Toxin-Induced Abdominal Pain - Dr. Dulaney

Black Widow Spider

Symptoms

• Bite produces sharp pain, may have erythema/halo, systemic sx start at site and spread proximally
  
• Hypertrophic myopathic syndrome: 30min - 3 hrs post bite, skeletal muscle cramping, involve chest and abd, transient muscle weakness for weeks
• N/V, tremor, bronchorrhea, dyspnea, priapism, diaphoresis, HTN

Treatment

• IVF, pain medication (benzo+opiates).  Antibiotics not recommended
• Antivenom avail, horse serum risk of anaphylaxis.  Considered only in HTN crisis, refractory pain. 1 vial in 50ml NS over 1 hour. 

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LEAD 

Symptoms

• Lead levels during brain development correspond with lower IQ
• Moderate lead levels: vomiting, abd pain, anorexia, constipation.  Hyper-irritable child
• High levels: Anemia, cachexia, encephalopathy, peripheral neuropathy.  Very high = sz coma death

Treatment

• Test by venous blood sample, 1-2 week turnaround.  Can call lab to expedite.
• Tx by chelation therapy, succimer is PO, everything else IV
• FB lead ingestion:  Anything larger than BB comes to ED, emergent removal if in esophagus or airway, otherwise bowel prep with golytely

Cyclopeptite containing mushrooms

• Aminanita, Galerina, Conocybe.  Late summer to autumn.  Heat stable toxin
• Hepatotoxicity
• No sx first 6 hrs..  Then abd pain, Vomiting, diarrhea.  
• 12-48hrs GI sx resolve, LFT increase, followed by fulminant hepatic failure, renal, cardiac failure, pancreatitis
• Use activated charcoal.  NAC not proven efficacious but can try.