Arsenic (Aiello)

• Heavy metal, readily absorbed via GI tract
• Tasteless, odorless
• Poisoning , contaminated water, can be in some preservatives
• Acute ingestion-garlic smell of breath and tissues, GI symptoms, dehydration, pulmonary edema, shock
• Arsine gas exposure- homelysis, hematuria, jaundice
• Workup: Urine arsenic level, EKG, cbc with retic, CMP, mg, phos, ca, lfts, CK
• Management: Supportive care, ABCs, IV, O2, remove exposure, IVF, Avoid QTC prolonging meds
• CHELATION therapy if severe symptoms, Dimercaprol. (Tough to Find) DMPS may be better alternative but logistically tough. Call Poison Control Center ASAP to help manage. Charcoal absorbs poorly to arsenic, evaluate for exchange transfusion in arsine exposure
• Admit to ICU if symptomatic from acute exposure, Asymptomatic can be obs

Toxicology Oral Boards Prep (Eisenstat)

• Oral Boards Update: ABEM made significant changes to licensing exams starting in 2026. Stay tuned for updates and details on how this develops.
• Botulism
  • Infant, Wound, Food Bourne
  • Supportive Care: Early Vent support, Wound management
  • Foodborne/Inhalational: Equine Serum Botulism Antitoxin- through CDC, Department of Health
  • Infant: Botulism IG (BabyBIG) through CDC, Department of Health
  • Wound-  ID, broad spectrum, tx similar to nec fasc
• Carbon Monoxide Poisoning
  • Critical Actions:
    • Perform Complete Neurologic Exam
    • POC Glucose
    • ABG with carboxyhemoglobin
    • 100% NRB
    • Admit for O2 therapy or transfer for hyperbarics

Environmental Tox (McGowen)

• Sorry, was too busy playing Kahoot. Study up for ITE.