Toxicology 2
It is used to increase cardiac contractility (it is a positive inotrope) and as an antiarrhythmic
agent to control the heart rate, particularly in the irregular (and often fast) atrial fibrillation.

Toxicity Symptoms - mouth irritation, vomiting, and diarrhea,  with conduction defects and
arrhythmias. Rx -  digoxin-specific antibody fragments ( Digifab)

Other plants with digitalis effect are  berries of lily-of-the-valley, red squill, and oleander.
 (Arboretum = Botanical Garden)
Severe metabolic acidosis, normal carboxyhemoglobin and methemoglobin suggests
cyanide poisoning in patients involved in closed-space fires (especially where nitrogen-
containing synthetic materials have burned).

Does not cause cyanosis.

Toxicity Causes- headaches, vertigo, confusion, seizures, apnea, and cardiac arrest.

Empiric cyanide levels not recommended due to half life of 1 hour.

Rx - the cyanide antidote kit (formerly known as the Lilly kit)
Foxglove / Digitalis
Cyanide Poisoning
naturally occurring substances found in the leaves of the khat (Catha edulis) plant.
sold as bath salts or plant food, Can be taken by multiple routes

structurally similar to amphetamines. work via blocking the reuptake of dopamine,
norepinephrine, and serotonin.
euphoria, increased energy, enhanced openness, and empathy, agitation, aggression,
hallucinations, tachycardia, hypertension, mydriasis, and hyperthermia,  palpitations, chest
pain, dry mouth, nausea, and vomiting, seizures, myocardial infarction, myocarditis,
rhabdomyolysis, excited delirium syndrome, serotonin syndrome, and death.

Rx -  IV benzodiazepines. While benzodiazepines,  passive or active cooling, IV fluids.
Inv -  EKG, electrolytes, renal function, hepatic transaminases, and a CK.
Standard drug screens for amphetamines are often negative.
Synthetic Cathinones (“Bath Salts”)
sold as herbal incense or air fresheners

structurally dissimilar to THC but clinical effects similar to THC.

SE - tachycardia, hypertension, agitation, hallucinations, agitation, anxiety, paranoia, and
vomiting. Seizures, acute kidney injury, and SVT have been reported.

Rx -  discontinuation of the drug and Benzodiazepines may be useful

not picked up on standard urine drug screens
Synthetic Cannabinoids (Spice, K2)
Colicky pain, constipation, anorexia, and intermittent vomiting, listlessness and irritability.

Lead encephalopathy listless, irritable,  drowsy, clumsy, frankly ataxic and seizures.

Peripheral neuropathy often occurs in adults with lead poisoning but is rare in children.

Slight aminoaciduria to a full Fanconi syndrome.

Microcytic anemia  - Erythrocyte protoporphyrin (EP), Moderately elevated in iron deficiency,
but high levels are the result of chronic lead poisoning. Also cause Basophilic Stipling.

Dense metaphyseal bands on radiographs of knees and wrists (lead lines)

LP should be avoided to reduce risk of herniation.

Treatment above level 44.

specific chelating drugs -  Succimer  [DMSA],  (British Anti-Lewisite [BAL], (CaEDTA)
Lead Poisoning - 44
Respiratory alkalosis ( hyperventilation) with metabolic acidosis ( lactic acid and keto-acid)

Levels above 150 mg/kg is toxic.

serum conc above 30 mg / dl is significant

inhibits platelet function, cause coagulopathy, elevated LFT,  leukocytosis, hypokalemia,
fluid loss, low CNS glucose concentration even in the presence of peripheral hyperglycemia.

Physical manifestations include fever, tachypnea, nausea, vomiting, tinnitus, lethargy,
slurred speech, and seizures.

Death from salicylism results from severe CNS toxicity.

Aspirin delays gastric emptying - charcoal can be used even after 1 hr.

Rx - urine alkalinization, fluid resuscitation, hemodialysis and hemoperfusion
Salicylate Intoxication