Toxicological Emergencies: Acute Intoxications

Emergency · Clinical Specialties

How it begins

Toxicology in the emergency department requires a deep understanding of toxicokinetics (what the body does to the xenobiotic under supraphysiological doses) and toxicodynamics (the molecular pathophysiological impact of the xenobiotic on target systems). When an overdose occurs, conventional first-order kinetic laws often become saturated, transitioning toward zero-order kinetics…

What it covers

1. Pharmacokinetic Alterations in Acute Intoxication
2. Zero Order Kinetics vs. Order One
3. Biotransformation Pathways and Generation of Toxic Metabolites
4. Airway with a Toxicological Approach
5. Ventilation (Breathing)
6. Circulation
7. Neurological Status (Disability) and the "Coma Cocktail"
8. Activated Charcoal (Single Dose and Multiple Dose)
9. · Single Dose Activated Carbon Protocol (CADU)
10. · Multiple Dose Activated Carbon (CADM) and "Gastrointestinal Dialysis"
11. Gastric Lavage (Current Status and Restrictions)
12. Total Intestinal Irrigation (IIT)
13. Appropriateness Criteria for Hemodialysis (HD)
14. Intravenous Lipid Emulsion Therapy (ILE / Lipid Rescue)
15. · Proposed Action Mechanisms
16. Pathophysiology and Clinical Semiotics
17. Urinary Retention and Ileus
18. Management and Use of Physostigmine
19. Peripheral Muscarinic Pathophysiology (Mnemonic: DUMBELS)
20. Peripheral Nicotinic Effects (Mnemonic: MTWTF — Days of the Week in English)
21. Central Manifestations
22. Adrenergic Pathophysiology
23. Thermoregulation and Rhabdomyolysis
24. Physiopathological Differences: Benzodiazepines vs. Barbiturates
25. Risks of Flumazenil
26. Classic Triad of Opioid Intoxication
27. Cardiovascular and Pulmonary Complications
28. Pathophysiology of Cell Damage and Metabolism
29. Clinical Phases of Intoxication
30. The Rumack-Matthew Nomogram
31. N-Acetylcysteine (NAC): Mechanisms and Administration Protocol
32. · NAC Action Mechanisms
33. · Classic 21-hour Intravenous Protocol (3-Stage Protocol)
34. NAC-induced Anaphylactoid Reactions
35. Pathophysiology of Complex Acid-Base Disorder
36. Cellular Neuroglycopenia and pH-Dependency
37. Urinary Alkalinization: The Principle of "Ionic Trapping"
38. Pathophysiology of Cardiotoxicity and Neurotoxicity
39. Electrocardiographic Criteria for Risk of Death
40. The Use of Sodium Bicarbonate as a Physiological Antidote
41. Cellular Pathophysiology
42. Serum Potassium as a Prognostic Factor
43. Clinical and Electrocardiographic Manifestations
44. Physiopathological Differentiation
45. High Dose Insulin-Euglycemia Therapy (HDI)
46. · Mechanism of Action
47. The Use of Glucagon in Beta-Blocker Overdose
48. The Alcohol Dehydrogenase (ADH) Pathway
49. Isopropanol (Rubbing Alcohol): The Exception without Acidosis
50. Gap Diagnosis (Anion Gap and Osmolal Gap)
51. ADH inhibition: Fomepizole vs. Ethanol
52. Cardiovascular Complications from Cocaine
53. Ecstasy (MDMA), Dilutional Hyponatremia and Cerebral Edema
54. Cellular Pathophysiology
55. Late Neurological Syndrome (TLS)
56. Treatment: Normobaric Oxygen Therapy vs. Hyperbaric (HBO)
57. Pathophysiology of Cellular Respiratory Blockade
58. Clinical Presentation and the Diagnostic Key "Cherry Red"
59. Specific Antidote Treatment
60. Molecular Mechanism of Action
61. Atropinization and the Role of Oximes (Pralidoxime, Obidoxime)
62. Intermediate Syndrome
63. Acute and Chronic Saturnism (Lead)
64. Mercury and Arsenic
65. Chelating Agents: Molecular Pharmacology
66. Analysis of the Electrocardiogram as a Toxicological Tool
67. Analytical Limitations of Urine Drug Screening (Screeing)
68. Consideration of Closure and Clinical Safety