1. obtain lab values

2. decontamination

-H&P and lab values obtained by physician

-pharmacists can sometimes order extra tests

1. Blood gases

2. Electrolytes

3. Renal function

4. serum osmolarity

5. ECG

-blood gases reflect dissolved gas in plasma

-hypoventilation: increases PCO2 and decreases PO2

-CO displaces O2 and Hb but no decrease in PO2 initially

-anion gap = (Na + K) - (Cl + HCO3)

-normally 12-16 meq/L

-increased anion gap > more positives > other ions are accompanying acidosis

-non drug causes

1. diabetic ketoacidosis

2. shock induced acidosis

3. renal failure

-cannot remove acids so they bind with bicarb and lower the bicarb amount

-drug causes

1. aspirin

2. metformin

3. methanol, glycols

4. isonazid

5. iron

hyperkalemia causes

1. potassium supplements

2. beta blockers

3. digitalis: damages Na/K ATPase

4. potassium sparing diuretics

hypokalemia causes

1. beta agonists

2. caffeine

3. insulin

4. thiazide

5. loop diuretics

6. theophylline

1. BUN

2. creatinine

3. muscle damage: leakage of creatine kinase and myoglobin

-equation that involves Na, BUN, glucose

-normal value = 280-290

-affected by alcohols

1. QRS complex

-widens with TCAs and quinidine

2. QTc

-increases with lithium and arsenic

3. AV block

-can be caused by digoxin

-occurs simultaneously with diagnostic procedures

-main goal is to remove toxins from GI tract

-removal from skin with warm water and mild soap (in absence of burns)

1. GI decontamination

2. dialysis and filtration

3. urinary elimination

-cause emesis with ipecac except for

1. convulsants and anti-emetics: ipecac may cause convulsions

2. petroleum products: can aspirate petroleum into lungs

3. corrosive agents: may burn upper GI tract

1. nasogastric or orogastric tube removal

2. endotracheal cuff or suction: preferred

-PEG electrolyte or GoLYTELY

-eliminates undissolved tablets through both oral administration and whole bowel irrigation

1. peritoneal dialysis: fluid in peritoneal cavity and drug flows into it

2. hemodialysis: blood is sent through a circuit past a semipermeable membrane REQUIRES HEPARIN

3. hemoperfusion: blood sent through a circuit and pressure forces fluid out to reduce blood volume, then fluid is replaced REQUIRES HEPARIN

-not proven with many drugs

-bicarb with salicylate poisoning is an exception

-metal toxicants differ from organic compounds > cannot be metabolically degraded

-blood levels may not always correlate with clinical symptoms, chelation is crucial for most effective removal of metals after exposure

1. EDTA

2. dimercaprol

3. succimer

4. ferroxamine

5. penicillamine

6. unithiol