Poisoning and overdose

Question 1

management of paracetamol overdose If ingestion less than 1 hour ago + dose >150mg/kg:

Answer 1

If ingestion less than 1 hour ago + dose >150mg/kg: Activated charcoal

If staggered overdose or ingestion >15 hours ago: Start N-acetylcysteine immediately

If ingestion <4 hours ago: Wait until 4 hours to take a level and treat with N-acetylcysteine based on level

If ingestion 4-15 hours ago: Take immediate level and treat based on level

Question 2

opiate overdose management

Answer 2

Naloxone will reverse opiate overdose

CNS and respiratory depression

Naloxone has a shorter half life so patient can go back into overdose

Question 3

features of benzodiazepine overdose

Answer 3

Reduced level of consciousness

Respiratory depression

Hypotension and bradycardia

Rhabdomyolysis

Hypothermia

Withdrawal, including seizures

ataxia, nystagmus, dysarthria

Question 4

management of benzodiazepine overdose

Answer 4

flumazenil

Question 5

paracetamol overdose management

Answer 5

Activated charcoal if ingested <1 hour ago

NAC, acetylcysteine

Liver transplantation

Question 6

features of paracetamol overdose

Answer 6

N/V

Hepatic necrosis: jaundice, encephalopathy, hypoglycaemia

Renal failure

Oliguria

Metabolic acidosis

Question 7

aspirin and salicylate overdose management

Answer 7

Urinary alkalinazation with IV bicarbonate

Haemodialysis in severe cases:

Activated charcoal if within an hour of presentation

Iv fluid resus

Potassium replacement as bicarbonate can lower potassium

Cooling measures

Iv benzodiazepines

CPAP

Gastric lavage

Question 8

features of severe cases of aspirin overdose

Answer 8

Renal failure

Heard failure

Coma

Convulsions

Non-resolution of CNS symptoms

Severe metabolic acidosis

Question 9

features of aspirin overdose

Answer 9

Ototoxicity, deafness, tinnitus

Mixed respiratory alkalosis then metabolic acidosis

Warm peripheries and bounding pulse

Tachypnoea and hyperventilation

Cardiac arrhythmia

Acute pulmonary oedema

Question 10

features of life threatening aspirin overdose

Answer 10

Features indicating a life-threatening attack: pulmonary oedema, metabolic acidosis, salicylate conc

Question 11

investigations for aspirin overdose

Answer 11

Plasma salicylate concentration 2hr

Plasma paracetamol concentration

CT head if patient has an altered mental state and intracranial pathology is suspected

Question 12

complications of aspirin overdose

Answer 12

Acute respiratory distress syndrome

Seizures

Drug-induced hepatitis

Cardiac arrest

Question 13

B blocker overdose management

Answer 13

Atropine if bradycardic

Glucagon in resistant cases

Correct hypocalcaemia with calcium

Question 14

carbon monoxide poisoning management

Answer 14

100% oxygen
hyperbaric oxygen

Question 15

TCA antidepressant overdose management

Answer 15

IV bicarbonate to reduce risk of seizures and arrhythmias in severe toxicity

Activated charcoal if they present within one hour of ingestion

Question 16

features of TCA overdose

Answer 16

Serotonin: nausea, GI upset, sexual dysfunction

Noradrenaline: tachycardia, tremors

Antihistamine: sedation, weight gain

Anticholinergic: dry mouth, blurred vision, confusion, constipation, tachycardia, urinary retention

Alpha-1 adrenergic: postural hypotension, drowsiness, dizziness

Manifestation within 6 hours of ingestion

Question 17

TCA overdose investigations

Answer 17

ECG, glucose, basic observations

Magnesium and bone profile

CXR, CT head

Question 18

lithium management

Answer 18

Saline

Haemodialysis in severe toxicity

Sodium bicarbonate

Question 19

SSRI overdose features

Answer 19

Nausea, vomiting, agitation, tremor, nystagmus, drowsiness, sinus tachycardia. There may be convulsions.

Question 20

serotonin syndrome features

Answer 20

marked neuropsychiatric effects, autonomic instability and neuromuscular hyperactivity. There may be hyperthermia, rhabdomyolysis, renal failure, and coagulation deficiencies.

Question 21

BB features

Answer 21

Bradycardia, hypotension, syncope, conduction abnormalities and heart failure.
Other features may include drowsiness, confusion, convulsions, hallucinations, and in severe cases coma.
Effects vary depending on the beta-blocker.

Question 22

CCB overdose features

Answer 22

Nausea, vomiting, diarrhoea, abdominal pain, haematemesis, and rectal bleeding.
Hypotension and hepatocellular necrosis can occur later.
If severe poisoning: coma, shock and metabolic acidosis.

Question 23

lithium toxicity features

Answer 23

There is a delayed onset of symptoms in deliberate overdose (12 hours or more).
Initially, apathy and restlessness followed by vomiting, diarrhoea, ataxia, tremor, weakness, dysarthria, and muscle twitching.

Question 24

lithium toxicity severe poisoning

Answer 24

If severe poisoning: electrolyte imbalance, dehydration, convulsions, renal failure, hypotension, and coma.

Question 25

cocaine overdose features

Answer 25

Agitation, hypertension, tachycardia, dilated pupils, hallucinations, hyperthermia, hypertonia, and hyperreflexia and cardiac effects such as chest pain, arrhythmias, myocardial infarction.

Question 26

amphetamine features

Answer 26

Initially excessive activity, wakefulness, hallucinations, paranoia, and hypertension.
Later there may be convulsions, hyperthermia, exhaustion and coma.

Question 27

opioid overdose features

Answer 27

Drowsiness, coma, respiratory depression, pinpoint pupils.