Winter’s Wrap 15/2/17 – Toxicology with Zeff

A great turnout for the first Footscray session!

A massive thanks to Dr Zeff Koutsogiannis for enlightening us on the usefulness of ABGs and cardiotoxic drug ingestions.



6 easy steps

1-2-3-4 rule

causes of metabolic acidosis – CAT MUDPILES (you fill it in!)

osmolar gap – make sure osmolality and UEC are requested at the same time

lactate gap  – compare the lab lactate measurement with blood gas machine measurement, consider “glycolate” a metabolite of ethylene glycol



SALT              NaBicarb – give as a bolus in TCA OD (not an infusion)

SUGAR          High dose insulin-dextrose to improve pump function in BB and CCB OD

COLOUR       Methylene blue for profound hypotension despite fluid, available from theatre 1-2ml/kg/hr

FAT                Intralipid only for LA injection with CVS toxicity


QT measurement – 3 limb leads, 3 V leads, take the MEDIAN measurement then plot on QT nomogram to determine likelihood of developing torsades


TAPNA  Australasia Toxicology Network Scientific Meeting April 27-29, 2017




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