72. ICU Toxicology with Dr. Adam Mora

Toxicology management in the intensive care unit requires rapid pattern recognition and precise physical examination to guide life-saving interventions. Clinical diagnosis centers on identifying classic toxidromes, such as opioid-induced respiratory depression, serotonin syndrome, lithium toxicity, and toxic alcohol ingestions. Effective management prioritizes stabilizing airway and hemodynamic status over immediate reversal, particularly when avoiding withdrawal symptoms or managing severe acidosis. For instance, naloxone administration focuses on restoring adequate ventilation rather than full consciousness, while sodium bicarbonate serves as the cornerstone for treating tricyclic antidepressant-induced sodium channel blockade. Clinicians must maintain a low threshold for nephrology consultation and extracorporeal support, such as hemodialysis or ECMO, when faced with refractory shock or irreversible CNS injury. Ultimately, successful outcomes depend on integrating clinical data with an understanding of the underlying pathophysiology and the socioeconomic factors influencing patient exposure.