Læknaneminn - 01.10.1996, Page 97

Overdoses and poisonings: physiological responses
Case 4
When the empty bottle was located, it revealed that
“Mini-Thin” diet pills contain ephedrine, a sympat-
homimetic agent. This patient illustrates well the
sympathetic toxidrome. The morning after admission
she was asymptomatic.
4. Calculated osmolality
= 2 [Na+] + Glucose/18 + BUN/2.8
A normal gap is < or = to lOmosm.
5. M- Methanol
N- Ethanol
Case 5
The hidden piece of information in this history is
that the father needs to spit frequently when playing
baseball because he uses snuff all the time. Thus, this
patient manifests the nicotinic toxidrome. Nicotine's
effects at the neuromuscular junction are at first excita-
tory but then a blockade is produced, and then the
patient develops muscular weakness or paralysis. The
patient was transferred from the rural emergency room
to the Childrens Hospital of Cincinnati, and on arrival
was noted to be completely recovered.
D- Diuretics
I- Isopropanol
E- Ethylene glycol
Case 6
This is a typical history of a patient presenting with
a narcotic or opiate toxidrome. It should be noted that
certain opiates require a large dose of naloxone to achi-
eve reversal.
OVERDOSE AND POISONING:
INITIAL LAB0R0T0RY REVIEW AND
PRELIMINARY CARE; SYMPTOMATIC TR-
EATMENT AND SUPPORTIVE CARE
1. Airway, Breathing and Circulation
2. Anion gap = [Na+] - ([HCO3-] + [CT])
The normal anion gap is 12 mEq/L
3. AT MUD PILES
A- Alcohol
T- Toluene
M- Methanol
U- Uremia
D- Diabetic ketoacidosis
P- Paraldehyde
I- Iron, isoniazid
L- Lactic acids
N- Ethylene glycol
S Salicylates, Strychnine
LÆKNANEMINN
87
2. tbl. 1996, 49. árg.