, low IQ, ataxiaBSL, ECG, Para, U+Es, LFTs, FBC_basophillic stippling, Free erythrocyte protoporphyrins (FEP) - surrogate for a lead level, AXR, psychomotor and neuro testsABCD-seizures, removal of FB, Consider WBI, chelation - succimer 10mg/kg or EDTA and IM BALWBI, index as family members may be affected, give chelation in pregnant women and kids
Acute Lithium GIT>25g significantOften caused by acute dehydration, AKI or low Na that impair excretionCauses (and can be caused by) GI symptoms - diarrhoea, N+V, abdo painBSL, Para, ECG, U+Es, Li Level peak at >5 in acute toxicityIv fluid resus, Aim UO >1ml/kg/hr to excrete, observe, if coma is unlikely due to Li
HD can be used but rarely necessary as fluids and maintaing UO is often all that is required
Chronic Lithium neurolevels do not correlate well with clinical symptoms, often caused by AKI, diabetes insipidus, low Na, dehydration, drug interactionsNeurotoxicity. Hansen Amdisen criteria Grade 1: tremor, ataxia, Grade 2: Hypertonia/hypotonia, Grade 3: seizure, comaPara, BSL, ECG, Li Level (confirm not predict), urine for diabetes insipid, TFTs HISTORY - NSAIDS, thiazides, SSRIs, ACEi, ToprimateABCD-seizures, HD for neuro sx and Li >2.5mmol/LHD, no AC Stop NSAIDS, ACEi, thiazides, Toprimate

Lithium can cause Diabetes insipid us = HyperNa
Local anaestheticsBupivicaine+ 1-2.5 Ropi 2.5-3 Lido 4-5 Mepivicaine 4-5 Prilo 5-7Na channel blockade resp depression, Cardiotoxicitity (bupi), neuro tox, methaemoglobinaemiaBSL, ECG, para, U+E, ABG for methaemoglobinaemiaABC-VT and TCA like, D-seizures often self limit , NaHCO3 1-2mmol/L (100mls), INTRALIPID 20% 1-2ml/kgRemember to always mention audit and education, open disclosure, feedback, quality assurance BS, for MetHb give methylene blue 1-2mg/kg