Sedative/hypnotic toxicity: Difference between revisions
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==Background== | |||
==Clinical Features== | |||
==Differential Diagnosis== | |||
{{Sedatve/hypnotic toxicity types}} | |||
==Evaluation== | |||
{{Toxic Alcohols Anion/Osmolar Gaps}} | |||
{{Toxidrome Chart}} | |||
==Management== | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[ | *[[Toxicology (Main)]] | ||
[[Category: | [[Category:Toxicology]] | ||
Latest revision as of 22:22, 25 July 2016
Background
Clinical Features
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
Toxic Alcohols Anion/Osmolar Gaps
| Osmolar gap | Metabolic acidosis | Osmolar gap | Anion gap | Ketones | Ca Oxolate stones | Reduced vision | Management |
|---|---|---|---|---|---|---|---|
| Ethanol | + | + | + (if ketoacidosis) | + | - | Mainly supportive | |
| Ethylene glycol | + | + | + | - | + | - | Fomepizole, Thiamine, Pyridoxine, +/- Dialysis |
| Methanol | + | + (early on, then disappears) | + | - | - | + | Fomepizole or ethanol, Folinic acid, +/- Dialysis |
| Isopropyl alcohol | - | + | - | + | - | + | Mainly supportive |
| Propylene gylcol | + | + (initially) | + (converted to lactate) | - | - | - |
Toxidrome Chart
| Finding | Cholinergic | Anticholinergic | Sympathomimetic | Sympatholytic^ | Sedative/Hypnotic |
| Example | Organophosphates | TCAs | Cocaine | Clonidine | ETOH |
| Temp | Nl | Nl / ↑ | Nl / ↑ | Nl / ↓ | Nl / ↓ |
| RR | Variable | Nl / ↓ | Variable | Nl / ↓ | Nl / ↓ |
| HR | Variable | ↑ | ↑ (sig) | Nl / ↓ | Nl / ↓ |
| BP | ↑ | ↑ | ↑ | Nl / ↓ | Nl / ↓ |
| LOC | Nl / Lethargic | Nl, agitated, psychotic, comatose | Nl, agitated, psychotic | Nl, Lethargic, or Comatose | Nl, Lethargic, or Comatose |
| Pupils | Variable | Mydriatic | Mydriatic | Nl / Miotic | |
| Motor | Fasciculations, Flacid Paralysis | Nl | Nl / Agitated | Nl | |
| Skin | Sweating (sig) | Hot, dry | Sweating | Dry | |
| Lungs | Bronchospasm / rhinorrhea | Nl | Nl | Nl | |
| Bowel Sounds | Hyperactive (SLUDGE) | ↓ / Absent | Nl / ↓ | Nl / ↓ |
- ^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
- Withdrawal from substances have the opposite effect