Toxicology ⭐

TOXICOLOGY

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Poisoning Assessment & Diagnostics

• General Approach to Drug Poisoning
• Initial Management of the Critically ill adult with an Unknown overdose
• Approach to the Child with Occult Toxic exposure
• Serum Osmolality, Osmolar gap 
• Urine Drug Screen
• Body Stuffing / Body Packing

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Toxidromes (Major Clinical Syndromes)

• Sympathomimetic toxidrome (see in Methamphetamine)
• Anticholinergic poisoning
• Cholinergic toxidrome (see in Organophosphate)
• Opioid toxidrome (see in Opioid)
• Sedative-hypnotic toxidrome (see in BZD)
• Serotonin syndrome
• Neuroleptic malignant syndrome (NMS)
• Hallucinogenic syndrome
• Withdrawal syndromes (opioid, benzodiazepine, alcohol)

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Decontamination

• Gastrointestinal decontamination

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Antidotes (Comprehensive Section)

• N-acetylcysteine (paracetamol antidote)
• Naloxone (opioid antidote)
• Flumazenil (BZD antidote)
• Digoxin-specific Fab fragments
• Physostigmine (anticholinergic antidote)
• Atropine & pralidoxime (2-PAM) (organophosphate, carbamate antidote)
• Methylene blue (methemoglobinemia antidotes)
• Hydroxocobalamin, Sodium thiosulfate (cyanide antidote)
• Deferoxamine (iron antidote)
• EDTA, succimer (lead antidote)
• Heavy metal antidotes
• Glucagon, calcium, HIE, Lipid emulsion (Beta-blocker/CCB antidotes)
• Fomepizole (toxic alcohols antidote)
• Anticoagulant Reversal
• Antiplatelet Reversal

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Enhanced Elimination

• Enhanced Elimination

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Specific Poisonings: Pharmaceuticals

Analgesics

• Acetaminophen (paracetamol) poisoning
• Aspirin (salicylates) poisoning
• Clinical, Diagnosis
• Management
• NSAID poisoning
• Acute Opioid Toxicity
• Opioid withdrawal
• Clinical, Assessment, Diagnosis
• Emergency Mx
• Detoxification
• Adolescent
• Clonidine and Imidazoline poisoning

Cardiovascular Drugs

• Beta-blockers poisoning
• Calcium channel blockers poisoning
• Digoxin poisoning

Sedatives & Hypnotics

• Benzodiazepines poisoning
• BZD withdrawal
• Gabapentinoid poisoning (+ withdrawal)
• Gamma-Hydroxybutyrate (GHB) poisoning
• Withdrawal & Dependence
• Barbiturates poisoning
• Meprobamate poisoning
• Baclofen and Phenibut poisoning (+ withdrawal)

Stimulants

• Methamphetamine poisoning
• Ketamine poisoning
• Phencyclidine (PCP) poisoning
• PCP poisoning in children, adolescent
• Cocaine poisoning
• Acute intoxication
• Cocaine use: 
• Cardiogenic complication
• Pulmonary complication
• MDMA poisoning
• Caffeine poisoning
• Nicotine poisoning 
• Theophylline poisoning
• Dextromethorphan poisoning
• Kratom poisoning

Neuro / Psychiatric Medications

• TCA poisoning
• SSRIs poisoning
• SNRIs poisoning & others
• Antipsychotics poisoning
• Lithium poisoning
• Carbarmazepine poisoning
• Valproic acid poisoning 
• Acute Cannabis intoxication
• Cannabinoid hyperemesis syndrome
• Cannabis withdrawal

Endocrine & Metabolic Drugs

• Factitious hypoglycemia
• Metformin-associated lactic acidosis
• Sulfonylurea-induced hypoglycemia

Antimicrobials

• Isoniazid poisoning

Others

• Local Anesthetic Systemic Toxicity (LAST) 

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Specific Poisonings: Non-Pharmaceutical Toxicants

• Occupational chemical exposure: Emergency care
• Household Product Ingestion

Alcohols & Glycols

• Ethanol intoxication
• Alcohol withdrawal syndrome
• Methanol / Ethylene glycol poisoning
• Isopropyl alcohol poisoning

Gases & Fumes

• Inhalant misuse
• Carbon monoxide poisoning
• Cyanide poisoning
• Methemoglobinemia
• Smoke inhalation

Heavy Metals

• Acute Iron poisoning
• Lead poisoning
• Clinical, Diagnosis
• Management
• Mercury toxicity
• Arsenic
• Acute poisoning, Arsine Gas toxicity
• Chronic poisoning
• Cadmium toxicity

Household Agents

• Household Product Ingestion
• Acute Hydrocarbon Exposure
• Corrosives (acid/alkali)
• in children

Industrial Chemicals

• Organophosphates / Carbamates poisoning
• Rodenticide poisoning
• Anticoagulant Rodenticide poisoning
• Clinical, Diagnosis
• Management
• Paraquat / Diquat poisoning

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Environmental & Biological Toxins

Envenomation (Comprehensive)

• Snake envenomation (hematotoxic, neurotoxic, myotoxic species)
• Clinical, Diagnosis
• Management
• Red-necked keelback bite
• Scorpion stings
• Spider bites
• Recluse spider bites
• Widow spider bites
• Marine envenomation (Coral, sea urchin, fish, stingray)
• Jelly fish stings

Plant Toxins

• Toxic plant ingestion
• Clinical & Evaluation
• Management
• Amatoxin mushroom poisoning
• Mushroom poisoning
• Clinical & Evaluation
• Management

Foodborne Toxins

• Ciguatera fish poisoning
• Scrombroid poisoning
• Shellfish, Pufferfish poisoning
• Botulism (see in NMJ disorders from Toxins)

Bacterial & Biological Agents

• Bioterrorism toxins 

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Pediatric Toxicology

• Approach to the Child with Occult Toxic exposure
• Ingestions: button batteries
• Substance-Exposed Child (SEC) / Drug-Endangered Child

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Occupational & Environmental Health

• see in Environment
• Performance-enhancing supplement

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