Chapter 16- Emergency Poisoning

Question 1

What drug overdose is repeated doses of activated charcoal given?

Answer 1

Carbamazepine 
Dapsone 
Phenobarbital 
Quinine 
Theophylline

Question 2

What’s aspirin overdose treated with

Answer 2

Activated charcoal

Question 3

What’s opioid overdose treated with

Answer 3

Repeated doses of Naloxone (short half life)

Question 4

What’s paracetamol overdose treated with

Answer 4

Acetylcysteine

Question 5

What is used in lidocaine toxicity?

Answer 5

Intralipid

Question 6

What is used for benzodiazepine toxicity?

Answer 6

Flumazenil

Question 7

What is used for digoxin toxicity?

Answer 7

Digoxin-specific antibody

Question 8

What is used for heparin toxicity?

Answer 8

Protamine sulphate

Question 9

What is used for opioid toxicity?

Answer 9

Naloxone

Question 10

What is used for paracetamol toxicity?

Answer 10

Acetylcysteine

Question 11

What is the MHRA advice surrounding the use of acetylcysteine?

Answer 11

Reminder for possible need to continue treatment even after the recommended 3 dose regimen over 21 hours
This is on an individual patient case-by-case basis

Question 12

What two places can you find information on poisoning?

Answer 12

ToxbaseUK National Poisons Information Service

Question 13

Within how much time of poisoning should activated charcoal ideally be taken?

Answer 13

Within 1 hour

Question 14

Activated charcoal should not be used in the poisoning of what substances?

Answer 14

Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts including iron and lithium salts

Question 15

What is the treatment of choice for severe aspirin poisoning?

Answer 15

Haemodialysis

Question 16

In opioid poisoning, are the patient’s pupils pinpoint or dilated?

Answer 16

Pinpoint

Question 17

What is the disadvantage of naloxone administration in opioid poisoning?

Answer 17

Has a shorter duration of action of many opioids so may require repeated doses Can however be given via continuous infusion

Question 18

When would you consider the use of activated charcoal in paracetamol overdose?

Answer 18

If paracetamol in excess of 150 mg/kg is thought to have been ingested within the previous hour.

Question 19

In what situations would you give acetylcysteine in paracetamol overdose?

Answer 19

• If on the treatment line on the paracetamol overdose graph-Who present 8–24 hours after taking an acute overdose of more than 150 mg/kg of paracetamol- Staggered overdose if ingested more than 150mg/kg, if patient’s risk of toxicity is uncertain- Patients with features of hepatic injury, jaundice

Question 20

When is a paracetamol overdose classed as staggered?

Answer 20

If they have taken a toxic dose over more than 1 hour

Question 21

The paracetamol treatment graph is unrelieable in what kind of overdose?

Answer 21

Staggered

Question 22

What is the dosing regimen for acetylcysteine in paracetamol overdose?

Answer 22

1st infusion for 1 hour 150mg/kg
2nd infusion for 4 hours 50mg/kg
3rd infusion for 16 hours 100mg/kg

Question 23

Does TCA overdose result in dilated or pinpoint pupils?

Answer 23

Dilated

Question 24

What is used to treat bradycardia in acute overdose of beta blockers?

Answer 24

Atropine

Question 25

What lithium level is associated with serious toxicity?

Answer 25

>2 May need treatment with haemodialysis

Question 26

Oxygen should be administered to patients with what types of poisoning?

Answer 26

Cyanide, Carbon monoxide

Question 27

Sodium thiosulphate is used for what type of poisoning?

Answer 27

Cyanide

Question 28

How do you treat convulsions caused by overdose/poisoning?

Answer 28

If over 5 minutes in duration must give IV Diazepam or Lorazepam. If IV not available give buccal midazolam or rectal diazepam.

Question 29

How can you treat toxicity from carbamazepine, phenobarbital, quinine, theophylline or dapsone?

Answer 29

Repeated doses of charcoal

Question 30

Symptoms of aspirin poisoning?

Answer 30

Hyperventilating, tinnitus, deafness, sweating.

Question 31

How do you treat aspirin and antidepressant poisoning?

Answer 31

Treat using charcoal and sodium bicarbonate to increase the urinary excretion (make sure to correct the K+ concentration before)

Question 32

Symptoms of paracetamol poisoning?

Answer 32

Nausea and vomiting

Question 33

What is used to treat benzodiazepine overdose?

Answer 33

Flumazenil

Question 34

What is used to treat a betablocker overdose?

Answer 34

Atropine IV (reverses bradycardia)

Question 35

What is used to treat calcium channel blocker overdose? (HINT-4)

Answer 35

Charcoal, calcium chloride, calcium gluconate, atropine (for bradycardia)

Question 36

How do you treat iron poisoning?

Answer 36

Desferrioxamine mesilate (deferoxamine)

Question 37

Signs of theophylline toxicity?

Answer 37

Agitation, tachycardia, hyperglycemia, hypokalaemia

Question 38

How do you treat theophylline toxicity?

Answer 38

Repeated doses of activated charcoal, manage hypokalaemia with IV KCL, short acting beta blocker e.g esmolol for severe tachycardia

Question 39

How do you treat heparin toxicity?

Answer 39

Protamine sulphate IV

Question 40

What is more likely to occur in poisoning, hypertension or hypotension?

Answer 40

HypotensionTreat by elevating foot of bed and giving IV sodium chloride or a colloid to increase plasma volume.

Question 41

If someone is having a convulsion as a result of an overdose/ poisoning, what can be done?

Answer 41

Leave if under 5 minsIV diazepam or lorazepam (NB benzo's should NOT be given by IM route)If IV not available:Buccal midazolam (not licensed for adults or children unfer 3 months)Rectal diazepam

Question 42

Somebody has been stung by a bee and has had a severe anaphylactic reaction to it. How should this be managed?

Answer 42

EpipenIM adrenaline/ epinephrine