Toxicology Flashcards

1
Q

What are the King’s College criteria for liver transplant in paracetamol overdose? (5)

A
  1. PH <7.3
  2. Cr>300
  3. Lactate >3.5 on admission or >3 24 hours post-ingestion or after adequate fluid resus
  4. PT>100 seconds
  5. Encephalopathy grade 3 or 4 (stupor or coma respectively)
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2
Q

How do you calculate an anion gap?

A

Na - (Cl + HCO3) = 4-12

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3
Q

How do you adjust an anion gap in hypoalbuminaemia?

A

Reduce anion gap by 0.25 per 1g of albumin <40

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4
Q

What is the SNAP regimen?

A

100mg/kg in 200mls 5% dextrose over 2 hours
Then: 200mg/kg in 1L 5% dextrose over 10 hours

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5
Q

Normal anion gap met acidosis causes:

A

CAGE
Chloride
Addisons/Acetazolamide
GI losses - stoma/GI/diarrhoea
Extras - RTA, DKA recovery, oral acidifying salts

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6
Q

Raised anion gap met acidosis

A

CAT MUDPILES
CO/cyanide/CHF
Aminoglycosides (gent etc)
Toluene (glue sniffing), Teophylline
Methanol
Uraemia
DKA/EtOH/starvation Ketosis
Paracetamol/Paraldehyde/Pyroglutamic acidosis
Iron/Isoniazid/Inborn errors of met
Lactic acidosis
Ethylene glycol, Ethanol
Salicylates

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7
Q

What are the features of serotonin syndrome?

A

Tremor, diarrhoea and restlessness are most common.
Others:
Autonomic - tachycardia, hyperthermia, dilated pupils, sweating ++
Neuromuscular - tremor, increased tone, hyperreflexia
D - agitation, confusion

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8
Q

What are the common features of TCA OD?

A

Onset within 1-2 hours:
- anticholinergic
- divergent squint
- increased tone
- up going planters
- acidosis
- seizures/coma

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9
Q

What are the ECG changes in TCA OD?

A

Progressive from:
1. Sinus tachycardia
2. Prolonged PR & QRS
3. Ventricular arrhythmia and Heart block

Note a dominant R wave in aVR and a slurring of the terminal QRS

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10
Q

What is the antidote for TCA OD?

A

Sodium bicarbonate 8.4% 100mls

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