Papitchaya Pichedboonkiat MD SCAN Ethylene glycol toxicity Ethylene glycol toxicity Source Glycerin substitute hydraulic fluid antifreeze adulterated alcoholic beverages adulterated toothpaste ID: 914580
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Slide1
TOXICOLOGICAL EMERGENCY
Spot Diagnosis
Papitchaya
Pichedboonkiat
, MD.
Slide2SCAN!!
Slide3Ethylene glycol toxicity
Slide4Ethylene glycol toxicity
Source : Glycerin substitute, hydraulic fluid, antifreeze, adulterated alcoholic beverages, adulterated toothpaste (
diethylene
glycol)
Clinical 3 stages
Neurologic stage : 30 min- 12hr
Cardiopulmonary stage : 12-24
hr
Renal stage : 24-72
hr
Slide5Ethylene glycol toxicity
Slide6Toxic effect
Metabolic
acidosis
T
issue
toxicity from glycolic acid and calcium oxalate
tissue damage
Slide7Diagnosis
Ethylene glycol level >20 milligrams/
dL
(>3.2
mmol
/L)
Early: unexplained
osmolal
gap >10
mOsm
/kg H2O
Later: elevated anion gap metabolic acidosis and calcium oxalate crystals in urine
Slide8Calcium Oxalate Crystals
Slide9Treatment
Fomepizole
15 milligrams/kg IV over 30 min and then 10 milligrams/kg IV
over 30
min every 12 h
Ethanol
10 mL/kg of 10% IV
ethanol
100 milligrams/kg per h to keep ethanol
level >150
milligrams/
dL
Slide10Slide11Tricyclic antidepressant toxicity
Slide12Slide13Slide14Slide15Slide16Methemoglobinemia
Slide17Slide18Slide19Clinical features
20- 30% :anxiety
, headache,
weakness,
light-headedness
, tachypnea
and sinus
tachycardia
50-60
%
: impair
oxygen delivery to vital
tissues
myocardial
ischemia, dysrhythmias, depressed mental status (
including coma
), seizures, and lactate-associated metabolic
acidosis
70%
: coma , death
Slide20Chocolate blood
Slide21Slide22Hydrofluoric acid toxicity
Slide23Hydrofluoric acid
colorless, corrosive liquid
commercial
(20%) and household (20
%, typically
6%-12
%) formulations
glass etching, electroplating, and semiconductor
manufacturing
dermal, ocular
, pulmonary, and gastrointestinal routes
Slide24Hydrofluoric acid
Free fluoride ion complexes with body calcium and magnesium
Calcium chelation and cellular death
Most burn occur on the upper extremities
Ingestion : GI injury (corrosive)
Systemic effect :
hypocalcemia
, hyperkalemia
,
hypomagnesemia
, metabolic acidosis, ventricular dysrhythmia, cardiac arrest
Slide25Hydrofluoric Acid Burn
Slide26Treatment of Hydrofluoric
acid
Skin exposure
Solve with quaternary ammonium solution
2.5%Calcium
gluconate
q 4-6
hr
( 25ml of 10% calcium
gluconate
sol with 75 ml of KY jelly
Ingestion
Gastric lavage with NSS is recommended
Systemic
Close observe +observe cardiovascular effect
Monitor EKG
Monitor +correct
Ca
, Mg, Electrolyte ,
HyperK
Slide27Lead poisoning
Slide28Lead poisoning
most common cause of chronic metal
poisoning
inhalation ,
ingestion
Slide29Lead poisoning
Slide30Lead Lines
Slide31Basophilic Stippling
Slide32Slide33Digitalis Glycoside toxicity
Slide34Digitalis Glycoside toxicity
Source
Drug : Digoxin
Plant : Foxglove, Oleander, Lily
Animal : Skin of toad
Bufonidae
Slide35Oleander
Slide36Foxglove
Slide37Pathophysiology
inhibits
sodium-potassium ATPase
increased intracellular sodium
and increased
extracellular
potassium
sodium-calcium
antiporter
is not able to
effectively remove
calcium from the
myocyte
increase
in intracellular calcium
delayed
after-
depolarizations
premature ventricular contractions and dysrhythmias
Slide38Slide39Slide40Diagnosis
ECG : PVC, Bidirectional VT, Scooped appearance
Serum digoxin level
Serum potassium : better prognosis indicator than serum digoxin in acute toxicity
Slide41Slide42Slide43Indication of Digifab
Severe toxicity
K > 5.5 in adult
K> 6 in children
Known of fetal dose
Adult > 10mg
Children > 4 mg
Serum
conc
≥ 10
ng
/ml
Chronic ingestion
Adult >6
ng
/ml
Children > 4
ng
/ml
Slide44