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What is the toxic dose for mild to moderate acetaminophen toxicity in an acute ingestion? | The toxic dose for mild to moderate acute acetaminophen toxicity is over 200 mg/kg for acute ingestion or 150 mg/kg for acute on chronic ingestion. |
At what serum ethanol level is mild to moderate ethanol toxicity typically observed? | Mild to moderate ethanol toxicity is typically observed at serum levels over 100 mg/dL. |
What is the management for severe ethanol toxicity? | For severe ethanol toxicity: measure serum ethanol level if believed to be cause of altered mental status, consider and rule out other reversible causes (hypoglycemia, hypoxia, opiate intoxication), patients who are comatose may require airway protection, treat alcoholic ketoacidosis with fluid replacement and dextrose... |
What is the observation criteria for patients with mild to moderate ethanol toxicity? | Observation criteria for mild to moderate ethanol toxicity: observe patients until sober if intoxicated; if minimally intoxicated, a responsible sober adult caregiver is available, and no trauma or medical issues exist, discharge might be possible; refer chronic alcoholics or those with high-risk drinking to detoxifica... |
At what salicylate level should urine alkalinization be initiated? | Urine alkalinization should be initiated for salicylate concentrations greater than 30 mg/dL that are rising. |
What are the toxic doses for mild to moderate salicylate toxicity? | For mild to moderate salicylate toxicity: acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less. For oil of wintergreen (98% methyl salicylate), greater than a lick or taste by children under 6 years or greater than 4 mL by patients 6 years and older may cause toxicity. |
What is the management for severe acute salicylate toxicity? | Management for severe acute salicylate toxicity: continue urine alkalinization, strongly consider hemodialysis (indications include renal failure, CHF, altered mental status, seizures, cerebral edema, worsening acidosis despite adequate resuscitation, persistently rising salicylate concentrations), patients with altere... |
What is the treatment approach for mild to moderate sertraline toxicity? | Treatment for mild to moderate sertraline toxicity: primarily supportive care; activated charcoal may be helpful if presenting shortly after ingestion; give benzodiazepines titrated to effect for anxiety and seizures. |
What are the observation criteria for patients with citalopram/escitalopram toxicity? | Observation criteria for citalopram/escitalopram toxicity: ingestion of more than 600 mg citalopram or more than 300 mg escitalopram requires cardiac monitoring for 8 hours (11 hours if no activated charcoal within 4 hours of ingestion); ingestion of more than 1000 mg citalopram or more than 500 mg escitalopram require... |
What is the management for severe bupropion toxicity? | Management for severe bupropion toxicity: treat seizures with benzodiazepines (recurrent seizures may require barbiturates or propofol); treat hypotension with fluids and pressors if needed; treat ventricular dysrhythmias with intravenous sodium bicarbonate or lidocaine if bicarbonate unsuccessful; consider intravenous... |
What are the toxic doses for aripiprazole toxicity? | Toxic doses for aripiprazole: over 15 mg for children under 12 years old (acute), over 50 mg for patients 12 years and older (acute). |
What is the management for mild to moderate iron toxicity? | Management for mild to moderate iron toxicity: supportive care with IV fluids; activated charcoal not effective; symptomatic patients need observation for deterioration and acidosis; abdominal x-rays and iron concentration measurement recommended; consider whole bowel irrigation for large tablet ingestion; iron concent... |
At what serum lithium level is severe chronic toxicity observed? | Severe chronic lithium toxicity is observed at: between 2.5 and 3.5 mEq/L (predicted outcome moderate to severe effect), and over 3.5 mEq/L (predicted outcome severe effect). |
What is the management for severe chronic lithium toxicity? | Management for severe chronic lithium toxicity: orotracheal intubation for airway protection if recurrent seizures, increasing somnolence or coma develop; administer intravenous normal saline to enhance renal elimination (goal urine output 2-3 mL/kg/hr); IV fluids and vasopressors may be needed for hypotension; treat a... |
What is the minimum toxic dose of methanol? | The minimum toxic dose of methanol is approximately 100 mg/kg. |
At what methanol concentration should ADH inhibition be initiated? | ADH inhibition should be initiated for patients with methanol concentration of more than 25 mg/dL or metabolic acidosis. |
What is the management for severe methanol toxicity? | Management for severe methanol toxicity: patients with severe acidosis, visual changes, or depressed level of consciousness should be started immediately on ADH inhibitor and intravenous folate; hemodialysis should be initiated and continued until methanol concentration is undetectable and serum pH is normal; treat sei... |
What is the observation criteria for ethylene glycol toxicity? | Observation criteria for ethylene glycol toxicity: inadvertent ingestion <10 mL in adult can be monitored at home; children with >lick/sip/taste or adults with known inadvertent ingestion of a swallow (10-30 mL) should be referred to healthcare facility; patients with symptoms should also be referred; patients with no ... |
When should digoxin immune Fab be administered for acute digoxin toxicity? | Digoxin immune Fab should be administered for acute digoxin toxicity in patients with hyperkalemia (>5 mEq/L), symptomatic bradycardia, ventricular ectopy, or dysrhythmias. |
What is the toxic serum digoxin level for acute toxicity? | The toxic serum digoxin level for acute toxicity is 10 ng/mL. |
At what blood lead level does severe toxicity typically occur? | Severe lead toxicity: over 40 mcg/dL usually needs chelator treatment; levels 60-80 mcg/dL may cause GI symptoms and subclinical renal effects; levels above 80 mcg/dL can lead to serious overt intoxication including abdominal pain and nephropathy; encephalopathy and neuropathy usually occur with levels over 100 mcg/dL. |
What is the management for mild to moderate arsenic toxicity? | Management for mild to moderate arsenic toxicity: fluid resuscitation should be initiated immediately (with caution for pulmonary/cerebral edema); when significant acute ingestion confirmed, chelation therapy should be initiated immediately prior to laboratory confirmation; in chronic toxicity, decision to chelate must... |
What are the admission criteria for arsenic toxicity? | Admission criteria for arsenic toxicity: all patients with acute arsenic toxicity should be admitted. |
At what serum phenytoin level is nystagmus commonly observed? | Nystagmus is common at serum phenytoin concentrations above 20 mg/L; ataxia, slurred speech, and tremor above 30 mg/L. |
What is the management for severe phenytoin toxicity? | Management for severe phenytoin toxicity: supportive care, which may include intubation for comatose patients; if seizures occur, treat with benzodiazepines and evaluate for other causes of seizures. |
What are the toxic serum theophylline levels? | Toxic serum theophylline levels: over 40 mcg/mL for chronic toxicity, over 80 mcg/mL for acute toxicity. |
What is the management for severe theophylline toxicity? | Management for severe theophylline toxicity: primary treatment is sedation with benzodiazepines (high doses may be required); hemodynamically significant tachycardia should be treated with esmolol; hypotension should be treated with IV fluids; hemodialysis should be performed in patients with severe toxicity and high s... |
What is the management for severe diphenhydramine toxicity? | Management for severe diphenhydramine toxicity: orotracheal intubation for airway protection should be performed early; gastric lavage may be of benefit if patient presents soon after large ingestion; administer activated charcoal; severe delirium may require large doses of benzodiazepines for sedation; seizures may re... |
What are the observation criteria for antihistamine toxicity? | Observation criteria for antihistamine toxicity: patients with deliberate ingestions and symptomatic patients should be sent to a health care facility for observation for 6 to 8 hours; a patient with a deliberate overdose requires a psychiatric evaluation prior to discharge. |
What is the management for severe captopril toxicity? | Management for severe captopril toxicity: adequate circulatory support with IV fluids and vasopressors (if needed) should be assured if patient presents with circulatory collapse; correct severe hyperkalemia using standard treatments such as glucose, insulin, calcium, sodium bicarbonate, sodium polystyrene sulfate and ... |
What are the defined daily doses (DDD) for ACE inhibitors? | Defined daily doses (DDD) for ACE inhibitors: Captopril: 50 mg; Enalapril: 10 mg; Fosinopril: 15 mg; Lisinopril: 10 mg; Perindopril: 4 mg; Ramipril: 2.5 mg; Trandolapril: 2 mg. |
What is the management for severe felodipine toxicity? | Management for severe felodipine toxicity: patients with bradycardia and hypotension require standard ACLS treatment; high dose insulin and dextrose should be considered early in patients with significant hypotension; use intravenous calcium (repeat bolus or continuous infusion often needed); administer standard vasopr... |
At what INR level is severe warfarin toxicity observed? | Severe warfarin toxicity: INR 3.0 to 4.5 (moderate), INR >4.5 (severe), INR significantly elevated often >10 (life-threatening). |
What is the management for severe warfarin toxicity? | Management for severe warfarin toxicity: provide supportive care including IV crystalloids, oxygen, mechanical ventilation if necessary; for significant bleeding, transfuse packed red blood cells and fresh frozen plasma; factor concentrates like cryoprecipitate or 4-factor prothrombin complex concentrate may be needed ... |
What is the management for severe valproic acid toxicity? | Management for severe valproic acid toxicity: resuscitation, symptomatic and supportive care; early intubation in patient with declining level of consciousness; hypotension: treat with IV fluids, if no response start vasopressors; consider hemodialysis in patients with severe toxicity not responding to supportive care;... |
What are the toxic serum valproic acid levels? | Toxic serum valproic acid levels: serum levels exceeding 450 mg/L are associated with drowsiness or obtundation; levels greater than 850 mg/L are associated with coma, respiratory depression, and metabolic perturbations. |
What is the management for severe carbamazepine toxicity? | Management for severe carbamazepine toxicity: supportive care is mainstay; CNS: mental status depression may require airway protection, treat seizures with benzodiazepines; CARDIOVASCULAR: treat hypotension with isotonic fluids, if unresponsive to fluids use vasopressors, treat QRS widening with sodium bicarbonate bolu... |
What is the management for severe phenobarbital toxicity? | Management for severe phenobarbital toxicity: orotracheal intubation for airway protection should be performed if patient is increasingly drowsy or comatose; administer activated charcoal; severe hypotension and hypothermia may develop requiring aggressive supportive care including passive rewarming, normal saline admi... |
What is the management for severe oral amoxicillin toxicity? | Management for severe oral amoxicillin toxicity: acute anaphylaxis treatment includes administer oxygen, aggressive airway management, antihistamines, epinephrine, corticosteroids, ECG monitoring, and IV fluids; treat dysrhythmias with standard antiarrhythmic drugs if necessary; treat seizures initially with IV benzodi... |
What is the management for severe ibuprofen toxicity? | Management for severe ibuprofen toxicity: maintain an open airway and support ventilation; treat seizures with benzodiazepines; treat hypotension with fluids and adrenergic vasopressors; treat coma with intubation; monitor ECG and arterial blood gases in patients with severe toxicity. |
What is the management for severe metformin toxicity? | Management for severe metformin toxicity: early intubation and ventilation for respiratory/mental status depression; ensure IV fluids and vasopressors if needed for circulatory collapse; for severe acidosis (pH ≤7.1), administer IV sodium bicarbonate (1-2 mEq/kg bolus) to correct pH (>7.2); consider hemodialysis for se... |
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