Toxicology

Hydroxocobalamin dose (cyanide toxicity) = 5 grams

Physostigmine for anticholinergic toxicity

When giving physo, pts need to be on a monitor, with pulse oxymetry, and with frequent auscultations after each dosing listening for bronchospasm, while having atropine at your side.  Dilute the 1mg/mL of physo 1:10 so that you only give 0.1mg (1mL of the dilute sol.) at a time.  This will prevent the possibility of acute seizures, bradycardia/ AV blocks or sialorrhea/ bronchospasm.  If after 1mg of physo given the patient is still anticholinergic you've made a diagnosis of anticholinergic toxicity. They should have become cholinergic after that dose.  You need to give more physo until the MS is OK/ or anticholinergic symptoms are gone. This depends on how much, and when the patient overdosed, etc. Titrating this takes time at the bedside and keen clinical observation.  -Reuben Olmedo

Physostigmine for quetiapine overdose (Am J Emerg Med 2011 July 28)

Serum Osmolarity: 2(Na) + glucose/18 + BUN/2.8 + etoh/4.6

 Henna chemical = para-phenylenediamine (can cause allergic reaction)

Urushiol = allergenic oil found in Anacardiaceae family plants, including poison ivy, poison sumac, as well as mangoes, and cashews (before they are heat-treated, as they usually are before sold to consumers)