FACEM Toxicology and Poisoning 3

Question 1

A 2-year-old presents 8 hours after ingesting iron tablets with an initial period of vomiting that has now resolved.
The parents report the child appeared to improve about 2 hours ago.
What does this apparent clinical improvement most likely represent?

Accepted Answer

The latent phase of iron poisoning, preceding potential severe systemic toxicity

Answer

True resolution of iron toxicity requiring only observation

Answer

Phase 1 GI effects resolving before systemic absorption peaks

Answer

Successful emesis clearing the ingested iron

Question 2

A patient presents with high anion gap metabolic acidosis, calcium oxalate crystalluria, and progressive acute kidney injury after suspected ethylene glycol ingestion. What is the preferred specific treatment?

Accepted Answer

Fomepizole 15mg/kg IV loading dose

Answer

Ethanol infusion titrated to serum level 100 mg/dL

Answer

Activated charcoal 1g/kg via nasogastric tube

Answer

Sodium bicarbonate infusion alone to correct acidosis

Question 3

A patient on chronic lithium therapy presents with coarse tremor, ataxia, dysarthria, and confusion with a serum lithium level of 2.8 mEq/L. What is the most likely required treatment?

Accepted Answer

Hemodialysis

Answer

Aggressive normal saline diuresis and observation

Answer

Activated charcoal 1g/kg if within 2 hours of ingestion

Answer

Sodium polystyrene sulfonate to enhance GI elimination

Question 4

A patient presents with tachycardia, hypertension, diaphoresis, mydriasis, and agitation after cocaine ingestion, with ongoing chest pain. Which treatment should be specifically AVOIDED?

Accepted Answer

Beta-blockers for hypertension and tachycardia

Answer

Benzodiazepines for agitation and blood pressure control

Answer

Active cooling measures for hyperthermia

Answer

Aspirin for the chest pain

Question 5

A patient presents with urinary retention, mydriasis, flushed dry skin, tachycardia of 130 bpm, hyperthermia of 38.5°C, and delirium after ingesting diphenhydramine. Which toxidrome does this represent?

Accepted Answer

Anticholinergic toxidrome

Answer

Sympathomimetic toxidrome

Answer

Serotonin syndrome

Answer

Cholinergic toxidrome

Question 6

A patient develops sudden cardiovascular collapse during an interscalene brachial plexus block with bupivacaine. After initiating CPR and giving epinephrine, which treatment is most specifically indicated for local anesthetic systemic toxicity (LAST)?

Accepted Answer

20% intralipid emulsion 1.5 mL/kg IV bolus

Answer

Epinephrine 1mg IV repeated every 3–5 minutes

Answer

Sodium bicarbonate 2 mEq/kg IV bolus

Answer

Magnesium sulfate 2g IV infusion

Question 7

A patient on warfarin for atrial fibrillation presents with an INR of 10.2 and active intracranial hemorrhage confirmed on CT. What is the most appropriate immediate reversal strategy?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC) plus vitamin K 5–10mg IV

Answer

Stop warfarin and administer vitamin K 10mg IV alone

Answer

Fresh frozen plasma (FFP) 15 mL/kg alone without delay

Answer

Recombinant factor VIIa as first-line reversal