Toxicology

Consider hemodialysis for any of the following (Postgrad Med 2009;121:162-8):

Acute renal insufficiency

End-organ damage (severe pulmonary edema, seizures, rhabdomyolysis)

Altered mental status

Severe acid-base disturbances

If hemodialysis is not effective, hemoperfusion and continuous renal replacement therapies may be

Patients should be monitored for up to 24 hours because of the possibility of delayed or impaired

absorption.

During urine alkalinization, monitor for signs and symptoms of fluid overload, hypernatremia,

hypokalemia, hypocalcemia, and worsening alkalemia.

Patient Case

A 62-year-old man presents to the ED with the chief concern of nausea, tachypnea, and flu-like symptoms.

He is alert and oriented and can communicate that his symptoms have been worsening for the past 2 days.

He has been taking a combination cold product, which he thinks has helped. His medical history is signifi-

cant for a stroke, for which he takes aspirin 325 mg by mouth daily, and hypertension, for which he takes

amlodipine 5 mg by mouth daily. His vital signs are as follows: BP 135/82 mm Hg, HR 78 beats/minute, RR

29 breaths/minute, and temperature 100.2°F (37.9°C). Arterial blood gas results are as follows: pH 7.52, Pco2

25, and HCO3 20 mEq/L. A salicylate concentration is sent, which is 25 mg/dL. Which treatment manage-

ment strategy is most indicated for this patient?

Opioids as a single agent (not in combination with other agents) accounted for 20,392 overdoses and 346

deaths in 2022. The Centers for Disease Control and Prevention reports that almost 15,000 deaths are

caused by prescription opioid painkillers annually.

prescription), heroin, oxycodone, buprenorphine, and tramadol.

The most common agents associated with a toxicologic death were fentanyl (prescription and non-

prescription), heroin, oxycodone, methadone, and morphine.

Opioids act at the mu, delta, and kappa opioid receptors, although mu is responsible for most of the

opioids’ clinical effects.