Toxicology

Almost every pt with known or suspected ingestion needs: EKG/PA7/uhcg/APAP/ASA
            -EKG to assess QRS and QT intervals and associated ingestions
-uhcg for all females so can provide genetic counseling referral if pregnant
            -PA7 to rule out an anion gap acidosis and associated ingestions
            -APAP and ASA to rule out associated deadly and potentially treatable ingestions
                        -APAP is always obtained, as initially overdose is asymptomatic and treatable
                        -Some argue that normal vitals and exam r/o a clinically significant ASA OD
            -UDS is expensive, insensitive for many ingestants and almost never helps ED pt mgmt
Remember the ABCDE’s of toxicology:
-Antidotes (e.g. NAC, folate) and Alter Absorption (e.g. Activated Charcoal)
-Basics (the real ABCs)
-Change metabolism (e.g. fomepizole, ethanol)
-Distribute differently (e.g. oxygen)
-Enhance Elimination (e.g. diuresis, dialysis, hemoperfusion)
Gastric lavage rarely used, consider for lethal ingestions within 60min of ingestion
Activated Charcoal 1g/kg PO OR may give in ratio 10mg AC: 1mg ingested substance
            -Usual adult dose is 50g PO (combined with sorbitol in pre-mixed bottles)
            -Administer repeat dosages without sorbitol or may cause electrolyte abnormalities
            -In practice, given to most awake patients with known ingestion