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Toxicological Emergencies Flashcards

7 cards from real ENPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. Whole bowel irrigation (WBI) is MOST indicated for which pediatric ingestion scenario?

    Answer: Iron tablets, sustained-release medications, or drug body packing

    WBI is reserved for substances not adsorbed by activated charcoal (iron, sustained-release drugs) or illicit drug packets that require mechanical clearance.

  2. A 16-year-old with tricyclic antidepressant (TCA) overdose presents with QRS widening on ECG. What is the PRIORITY treatment?

    Answer: Sodium bicarbonate bolus

    Sodium bicarbonate alkalinizes serum and reduces TCA binding to cardiac sodium channels, narrowing the QRS complex and preventing dysrhythmias.

  3. Which laboratory test is MOST important to guide treatment in a child with suspected acetaminophen overdose?

    Answer: Serum acetaminophen level at 4 hours post-ingestion plotted on the Rumack-Matthew nomogram

    A 4-hour serum acetaminophen level plotted on the Rumack-Matthew nomogram determines whether N-acetylcysteine therapy is indicated.

  4. Which clinical finding in a toddler indicates systemic iron toxicity requiring chelation therapy?

    Answer: Metabolic acidosis with serum iron level >500 mcg/dL

    Serum iron >500 mcg/dL with metabolic acidosis indicates severe systemic iron toxicity requiring deferoxamine chelation therapy.

  5. What is the mechanism of action of deferoxamine in iron toxicity?

    Answer: Chelates free iron and promotes its excretion as ferrioxamine in urine

    Deferoxamine binds free iron in a chelate complex (ferrioxamine), which is then renally excreted, producing the classic 'vin rosé' urine color.

  6. A 14-year-old with moderate-severe salicylate toxicity presents with tachypnea and altered mental status. Which acid-base disturbance is expected?

    Answer: Mixed respiratory alkalosis and high anion gap metabolic acidosis

    Salicylate toxicity causes early respiratory alkalosis (direct brainstem stimulation) followed by high anion gap metabolic acidosis from uncoupled oxidative phosphorylation.

  7. Which child is at HIGHEST risk for lead toxicity?

    Answer: 2-year-old living in a pre-1978 home with deteriorating paint

    Children under 6 in pre-1978 housing face the highest lead exposure risk from deteriorating lead-based paint chips and household dust.

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