20111216-2toxicologyconference1.ppt.pptVIP

GU: acute renal failure, hamaturia Acid-base: metabolic acidosis (concurrent ethanol ingestion may delay acidosis 1 hr ) Electrolyte: hypomagnesemia, hypokalemia, hypophophatemia Musculoskeletal: rhabdomyolysis (severe poisoning) Reproductive: birth defects of CNS (ingested together with other solvents) ? Keypoints of PE: Vital sign, mental status, pupuils, thorough visual exam Clinical features Formate accumulation lead to cytochrome oxidase inhibition, mitochondrial disruption and demyelination in optic neuron S/S: blurred or double vision, constricted visual fields, , optic disc hyperemia or atrophy, mydriasis, papilledema, visual impairment, relative afferent pupillary defect, spots before eyes, central scotomata , nystagmus, whiteness. Fixed, dilated pupils suggest severe poisoning Ocular toxicity @ Relative afferent pupillary defect @ Normal Diagnostic testing Finger sugar (rule out hypoglycemia, DKA, HHNK) Arterial or venous blood gas , renal function, electrolytes, serum osmolality, methanol, ethanol , ethylene glycol, isopropanol concentration, lactate, acetaminophen and salicylate levels (to help determine diagnosis) ? high anion gap? HCO3 8 ? Osm gap 10 ? mild elevated lactate levels? ECG Pregnancy test in women of childbearing age Keep airway, breathing, circulation： * Endotracheal intubation if mental status change or respiratory failure ? hyperventilated with large minute ventilations to prevent profound acidemia * IV crystalloid + vasopressors if hypotension Treatment Decontamination : * GI – not very useful ( methanol is rapidly absorbed and binds poorly to activated charcoal). Gastric aspiration by NG