Flashcards in Ingestion of possible toxic substance Deck (15):
Toxidrome of cholinergic drugs
Toxidrome of anti cholinergic drug
Dry flushed skin
Toxidrome of tricyclics antidepressant drugs
Wide QRS complex
Common toxic or potentially toxic substance that are ingested accidentally
Common unintentional ingestion
- Drugs - paracetamol, sedatives, antidepressant
- Household agents - Bleach, disinfectants, Dishwasher tablets
Common intentional ingestion a
Presentation of intoxications
Mx of ingestion of toxins
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.
Q to ask on Hx for accidental ingestion in young children
What was ingested, when and estimate of the quantity.
Risk factors for overdose in children
Children in care
Child abuse or bullying
Other self harming behaviour.
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
- 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.
Public health measures that can be taken to reduce the risk of accidental ingestion
Kidsafe house in Brisbane which demonstrate accident prevent.
- Respiratory suppression
- Miosis, and
- decrease GI motility
- Coma, Cardiac arrest and death
- Naloxone - Short half life
- supportive therapy
mild depression of vital
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
Stop - Supportive therapy
Slow - Taper
Swap - Methadone.