Order Toxins and Poisoning Essay

Order Toxins and Poisoning Essay
Order 5907763
Order Toxins and Poisoning Essay
1. A 24-year-old male caterer is admitted to the ICU approximately 24 hours after ingesting what
he described as a “sweet-tasting” liquid from the canned fuel used to heat the food. Fomepizole
therapy was started promptly in the emergency department and toxic alcohol levels are sent to
the lab and pending. On arrival to the ICU, he complains of being “in a snowstorm.” What is the
etiology for his visual changes?
A. Focal (partial) seizure in the occipital lobe
B. Direct damage to the retina and optic nerve
C. Basal ganglia hemorrhage
D. Vitamin B12
(cobalamin) deficiency–induced neuron demyelination
E. Substance-induced delirium
2. A 32-year-old male auto mechanic is transferred to your ICU from a small local hospital for
consideration of dialysis. Two days prior, the patient ingested an entire jug of antifreeze at
work on a dare. He was admitted to the local hospital for supportive care but developed
progressive oliguric renal failure. On arrival to your hospital, a small amount of dark urine is
present in the Foley catheter, which is sent to the lab for analysis. The lab calls you to tell you
that there are crystals present in the urine. What is the likely composition of these crystals?
A. Uric acid
B. Calcium pyrophosphate
C. Magnesium ammonium phosphate (struvite)
D. Calcium oxalate
E. Cysteine
Order Toxins and Poisoning Essay
3. A 28-year-old male is admitted from the emergency department after he was found unconscious
at a party. The patient was given two doses of intranasal naloxone empirically with minimal
improvement in his mental status. After he began to vomit, he was intubated for airway
protection and placed on an infusion of propofol for sedation. His friends told the ED
physicians that he ingested several tablets of crushed oxycodone, a “large number” of shots of
liquor, and some of his friend’s newly distilled moonshine. His ethanol level in the ED was
453 mg/dLand a toxicology screen was positive for oxycodone. On arrival to the unit, your
intern suggests treating empirically with fomepizole given the moonshine ingestion. You reply
that fomepizole therapy can be deferred at present because of the presence of:
A. Oxycodone
B. Propofol
C. Ethanol
D. Naloxone
E. Moonshine
4. A 36-year-old female is admitted to the ICU for altered mental status after ingestion of an
unknown substance in a suicide attempt. Laboratory studies in the emergency department were
as follows:
Sodium 140 mEq/L
Potassium 4.0 mEq/L
Chloride 100 mEq/L
Bicarbonate 24 mEq/L
Blood urea nitrogen (BUN) 10 mg/dL
Glucose 100 mg/dL
Ethanol level 100 mg/dL
Measured serum osmolality 340 mOsm/kg
Which of the following calculated values most strongly supports the diagnosis of a toxic alcohol
ingestion?
A. Osmolal gap >25 mOsm
B. Osmolal gap 20 mEq
D. Anion gap <10 mEq
5. A 41-year-old male was admitted from the emergency department for altered mental status after
drinking a bottle of an unknown liquid. A venous blood gas and measures of the serum
electrolytes, renal function, and anion gap were all normal and ethanol level was 100 mg/dL.
On arrival to the floor, repeat labs demonstrate a measured serum osmolality that is 40 mOsm
above the calculated value. The patient is found to be hypotensive and has a pH of 7.05 and an
anion gap of 30 mEq. The next osmolal gap is nearly normal. Which of the following alcohols
is NOT likely to be the ingested agent?
A. Methanol
B. Ethylene glycol
C. Ethanol
D. Propylene glycol
E. Isopropyl alcohol
6. A 48-year-old male is well known to your hospital for his severe alcohol use disorder. In the
emergency department a breathalyzer showed an ethanol level of 250 mg/dL, and he was noted
to be more somnolent than usual. He then had an episode of emesis streaked with bright red
blood. He was intubated for airway protection and admitted to the ICU. In the ICU, an elevated
osmolal gap is noted and he is started empirically on fomepizole. The next day, an arterial
blood gas is drawn with a pH of 7.38, but the patient does not awaken to participate in a
spontaneous awakening trial/spontaneous breathing trial (SAT/SBT). What is the likely
substance responsible for his continued altered mental status?
A. Isopropyl alcohol
B. Methanol
C. Propylene glycol
D. Ethylene glycol
E. Ethanol
7. A 53-year-old female is well known to your hospital for her near-daily visits for acute alcohol
intoxication. After a curious 3-day absence from the emergency department, she is brought in by
local paramedics after being found, confused, in a local park. Her heart rate on arrival is
163 bpm and her blood pressure is 210/105. She is noted to be tremulous and diaphoretic and
tells the ED that she quit alcohol “cold turkey” 3 days prior. Despite repeated doses of
parenteral lorazepam, she continues to be in moderate-to-severe alcohol withdrawal and a
continuous infusion of lorazepam is initiated. Assuming that the infusion is titrated to avoid
oversedation, what acid-base disturbance would you expect to see with a prolonged infusion of
lorazepam?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Primary respiratory alkalosis with secondary metabolic acidosis
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