Endocrine/ Metabolic/ Elemental

Answer 1

R
- Usual

R
- <
- *Kids: *.

S
ANTICIPATE:

-SUPPORT:

I
- 12-lead, BGL, parac (delib)

D
AC:

E

A

D
OBSERVE hours

Question 2

IRON OD

Answer 2

R
- Usual

R
Predictors of toxicity:
- >60mg/kg
- Level >90
- Kids: accidental usually benign.

S
Stage 1- GI corrosion
Within 6 hours:
profound GI upset with significant fluid loss

Then, apparent improvement

Stage 2- Systemic toxicity
1-2 days:
ACUTE HEPATIC FAILURE

-SUPPORT:
- Fluid replacement ++

I
- 12-lead, BGL, parac (delib)
- AXR: confirm/ quantify
- Iron level: >90 bad
-ABG: lactic acidosis

D
AC won’t work.
Whole bowel irrigation if >60mg/kg
Endoscopy +/-

E
No

A
- DESFERRIOXAMINE (chelation)

D
OBSERVE 6 hours. If no GI symptoms, clear.

If survive liver failure, delayed cirrhosis, GI strictures.

Question 3

METFORMIN

Answer 3

R
- Usually in setting of intercurrent AKI (fully renally cleared)
- >10g
- Kids: up to 1700mg benign.

S
ANTICIPATE:
- Hypoglycaemia mild or none
- Severe lactic acidosis
—> 50% mortality! in Tx toxicity
—> Prognosis much better in OD
- Ass’d HyperK

-SUPPORT:
- SODI BIC for acidosis
- HyperK Tx

I
- 12-lead, BGL, parac (delib)
- Gas

D
AC: Yes within 2hrs

E
Haemodialysis (removes drug itself AND H+)
–> ALL those with acidosis from therapeutic admin. + sick ODs.

A
No

D
OBSERVE 8 hours. Well if the BICARB is okay (not just pH)

Question 4

SULFONYLUREAS (‘ ides)

Answer 4

R
- Usual

R
- ANY potentially bad (even 1 tab adults)
- Kids: “one pill can kill”.
- If usual med, can cause tox in intercurrent AKI

S
ANTICIPATE:
Prolonged and profound hypoglycaemia from 8 hours

-SUPPORT:
If BSL <4:
Glucose boluses PRN until octreotide started
—> adults 50ml 50%/ kids 2-5ml/kg 10%

I
- 12-lead, BGL, parac (delib)
- BSL min hourly to start

D
AC: Yes (1hr IR, 4h SR)

E
No

A
- If BSL <4:
- OCTREOTIDE 50microg IV –> 25microg/hr. Min 24hrs.
- Kids: 1microg/kg —> 1microg/kg/hr
–> Won’t usually need ongoing glucose once this is on
—> At least 24/24

D
OBSERVE 18 hours

Question 5

INSULIN

Answer 5

R
- Any deliberate possibly bad
- Worse in non-diabetics who have endogenous insulin + no resistance
- Poor severity/duration correlation with dose.
—> In OD, duration of action no longer dep on insulin type, dictated by release from adipose injection site.
- Prognosis excellent if early, if presents in coma: grim

S
ANTICIPATE:
Prolonged and profound hypoglycaemia for 3+ days
Electrolyte derangement
- HypoK
- HypoMg
- HypoPO4

I
- 12-lead, BGL, parac (delib)
- 15 minutey BGLs during resus, then hourly.
- K, Mg, Ph

D
AC: No

E
No

A
If BGL <4:
GLUCOSE
- adults: 50ml 50%. Rpt. –> 100ml/hr 10%
- kids: 2ml/kg 10%. Rpt. –> maint. rate 10%

• If symptomatic hypos: repeat bolus
• If Asymptomatic hypos: increase rate
• Aim BSL >4
• If failing, CVC to allow 50% conc. infusion (up to 150ml/hr)

(Glucagon is only if no IV access.)

Avoid big BSL spikes that can stimulate endog production

D
OBSERVE 6 hours

On glucose infusions, get endogenous hyperinsulin state- can be difficult ++ to wean

Question 6

COLCHICINE

Answer 6

BAD!
1-2 in kids okay.

>0.5mg/kg (80% mort)
>0.8…. 100%.

______
From 2 hours:
- GI, fluid loss++
- Leuks
Week 1:
- Bone Marrow Suppression
- Rhabdo
- ARDS
After 1 week:
- Alopecia

…. Supportive only!