Daily Archives: January 14, 2021

Conference Notes 1/13

Posted on by
Reply
  • ITE- grab bag (E Thomas)
    • Spider bite, necrotic wound>brown recluse
    • MCC erythema multiforme> HSV
    • Strawberry cervix>trich
    • Pre-E, less than 24 weeks>mole pregnancy
    • Abdominal pain after sex>ovarian torsion
    • Most common personality disorder>borderline
    • Patient intentionally fakes symptoms>malingering
    • Sudden paralysis after traumatic event>conversion
    • Discriminatory zone for TVUS>1500
    • PID/RUQ pain/shoulder pain>Fitz Hugh Curtis
    • MCC postpartum hemorrhage>uterine atony
    • Pizza pie fundus>CMV
    • Corneal dendrites>HSV keratitis
    • Tachycardia out of proportion to fever>thyroid storm
    • Alcohol, AMS, ataxia, nystagmus>wernicke
    • Stingray wound>hot water
    • Beta blocker OD>hypoglycemia
  • One Pill Can Kill (Lund)
    • Ingestions–fatal in small doses
      • CCB
      • Cyclic antidepressants
      • Lomotil
      • Opiates
      • Salicylates
      • Toxic alcohols
      • Sulfonylureas
      • Camphor
      • Clonidine
      • Antimalarials
    • CCB OD
      • Hypotension, bradycardia, bradydysrhythmias, hyperglycemia
      • Tx: charcoal, fluids, atropine, calcium, intralipid
    • Salicylates
      • Oil of wintergreen, ASA, pepto-bismol
      • n/v, tinnitus, delirium, hallucinations, pulmonary edema, cerebral edema, mixed anion gap metabolic acidosis with respiratory alkalosis
    • Sulfonylureas
      • Hypoglycemia, lethargy, irritability, confusion, HA, seizures
      • Tx: observation x24 hrs
      • Dextrose bolus, then consider infusion
      • Can give octreotide (inhibits secretion of insulin)
    • Clonidine
      • Alpha 2 agonist, (afrin, visine)
      • Opioid syndrome: lethargy, coma, miosis, respiratory depression
      • Tx: naloxone, atropine, IV fluids, inotropes
    • Camphor
      • Campho-phenique, vicks vaporub
      • GI distress, generalized warmth, CNS hyperactivity, CNS depression, n/v, oropharyngeal irritation/burning/stinging
      • Tx: benzos, phenobarb
    • Amitriptyline
      • CNS depression, seizures, cardiac conduction abnormalities (QRS prolongation), hypotension, mydriasis, flushing, dry mucous membranes, hallucinations, hyperthermia
      • Tx: benzos for seizures, sodium bicarb for QRS widening >100ms
    • Lomotil
      • Opioid receptor agonist +/-atropine
      • Classically biphasic, with anticholinergic symptoms 2-3 hours s/p ingestion followed by opioid symptoms
      • Tx: naloxone
      • Dispo: admit
  • Toxic Alcohols (Bosse)
    • Ethanol
      • Can cause hypoglycemia
      • Is dialyzable
    • Isopropanol
      • Rubbing alcohol
      • Metabolized to acetones
      • No metabolic acidosis
      • Supportive treatment, can be dialyzed
    • Methanol
      • Windshield washer fluids, solid cooking fuel, embaling fluid, tainted beverages
      • Toxic metabolite is formate (formic acid)
      • CNS effects, visual effects, pancreatitis, symptoms delayed in onset
      • Metabolic acidosis with elevated anion gap
    • Ethylene glycol
      • Antifreeze (sweet taste)
      • Toxic metabolites: oxalate, glycolaldehyde, glycolic acid, glyoxylic acid
      • CNS effects, metabolic acidosis, renal toxicity, myocardial dysfunction
      • Oxalate can cause hypocalcemia by calcium oxalate precipitation
      • Oxalate crystals in urine
      • Wood’s lamp to urine, antifreeze products may contain fluorescein, not a great test
    • Osmol gap
      • Difference between measured serum osmolality and calculated serum osmolarity
      • Normal serum osmolality: 275-295 mOsm/kg
    • Antidotes
      • Ethanol, fomepizole
      • Competitive inhibitors of alcohol dehydrogenase
      • If ethanol must be used, give orally. Keep blood level >100mg/dL
      • Treat if methanol or ethylene glycol level >20mg/dL
      • Can be stopped once level less than 20mg/dL
      • Dialysis
        • Consider if patient has end organ manifestations (even if levels undetectable)
      • Folic acid for methanol
      • Thiamine and pyridoxine for ethylene glycol
    • Send methanol and ethylene glycol levels ASAP