Clinical Toxicology II Elective - Toxic Inhalations

Chlorine and phosgene are both considered...

A) Simple asphyxiants
B) Chemial asphyxiants
C) Pulmonary irritants
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Chlorine and phosgene are both considered...

A) Simple asphyxiants
B) Chemial asphyxiants
C) Pulmonary irritants
C) Pulmonary irritants
CO, CN, and MetHgb are considered...

A) Simple asphyxiants
B) Chemial asphyxiants
C) Pulmonary irritants
B) Chemial asphyxiants
N2, propane, and CO2 are considered...

A) Simple asphyxiants
B) Chemial asphyxiants
C) Pulmonary irritants
A) Simple asphyxiants
These types of inhalants work primarily by displacing oxygen alone

A) Simple asphyxiants (N2, propane, CO2)
B) Chemial asphyxiants (CO, CN, MetHgb)
C) Pulmonary irritants (chlorine, phosgene)
A) Simple asphyxiants (N2, propane, CO2)
How should exposures to simple asphyxiants (N2, propane, CO2) be managed?
Managed by removal from environment and O2
These types of inhalants work by displacing oxygen as well as tissue involvement (pulmonary edema, etc)

A) Simple asphyxiants (N2, propane, CO2)
B) Chemial asphyxiants (CO, CN, MetHgb)
C) Pulmonary irritants (chlorine, phosgene)
C) Pulmonary irritants (chlorine, phosgene)
How should exposures to pulmonary irritants (chlorine, phosgene) be managed?
Managed by removal from environment, assisted ventilation if needed, and oxygen
What are some of the common sources for carbon monoxide poisoning?
Produced by incomplete combustion

Most commonly caused by fires, smoke inhalation, automobil exhaust, charcoal grills, kerosene heaters, gas fired appliances, and methylene chloride
This type of poisoning works by decreasing the oxygen carrying capacity of hgb and also provides direct inhibition of cytochrome oxidase and disruption of cellular respiration.

A) Cl
B) Phosgene
C) CO
D) Cyanide
E) Methemoglobinemia
C) CO
What is the typical presentation of carbon monoxide toxicity look like?
Headache, dizziness, N/V, memory impairment, angina, and in cases of more severe exposure syncope, seizure, arrhythmias, hypotension and death

May also present with cherry-red skin
How is carbon monoxide poisoning managed?- O2 at highest concentration, management of secondary symptoms (seizures, hypotension, arrhythmias)The half-life of carbon monoxide in this setting is 1-1.5 hours A) Room air B) 100% normobaric O2 C) 100% O2 at 2-3 ATM D) All of the aboveB) 100% normobaric O2The half-life of carbon monoxide in this setting is 6 hours A) Room air B) 100% normobaric O2 C) 100% O2 at 2-3 ATM D) All of the aboveA) Room airThe half-life of carbon monoxide in this setting is 20-30 minutes A) Room air B) 100% normobaric O2 C) 100% O2 at 2-3 ATM D) All of the aboveC) 100% O2 at 2-3 ATM AKA hyperbaric oxygenWhat are the 3 major indications for hyperbaric oxygen therapy for carbon monoxide toxicity?- severe intoxication (noted by symptoms: coma, seizure, etc) - pregnancy - newbornWhat are some potential causes of methemoglobinemia?- Nitrites, nitrates - Bromates, chlorates - Anilline derivatines - Antimalarials - Dapsone - Sulfonamides - Local anesthetics (benzocaine) - Amyl, butyl nitriteThis type of toxicity works by oxidizing Fe2 to Fe3 which renders it incapable of carrying oxygen. A) Cl B) Phosgene C) CO D) Cyanide E) MethemoglobinemiaE) MethemoglobinemiaHow does methemoglobinemia typically present?- Headache, dizziness, nausea, "chocolate cyanosis"Chocolate cyanosis typically occurs in a MetHgb > ___%.15%Methylene blue should be considered for methemoglobinemia when MetHgb levels are over ___%20%-30%This type of toxicity causes disruption in cellular cytochrome oxidase and block utilization of oxygen A) Cl B) Phosgene C) CO D) Cyanide E) MethemoglobinemiaD) CyanideWhat are some common sources for cyanide toxicity?- Burnt plastics, wool, silk, etc (common in house fires) - Metallurgy - Cyanogenic glycosides (apricot pits, cassava)What does the presentation of cyanide toxicity typically look like?Abrupt onset of headache, nausea, dyspnea, confusion, syncope, seizures, coma, agonal respirations, and CV collapseWhich of the following labs show a positive correlation with blood cyanide concentration? *Pick 3* 1) Plasma lactate 2) Systolic BP 3) Arterial pH 4) Anion gap 5) Blood glucose1) Plasma lactate 4) Anion gap 5) Blood glucoseWhich of the following labs show a negative correlation with blood cyanide concentration? *Pick 2* 1) Plasma lactate 2) Systolic BP 3) Arterial pH 4) Anion gap 5) Blood glucose2) Systolic BP 3) Arterial pHA plasma lactate over ____ mmol/L is indicative of cyanide poisoning10 mmol/LA pH under ____ is indicative of cyanide poisoning7.31Cyanide toxicty is recognized as a blood level > ____ mg/L0.5 mg/LWhat antidote is used for cyanide toxicity currently?Hydroxycobalamin (vitamin B12a) [Cyanokit]. Used to use a 3 agent combination for cyanide toxicity but apparently it's been discontinued now. PRAISE BETrue or false... All patients with cyanide exposure should recieve hydroxycobalamin.False! In cases of mild toxicity, oxygen therapy alone may be used. For more severe cases decontamination + oxygen + antidote is recommended. However I imagine in the field most patients with exposure will be getting it to be on the safe side.