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Benzodiazepine Equivalence

Intermediate Acting:    Alprazolam (Xanax) 0.5 mg OP Peak: 1-2 hrs Half-life: 6-12hrs Use: anxiolytic Lorazepam (Ativan) 1 mg PO Peak: 2 hrs Half-life: 12 hrs Use: anxiolytic, anticonvulsant, hypnotic Clonazepam (Klonopin) 0.5 mg PO Peak: 1-4 hrs Half-life: 30-40 hrs Use: anxiolytic, anticonvulsant Temazepam (Restoril) 10 mg PO Peak: 1-2 hrs Half-life: 8-10 hrs Use: anxiolytic, hypnotic Long Acting:  

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VBG vs ABG

Notes: In a meta-analysis, Bloom et al. note that there is good correlation between arterial and venous pH and HCO3. They also concluded that despite variability in arterial and venous pCO2 and lactate, normal venous levels have good negative predictive values. 1 Zeserson et al. studied VBG and SaO2 (pulse oximetery) results in critically ill patients. This population included 41% ED,

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Lithium Toxicity

Symptoms: (Neurological findings appear late in acute ingestion, but are common presenting complaints in chronic toxicity.) Nausea Vomiting Diarrhea QTc prolongation (rare) Lethargy Ataxia Confusion Tremors, fasciculations, or myoclonic jerks Seizures Encephalopathy Nephrogenic Diabetese Insipidus (in chronic toxicity) Testing: Lithium level Therapeutic  lithium level is 0.8 – 1.2 mEq/L  (mmol/L) 1.5-2.5 mEq/L (mmol/L) – mild symptoms, chronic toxicity, tremor, slurred

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Toxidromes

US Poison Control Center Hotline 1-800-222-1222 Anticholinergic Syndrome Physiology:Inhibition of muscarinic cholinergic neurotransmission (blocking acetylcholine from binding receptors) gives these drugs their effect. Receptors are found on smooth muscle in the GI tract, bronchi, heart, salivary and sweat glands, the cilliary body of the eye, Drugs: antihistamines, sleep aids, tricyclic antidepressants, cold preparations, atropine, cyclopentalate (eye drops) Plants: deadly nightshade (belladonna), jimson weed Clinical Features: “Red as

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