Category Archives: Toxicology

Book Review: Toxicology in a Box

Toxicology in a box is a pretty cool toxicology learning tool. The box contains 154 flashcards with classic and memorable drawings of important poisonings and toxidromes. On the reverse of each card, there is additional important information about sources, classic scenarios, signs/symptoms, mechanisms of action, treatment and clinical pearls.The cards are hilarious (sometimes!) and memorable. It’s really hard to forget… Read More »

Hypoxia: Critical but Often Poorly Understood Concepts

Hypoxemic Hypoxia Arterial hypoxemia almost always points to either a reduction of the inspired oxygen tension or to a lung problem. When troubleshooting a hypoxemic patient, it sometimes helps to investigate the problem by breaking it down in an organized and stepwise fashion: Hardware and access issues: these are more or less obvious plumbing problems which can generally be… Read More »

Success with DRESS: What You Need to Know about Drug Reaction with Eosinophilia and Systemic Symptoms

Introduction Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially life-threatening medical emergency. Patients present with fever, rash and internal organ dysfunction or failure. Organs affected include liver (hepatitis, fulminant hepatic failure), lungs (pneumonitis), kidneys (renal failure, nephritis), brain (encephalopathy and/or aseptic meningitis), and heart (myocarditis, heart failure). Endocrine dysfunction such as hyperthyroidism, diabetes mellitus, and… Read More »

Mnemonic for Side Effects of Antimycobacterial Agents

Here is a mnemonic that will help you remember the side effects of  antimycobacterial agents: Rifampin cause Red discoloration of urine and tears, which can lead to patient anxiety and ruined contact lenses. Patients should be counseled about this ahead of time and should be advised not to wear contact lenses while being treated with this medication. Ethambutol… Read More »

How to Solve Triple Acid-Base Problems Quickly in Your Head

Introduction You can solve triple acid-base problems with basic arithmetic and straightforward logic. As an example, let’s work through the following rather classic triple acid-base problem: An afebrile, atraumatic 26-year-old male with no past medical history is brought to the emergency department because of a three hour history of altered mental status, vomiting and vertigo. The physical examination is positive only for somnolence… Read More »

How to Spot a Falsely Normal Anion Gap

Introduction A high anion gap metabolic acidosis can be a very dangerous acid-base abnormality. The “gap” itself is just a number – it isn’t harmful per se. Rather, the danger is from the acidosis and from the process that is generating the abnormal and excessive organic acid load. The most common screening test for high anion gap metabolic acidosis is… Read More »

Acid-Base Abnormalities and Their Causes

Introduction Acid-Base pathophysiology plays an important role in every aspect of medical practice, including psychiatry. Doctors and medical students need to know, both for real life and for examinations, the predicted acid base disorder of various diseases. It is much easier to interpret ABGs when you know ahead of time what to expect: So let’s start with the metabolic… Read More »