study_ing
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i keep mixing these up...tretment for CN- toxicity
treatment for isosorbide dinitrate toxicity
that f or methemoglobinemia
any suggestions?
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| study_ing
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| tolito
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methemog,,,, treat a blue pt with a blue drug..rx, methylene blue injection. and vitamin c. hb is oxidised from fe2 to fe2 so we want antioxidant.
isosorbide...hmm trying to figure out the drug. will respond soon.
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| study_ing
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ethanol?? wasnt ethanol for methanol toxicity
look isosorbide--> CN-->for which methemoglobinemia is induced by giving sumthin so that the oxidised Fe binds to CN--
or may be not
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| tolito
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sorry changed it to ascorbic acid.
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| tolito
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for cyanide poisoning, i know we give a nitrite or thiosulphate.
nitrite induces methb formation which binds cyanide. thiosulphate binds cyanide.
yet to see isosorbide. will keep checking
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| tolito
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hey, of course you can give isosorbide, it is a nitrate!!!!
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| study_ing
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no!! u c thats what i muddle up and in the end it s massive confusion
isosorbide nitRATE--cozes CN toxicity for which u give thiosulphate or nitrite!!
mayb...
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| tolito
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NO. I checked up the references. one of the side effects of isosorbide is methb. so it can be used in the management of methb. but the main drugs for methb are amy nitrite ( a gas that is inhaled at scene before infusion of thiosulphate.
there is a catch with using nitrite to induce methb whcih is supposed to bind cyanide. the methb itself may need to be treated!!! so first test for level of free methb. if present, then nitrite is contraindicated in cyanide poisoning. ( methb will opnly be free if there is no free cyanide)
is it clearer. i will look up the reference once again and post it.
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hanx
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| tolito
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between you and me, the guys in pharmacology are confused. they interchange nitrite and nitrate. i have scratched my books a zillion times and i ahve decided, i dont care. if i see amyl in front of nitr... it is what i want for cyanide poisoning
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| tolito
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http://www.emedicine.com/EMERG/topic909.htm
http://www.emedicine.com/ped/topic1432.htm
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| study_ing
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http://www.inchem.org/documents/antidote/antidote...
this was an additional souce i utilised
my summary--confusion
1.CN
2. isosorbide
3.meth hb
antidotes? side effects?
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| study_ing
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1. an iatrogenic source of CN is NITROPRUSSIDE THERAPY
treatment includes thiosulfate
or induction of methHB as it wud prevent binding to cytochrome.
ISOSORBIDE dinitrate has METH Hb as a side effect.
however Meth HB excess is toxic too.
Administer cyanide antidotes (sodium nitrite and sodium thiosulfate) as soon as possible, taking care not to create toxic methemoglobinemia. Do not delay treatment for confirmatory RBC cyanide levels
for that use methylene blue, ascorbic acid..
tolito ur great!!
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| study_ing
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while on the topic wanted to add this little but valuable point...
The best way to distinguish stimulant from anticholinergic overdose is the
skin
sweaty with stimulants
dry with anticholinergics
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| Dr J.
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I found this: There's no antidote for Isosorbide OD.
Correct hypotension and shock. Elevate the foot end of the
bed. Administer IV fluids. If no response, administer
dopamine 2-5 µg/kg/min progressing in 5-10 µg/kg/min
increments depending on the response. The intravascular
volume should be monitored with CVP or Swan Ganz catheter
pressure measurements.
If clinical features of methaemoglobinaemia are present
administer 100% oxygen. Advise strict bed rest. If
methaemoglobinaemia persists or if the methaemoglobin level
is over 30% give 1% methylene blue solution 0.1-0.2 ml/kg (1
to 2 mg/kg) IV over 5 minutes. The same dose may be
repeated within 1 hour if there is no improvement.
Good thread.
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| mjl1717
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Dr J. wrote:
I found this: There's no antidote for Isosorbide OD.
Correct hypotension and shock. Elevate the foot end of the
bed. Administer IV fluids. If no response, administer
dopamine 2-5 µg/kg/min progressing in 5-10 µg/kg/min
increments depending on the response. The intravascular
volume should be monitored with CVP or Swan Ganz catheter
pressure measurements.
If clinical features of methaemoglobinaemia are present
administer 100% oxygen. Advise strict bed rest. If
methaemoglobinaemia persists or if the methaemoglobin level
is over 30% give 1% methylene blue solution 0.1-0.2 ml/kg (1
to 2 mg/kg) IV over 5 minutes. The same dose may be
repeated within 1 hour if there is no improvement.
Good thread.
I like dopamine drips cause : At low doses it acts at D1 {increased renal blood flow} , at medium doses works at B1 causing + inotropy and at very high doses which is what we want here it causes alpha constriction via alpha 1. remember D1B1A1 letters in dobutamine which is mostly cardiospecific b1>b2. --------- [pass the lasix , please!]
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