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Flashcards in Ingestion of possible toxic substance Deck (15):
1

Toxidrome of cholinergic drugs

Organophosphates
Salivation
Sweating
Bronchospasm

2

Toxidrome of anti cholinergic drug

Dry flushed skin
Mydriasis

3

Toxidrome of tricyclics antidepressant drugs

Seizures
Wide QRS complex

4

Common toxic or potentially toxic substance that are ingested accidentally

Common unintentional ingestion
- Drugs - paracetamol, sedatives, antidepressant
- Household agents - Bleach, disinfectants, Dishwasher tablets

5

Common intentional ingestion a

Paracetamol
Alcohol
Sedatives
Antidepressants.

6

Presentation of intoxications

ALOC
Cardiac arrhythmia
Seizures

7

Mx of ingestion of toxins

ABCD
Discuss with national poisons centre
Monitor HR, RR, rhythm, AVPU
Advice on safety at home
Charcoal for aspirin, paracetamol, phenytoin, carbamazepine if ingested in the last hours.
Antidotes if required eg halo one for opiates, vitamin K for warfarin.

8

Q to ask on Hx for accidental ingestion in young children

What was ingested, when and estimate of the quantity.
Inspect container.

9

Risk factors for overdose in children

Children in care
Emotional upset
Child abuse or bullying
Psychiatric illness
Suicidal thoughts
Other self harming behaviour.

10

Paracetamol poisoning

Symptoms - N and V settle in less 24hr, Hepatic necrosis starts 3-4 days later with RUQ pain and later encephalopathy.
Liver failure and kidney failure signs
Rarely causes liver failure - need 20 to 30 tablets, eg greater than 150mg/kg or 10g
If greater then 150mg/kg ingest start Tx immediately
- IV N-acetlycysteine
- Oral methionine
If less
- Paracetamol levels 4 hrs after ingestion and plot on nomogram.
- If above Tx line then start N-acetlycysteine and continue for 24hrs.
Reduces risk of liver damage'
If significant OD then Ix of serial LFT, Coagulation, to monitor liver functions and U and E to monitor Renal function.
Really bad cases with acidosis, encephalopathy, or severe coagulopathy need urgent liver transplant.

11

Public health measures that can be taken to reduce the risk of accidental ingestion

Kidsafe house in Brisbane which demonstrate accident prevent.

12

Opiates Overdose

Symptoms
- Sedation
- hypotension
- Bradycardia
- hypothermia
- Respiratory suppression
- Miosis, and
- decrease GI motility
- Coma, Cardiac arrest and death
Tx
- Naloxone - Short half life
- supportive therapy

13

Benzodiazepines overdose

Drowsiness
Lethargy
Ataxia
Confusion
mild depression of vital
Tx
ABCD

14

Withdrawal symptoms of opiates

weakness, anxiety, anorexia, insomnia, gastric distress, headache, sweating and hot and cold flashes.
Peak at day 6
Resolve by 2 weeks
Tx
Stop - Supportive therapy
Slow - Taper
Swap - Methadone.

15

Benzodiazepine withdrawal

Symptoms
- Anxiety
- depression
- Diarrhoea, constipation bloating
- insommia
- Irritability
- muscle arche
- perceptual disturbance
- Panic attacks
- Seizures
Tx
- Stop - Hospitalisation, supportive care.
- Swab - longer half
- Slow - reduce. For every year take 1month to withdraw.