ENPC Toxicological Emergencies 2 — Questions and Answers
Question 1: A child presents with bradycardia, hypotension, and altered mental status after suspected beta-blocker overdose. Which treatment is MOST appropriate?
- Epinephrine bolus alone
- High-dose insulin therapy (Correct answer)
- Calcium chloride 10%
- Sodium bicarbonate
Correct answer: High-dose insulin therapy
High-dose insulin (1 unit/kg bolus followed by infusion) improves myocardial energy metabolism and cardiac output in beta-blocker toxicity.
Question 2: Which presentation characterizes the second phase (6-24 hours) of iron toxicity in a pediatric patient?
- GI hemorrhage and persistent vomiting
- Apparent improvement or symptom-free latent period (Correct answer)
- Circulatory shock and severe metabolic acidosis
- Hepatic failure with coagulopathy
Correct answer: Apparent improvement or symptom-free latent period
Phase II of iron toxicity (6-24 hours) is a deceptive latent period of apparent improvement before systemic toxicity develops.
Question 3: A 3-year-old ingests a button battery confirmed by X-ray to be lodged in the esophagus. What is the PRIORITY intervention?
- Induce vomiting immediately
- Administer activated charcoal
- Urgent endoscopic removal within 2 hours (Correct answer)
- Monitor and allow spontaneous passage
Correct answer: Urgent endoscopic removal within 2 hours
Esophageal button batteries require emergency endoscopic removal within 2 hours due to rapid liquefactive necrosis and perforation risk.
Question 4: Flumazenil reverses benzodiazepine overdose but should be used cautiously because it can:
- Cause prolonged sedation in children
- Precipitate seizures in benzodiazepine-dependent patients (Correct answer)
- Worsen respiratory depression
- Induce tachyarrhythmias
Correct answer: Precipitate seizures in benzodiazepine-dependent patients
Flumazenil can precipitate acute benzodiazepine withdrawal seizures in patients with physical dependence on benzodiazepines.
Question 5: A child with carbon monoxide poisoning has a carboxyhemoglobin level of 35%. What is the MOST appropriate oxygen therapy?
- Nasal cannula at 2 L/min
- Simple face mask at 6 L/min
- 100% oxygen via non-rebreather mask (Correct answer)
- Room air with close monitoring
Correct answer: 100% oxygen via non-rebreather mask
100% oxygen via non-rebreather mask reduces the carboxyhemoglobin half-life from ~5 hours on room air to ~60-90 minutes.
Question 6: Which substance is MOST likely to cause a delayed cardiovascular toxicity presentation 6-12 hours after ingestion?
- Immediate-release acetaminophen
- Aspirin
- Extended-release calcium channel blockers (Correct answer)
- Benzodiazepines
Correct answer: Extended-release calcium channel blockers
Extended-release formulations absorb slowly, causing delayed-onset cardiovascular toxicity requiring prolonged cardiac monitoring.
Question 7: A child presents with dry mouth, urinary retention, hyperthermia, tachycardia, flushed skin, and hallucinations. Which substance is MOST likely responsible?
- Heroin
- Diphenhydramine (Benadryl) (Correct answer)
- Cocaine
- Organophosphate
Correct answer: Diphenhydramine (Benadryl)
Diphenhydramine causes classic anticholinergic toxidrome: 'hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter.'
ENPC Toxicological Emergencies 2
A child presents with bradycardia, hypotension, and altered mental status after suspected beta-blocker overdose.
Which treatment is MOST appropriate?