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Psychiatry > Overdose and poisoning > Flashcards

Overdose and poisoning Flashcards

1
Q

What is the classic triad of symptoms for opiate overdose?

A
  1. Reduced consciousness
  2. Respiratory depression
  3. Miosis (pin-point pupils)
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2
Q

What key investigation must be performed if opiate overdose is suspected?

A

ABG –> assess the degree of type 2 respiratory depression

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3
Q

What is the antidote for opiate overdose?

A

Naloxone IV

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4
Q

What are the clinical features of bezodiazepine overdose?

A
  • Agitation, euphoria
  • Blurred vision
  • Slurred speech
  • Ataxia
  • Slate-grey cyanosis
  • Reduced consciousness
  • Respiratory depression
  • Hypotension, bradycardia
  • Hypothermia
  • Rhabdomyolysis
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5
Q

What is the antidote for benzodiazepine overdose?

A

Flumazenil

need to be careful as flumazenil can precipitate seizures

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6
Q

What are the clinical features of paracetamol overdose?

A
  • N+V
  • Hepatic necrosis (jaundice, RUQ pain, encephalopathy, hypoglycaemia)
  • Renal failure, oliguria
  • Metabolic acidosis

*usually asymptomatic until 24-72h later when acute liver failure occurs

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7
Q

What investigations should be performed if paracetamol overdose is suspected?

A
  • Paracetamol (+ salicylate) level (only accurate 4h after ingestion)
  • LFTs
  • Glucose
  • U&Es
  • Prothrombin time
  • ABG
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8
Q

How should paracetamol dose presenting <8h after ingestion be managed?

A

Activated charcoal if:

  • > 12g or 150 mg/kg of paracetamol
  • <2h (most effective <1h) after overdose

Acetylcysteine:

  • only administer if you have plasma paracetamol level
  • greatest effect if gent <12h after ingestion
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9
Q

How should paracetamol dose presenting >8h after ingestion be managed?

A
  • Acetylcysteine if >12g or 150mg/kg, regardless of current plasma level
  • 5% dextrose
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10
Q

How should paracetamol dose presenting >24h after ingestion be managed?

A
  • Seek expert advice from Toxobase
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11
Q

What are the clinical features of mild salicylate toxicity?

A
  • N+V
  • Epigastric pain
  • Tinnitus
  • Dizziness
  • Lethargy
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12
Q

What are the clinical features of moderate salicylate toxicity?

A
  • Sweating
  • Fever
  • Dyspnoea
  • Bounding pulse
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13
Q

What are the clinical features of severe salicylate toxicity?

A
  • Confusion
  • Convulsions
  • Coma
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14
Q

What are the clinical features of life-threatening salicylate toxicity?

A
  • Pulmonary oedema
  • Metabolic acidosis
  • Salicylate concentration >700 mg/L
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15
Q

What is the management of salicylate toxicity?

A
  • Activated charcoal
  • IV fluid resuscitation
  • Potassium replacement
  • Sodium bicarbonate
  • Haemodialysis (severe cases)
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16
Q

What is the management of beta blocker toxicity?

A

Glucagon

17
Q

Which TCAs are common to overdose on?

A

Amitriptyline

Dosulepin

18
Q

What is the presentation of TCA overdose?

A
  • Sedation
  • Confusion/delirium
  • Arrhythmia
  • Seizure
  • Hypotension
  • Anticholinergic - hyperthermia, flushing, dilated pupils
  • N+V
  • Headache
19
Q

What is the main investigation for TCA overdose?

A

ECG

  • sinus tachycardia
  • prolonged QRS
  • unusual R wave
  • prolonged QTc
20
Q

What is the management of TCA overdose?

A
  • Sodium bicarbonate

- Activated charcoal (1-2h since ingestion)

21
Q

What is the management of sympathomimetic (cocaine, amphetamine) overdose?

A

Benzodiazepines

22
Q

What is the management of carbon monoxide poisoning?

A

Hyperbaric oxygen

23
Q

What is the antidote for bupivicaine?

A

Intralipid

24
Q

What is the antidote for cyanide?

A

Hydroxycobalamin/Nitrites

25
Q

What is the antidote for digoxin?

A

Digoxin antibodies

26
Q

What is the antidote for heparin?

A

Protamine

27
Q

What is the antidote for hydrofluoric acid?

A

Calcium

28
Q

What is the antidote for iron?

A

Desferrioxamine

29
Q

What is the antidote for methanol?

A

Ethanol

30
Q

What is the antidote for methaemoglobin?

A

Methyline blue

31
Q

What is the antidote for organophosphates?

A

Atropine

32
Q

What is the antidote for sulfonylureas?

A

Octreotide

33
Q

What is the antidote for verapamil?

A

Calcium

34
Q

What is the antidote for warfarin?

A

Vitamin K/Octiplex

Psychiatry (8 decks)

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