- Cyanosis unresponsive to supplemental O2 administration = methemoglobinemia
- “Chocolate brown” blood = methemoglobinemia
- Therapeutic response to glucose = hypoglycemic agents, alcohols, salicylates
- Therapeutic response to naloxone = opioids (possibly other agents, ACEIs, clonidine, valproic acid)
- Coma: alcohol, sedative hypnotics, opioids, cyclic antidepressants, anticholinergics, CO, salicylates, isoniazid, organophosphates, anticonvulsants, antihistamines, clonidine, PCP, phenothiazines (see mnemonic COMATOSE PATIENT, Table 13.5)
- Respiration
Bradypnea: opioids, alcohols, benzodiazepines, clonidine, barbiturates, γ -hydroxybutyrate (GHB) Tachypnea: salicylates, sympathomimetics, methanol, ethylene glycol, theophylline, caffeine, cocaine Wheezing: organophosphates Kussmaul: salicylates, methanol, ethylene glycol
- Pulse
Bradycardia: beta-blockers, calcium channel blockers, clonidine, digoxin, sedative hypnotics, opioids, organophosphates, phenylpropanolamine Tachycardia: anticholinergics, sympathomimetics (cocaine, amphetamines, over-the-counter [OTC] cold remedies), theophylline, caffeine, iron, salicylate, cyclic antidepressants Dysrhythmias: anticholinergics, cyclic antidepressants, phenothiazines, beta-blockers, calcium channel blockers, organophosphates, CO, cyanide (CN)
- Blood Pressure
Hypotension: beta-blockers, calcium channel blockers, clonidine, opioids, iron, CAs, phenothiazines, CO, CN Hypertension: phenylpropanolamine (OTC cold remedies), sympathomimetics, phencyclidine (PCP), cocaine, amphetamines, anticholinergics, antihistamines
- Temperature
Hypothermia: alcohols, opioids, benzodiazepines, clonidine, barbiturates, phenothiazines, CAs, CO, antidepressants, hypoglycemic agents Hyperthermia: sympathomimetics, anticholinergics, salicylates, TCAs, cocaine, amphetamines, theophylline, phenothiazines
- Bedside Glucose Analysis
Hyperglycemia: salicylates, iron, isoniazid Hypoglycemia: hypoglycemic agents, alcohols, salicylates
- Arterial Blood Gas
CO: normal PO2, normal hemoglobin saturation and normal pulse oximetry, elevated lactate Methemoglobinemia: normal or increased PO2, decreased hemoglobin saturation and decreased pulse oximetry, elevated lactate Carboxyhemoglobin and methemoglobin levels
- ECG: terminal 40-ms frontal plane QRS vector, prolonged QRS = CAs (sodium-channel blocking agents)
- Urine ferric chloride assay (1 mL of urine + few drops of 10% ferric chloride): purple = salicylates, phenothiazines
- Urine:
Calcium oxalate crystals = ethylene glycol Ketones = acetone, isopropyl alcohol, salicylates
- Fluorescence under Wood’s lamp: ethylene glycol from antifreeze (fluorescein additive)
- Gastric contents deferoxamine test: (deferoxamine + hydrogen peroxide added to gastric contents yields a rose color) = iron
- Skin
Cherry red = CO, CN Blue/cyanosis = methemoglobinemia Flushing = anticholinergics, sympathomimetics, ethanol, antihistamines, niacin Hot, dry skin = anticholinergics Diaphoresis = sympathomimetics, salicylates, cocaine, PCP, organophosphates Jaundice = acetaminophen, mothballs (naphthalene-induced hemolysis), toxic mushrooms (eg, amanita phalloides)
- Odor
Acetone = isopropanol, methanol, chloroform, salicylate Wintergreen = methyl salicylate Alcohol = mixed ethanol (pure ethanol is odorless), isopropyl alcohol, methanol Garlic = organophosphates, arsenic, thallium, phosphorus Coal gas = CO Bitter almond = CN Rotten eggs = hydrogen sulfide Fruity = isopropanol, ethanol, amyl nitrite Mothballs = Camphor, naphthalene Petroleum = Petroleum distillate Pears = chloral hydrate
- Extrapyramidal signs (rigidity, dysphonia, torticollis, oculogyric crisis) = phenothiazines
- Myoclonus/rigidity = phenothiazines, anticholinergics, haloperidol
- Nystagmus = phenytoin, PCP, alcohol, barbiturates, sedative-hypnotics, carbamazepine, CO, lithium
- Psychosis/delirium = PCP, anticholinergics, phenothiazines, cocaine, heroin, sympathomimetics, LSD, marijuana, ethanol, antihistamines
- Ataxia = alcohols, phenytoin, barbiturates, benzodiazepines, CO
- Fasciculations = organophosphates
- Paralysis = organophosphates, botulinum toxin, carbamates, heavy metals
- Blindness = methanol
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