Overdose

Question 1

What is the management if a patient presents within 2 hours of a paracetamol overdose?

Answer 1

50mg activated charcoal PO (most effective <1hr)

Question 2

What is the management of a paracetamol overdose within 4-8hrs?

Answer 2

• Immediate paracetamol concentration
• Plot on nomogram and treat if indicated

Question 3

What is the management of a paracetamol overdose
after 8hrs?

Answer 3

• Commence NAC, immediate paracetamol concentration and ALT
• Plot on nomogram, continue NAC if paracetamol level above treatment line
• Cease NAC if paracetamol level is below treatment line and normal ALT
• Seek advice if paracetamol level below treatment line and ALT raised

Question 4

When would you treat immediately with NAC?

Answer 4

• Staggered OD
• Unclear hx
• Present >8hrs post ingestion
• > 12g or >150mg/kg has been ingested

Question 5

What investigations are done in paracetamol overdose?

Answer 5

• Paracetamol and salicylate level (only accurate >4hrs after ingestion), repeat paracetamol level 2hrs before completion of NAC, if >10mg/L continue NAC
• LFTs - ALT, if >50U/L continue NAC
• Liver screen for those at high risk of hepatotoxicity

Question 6

What are the signs and symptoms of paracetamol overdose?

Answer 6

Only develop around 24hrs after ingestion:
- N+v
- RUQ tenderness
- Hepatic problems - jaundice, RUQ pain, encephalopathy, hypglycaemia
- Renal failure
- Oliguria
- Metbaolic acidosis

Question 7

What is the presentation of an aspirin overdose?

Answer 7

Initial respiratory alkalosis due to central respiratory stimulation causing increased respiratory drive. Later metabolic acidosis develops alongside resp alkalosis due to the direct effect of salicylic acid.

Question 8

What is the management for aspirin overdose?

Answer 8

• Activated charcoal within 1hr
• Correct electrolyte abnormalities
• Sodium bicarb