Toxicology

Learning Objectives

Distinguish between the common clinical toxi-

dromes associated with acute poisonings.

an acute overdose.

Determine the best options for the management of

selected toxins.

Develop a patient care plan for a patient presenting

with an acute overdose.

Identify the adverse effects and monitoring of the

patient who is poisoned.

Airway, breathing, and circulation

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BP

Blood pressure

BUN

Blood urea nitrogen

CB1

Cannabinoid-1

CB2

Cannabinoid-2

Alcohol Scale

CK

Creatine kinase

CNS

Central nervous system

ECG

Electrocardiogram

ED

Emergency department

GI

Gastrointestinal

HIET

Hyperinsulinemic euglycemic therapy

HR

Heart rate

ICU

Intensive care unit

INR

International normalized ratio

RR

Respiratory rate

SBP

Systolic blood pressure

SCr

Serum creatinine

SSRI

Selective serotonin reuptake inhibitor

TCA

Tricyclic antidepressant

Self-Assessment Questions

Answers and explanations to these questions can be

found at the end of this chapter.

A 38-year-old woman with type 2 diabetes is admit-

ted for confusion and altered mental status. She

has an active prescription for glipizide 10 mg by

mouth twice daily, but she cannot respond to fur-

ther questioning. Her vital signs are as follows:

blood pressure (BP) 115/65 mm Hg, heart rate (HR)

68 beats/minute, respiratory rate (RR) 15 breaths/

minute, and temperature 98.6°F (37°C). Her point-

of-care glucose concentration is 45 mg/dL, and she

is given 50 mL of 50% dextrose in water intrave-

nously twice. Her follow-up point-of-care glucose

concentration is 50 mg/dL after the first dose and

57 mg/dL after the second dose, with no improve-

ment in symptoms. Which is the most appropriate

intervention at this time?

care unit (ICU) after a β-blocker overdose. After

administering 2 L of 0.9% sodium chloride and 3 g

of calcium gluconate, his vital signs are as follows:

BP 70/40 mm Hg, HR 52 beats/minute, and RR 22

breaths/minute. Which therapy is most appropriate

at this time?

A 76-year-old woman is admitted to the emergency

department (ED) with the chief concern of decreased

mental status. Her vital signs are as follows: BP

118/72 mm Hg, HR 57 beats/minute, and RR 17

breaths/minute. She is experiencing nausea, but

her physical examination is otherwise normal. Her

husband is concerned that she may not be taking

her medications properly. Given her presentation,

which common toxidrome is the patient most likely

experiencing?