Toxicology and Environmental Emergencies Flashcards

A patient presents with bradycardia, miosis, excessive salivation, urination, and muscle fasciculations after working in an agricultural field. Which toxidrome is this?

Answer: Cholinergic toxidrome (organophosphate poisoning)

The SLUDGE mnemonic (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis) describes cholinergic toxidrome from organophosphate exposure.

What is the antidote for organophosphate/cholinergic poisoning?

Answer: Atropine and pralidoxime (2-PAM)

Atropine blocks muscarinic receptors (treats secretions and bradycardia) and pralidoxime reactivates acetylcholinesterase in organophosphate poisoning.

A patient presents after acetaminophen overdose 4 hours ago. The Rumack-Matthew nomogram is used to determine treatment. Which antidote is indicated?

Answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes glutathione, preventing toxic accumulation of NAPQI and hepatotoxicity in acetaminophen overdose.

A patient presents with hypertension, tachycardia, hyperthermia, mydriasis, and agitation. Which toxidrome is this presentation consistent with?

Answer: Sympathomimetic toxidrome

Hypertension, tachycardia, hyperthermia, dilated pupils, and agitation constitute the sympathomimetic toxidrome seen with cocaine or amphetamine use.

A patient with a tricyclic antidepressant (TCA) overdose presents with a wide QRS complex and hypotension. Which treatment is most appropriate?

Answer: Sodium bicarbonate 1–2 mEq/kg IV bolus

Sodium bicarbonate alkalinizes the blood and increases sodium channel availability, reversing TCA-induced cardiac toxicity and wide QRS.

Which antidote is used for methanol or ethylene glycol poisoning to competitively inhibit alcohol dehydrogenase?

Answer: Fomepizole (4-MP)

Fomepizole is the preferred antidote for methanol and ethylene glycol poisoning as it inhibits alcohol dehydrogenase without the side effects of ethanol.