Overdose Flashcards

Question

opiates OD Mx? SEs?

Answer 1

Naloxone0.4–2mg IV; repeat every 2min until breathing is adequate Naloxone may precipitate features of opiate withdrawal— diarrhoea and cramps, which will normally respond to diphenoxylate and atropine (eg co-phenotrope)

Answer 2

Dystonia (torticollis, retrocollis, glossopharyngeal dystonia, opisthotonus) - procyclidine Treat shock by raising the legs (± plasma expander IVI, or inotropes if desperate) ``` Restore body temperature. Monitor ECG. Use lorazepam IV for prolonged fits in the usual way - 0.1mg/kg (usually 4mg) as a slow bolus into a large vein. If no response after 10–20min give a second dose. ``` Neuroleptic malignant syndrome: it may be treated with cooling. Dantrolene can help, bromocriptine and amantadine are alternatives

Answer 3

0.1mg/kg (usually 4mg) as a slow bolus into a large vein. If no response after 10–20min give a second dose. Beware respiratory arrest during the last part of the injection. Have full resuscitation facilities to hand for all IV benzodiazepine use. The rectal route is an alternative for diazepam if IV access is difficult.

Answer 4

used in many industrial processes causes vomiting, abdominal pain, diarrhoea, seizures, coma, renal failure, and tender hepatomegaly with jaundice and liver failure IV acetylcysteine may improve prognosis

Answer 5

Inactivates cholinesterase causing an increase in acetylcholine --> SLUD response: salivation, lacrimation, urination, diarrhoea also: sweating, small pupils, muscle fasciculation, coma, respiratory distress, and bradycardia Mx: Wear gloves; remove soiled clothes. Wash skin. Take blood (FBC and serum cholinesterase activity). Give atropine IV 2mg every 10min till full atropinization (skin dry, pulse >70, pupils dilated) Also give pralidoxime diazepam given slowly seems to help.

Answer 6

skin dry, pulse >70, pupils dilated

Answer 7

D&V, painful oral ulcers, alveolitis, and renal failure. found in weed killers Dx: Urine test Tx: Activated charrcoal at once (100g followed by a laxative) avoid O2 early on as promotes lung damage.

Answer 8

mild: nausea, muscle pain, blurred vision, amnesia, fever, confusion, and ataxia severe: tachyarrhythmias, hyperthermia, hyper/hypotension, water intoxication, DIC, raised K+, acute kidney injury (AKI), hepatocellular and muscle necrosis, cardiovascular collapse, and ARDS Tx: Administration of activated charcoal and monitoring of BP, ECG, and temperature for at least 12h (rapid cooling may be needed) Monitor urine output and U&E, LFT, CK, FBC, and coagulation Metabolic acidosis - give bicarbonate Anxiety: lorazepam IV as a slow bolus into a large vein Narrow complex tachycardias in adults: consider metoprolol 5mg IV. Hypertension can be treated with nifedipine or phentolamine Treat hypotension conventionally (p790). Hyperthermia: attempt to cool; if rectal T° >39°C consider dantrolene Hyperthermia with ecstasy is akin to serotonin syndrome, and propranolol, muscle relaxation, and ventilation may be needed.

Answer 9

low BP (vasodilation, viper cardiotoxicity), D&V; swelling spreading proximally within 4h of bite; bleeding gums or venepuncture sites; anaphylaxis; ptosis; trismus; rhabdomyolysis; pulmonary oedema. raised WCC, abnormal clotting, low platelets, U+Es, raised urine RBC, raised CK, low PaO2, ECG Avoid active movement of affected limb and incisions and tourniquets.

Answer 10

Vomiting ± RUQ pain. Later: jaundice and encephalopathy from liver damage (the main danger) ± acute kidney injury (AKI) GI decontamination if <4hr after OD - give activated charcoal Glucose, U&E, LFT, INR, ABG, FBC, HCO3 Ω ; blood paracetamol level at 4h post-ingestion If <10–12h since overdose, not vomiting, and plasma paracetamol is above the line on the graph , start acetylcysteine If >8–24h and suspicion of large overdose (>7.5g) err on the side of caution and start acetylcysteine, stopping it if level below treatment line and INR/ALT normal Next day do INR, U+E, LFT. If INR rising - continue acetylcysteine until <1.4 consider referral to specialist liver unit guided by eg King’s College criteria

Answer 11

given by IVI: 150mg/kg in 5% glucose over 15–60min; then 50mg/ kg in 500mL of 5% glucose over 4h; then 100mg/kg/16h in 1L of 5% glucose Rash is common - treat with chlorphenamine + observe; do not stop unless anaphylatoid reaction with shock, vomiting, and wheeze methionine - unreliable absorption if vomiting

Answer 12

Uncoupling of oxidative phosphorylation leads to anaerobic metabolism and the production of lactate and heat 150mg/kg: mild toxicity. •250mg/kg: moderate •>500mg/kg: severe toxicity. Levels over 700mg/L are potentially fatal Many early features unlike paracetemol: Vomiting, dehydration, hyperventilation, tinnitus, vertigo, sweating Rarely reduced GCS, seizures, reduced BP and heart block, pulmonary oedema, hyperthermia Present initially with respiratory alkalosis due to a direct stimulation of the central respiratory centres and then develop a metabolic acidosis. Hyper- or hypoglycaemia may occur.

Answer 13

General: Correct dehydration. Keep patient on ECG monitor. Give activated charcoal to all presenting less than 1h bloods: Paracetamol and salicylate level, glucose, U&E, LFT, INR, ABG, HCO3 Ω, FBC. Salicylate level may need to be repeated after 2h, due to continuing absorption if a potentially toxic dose has been taken. Monitor blood glucose 1–2hrly. urine: pH - consider catheterisation to monitor output and pH correct acidosis: If plasma salicylate level >500mg/L or severe metabolic acidosis, consider alkalinization of the urine, eg with 1.5L 1.26% sodium bicarbonate IV over 3h. Aim for urine pH 7.5–8. NB: monitor serum K+ as hypokalaemia may occur, and should be treated (caution if AKI) Dialysis: May be needed if salicylate level >700mg/L and if AKI or heart failure, pulmonary or cerebral oedema, confusion or seizures, severe acidosis despite best medical therapy, or persistently raised plasma salicylate. Contact nephrology early.

Answer 14

if HIV +ve (reduced hepatic glutathione) or if long-acting paracetamol has been taken, or if pre-existing liver disease or induction of liver enzymes has occurred