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Toxin-Induced Abdominal Pain - Dr. Dulaney

9/4/2014

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Black Widow Spider

Picture
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. 

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.
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  • RESIDENCY
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    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction