Overdose and Poisoning Flashcards Preview

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Flashcards in Overdose and Poisoning Deck (17):
1

What is the most appropriate treatment for:

A 16 year old girl who presents after ingesting 32 paracetamol tablets.

N-acetylcystine.

Management of paracetamol poisoning:
Activated charcoal if ingested less than 1 hour ago.
N-acetylcystine (NAC).
Liver transplantation.

2

What is the most appropriate treatment for:

A 72 year old woman who takes warfarin for atrial fibrillation is taken to the Emergency Department due to rectal bleeding.

Vitamin K

3

What is the most appropriate treatment for:

A 40 year old man presents after taking an overdose of amitriptyline. His ECG on arrival shows widening of the QRS complex.

IV bicarbonate

Management of tricyclic antidepressant overdose:
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity.
Arrhythmias: class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias.
Dialysis is ineffective in removing tricyclics

4

What is the best management in opiate overdose?

Naloxone

5

What is the best management in benzodiazepine overdose?

Flumazenil

6

What is the best management in salicylate poisoning? (2)

Urinary alkalinization is rarely used - it is contraindicated in cerebral and pulmonary oedema with most units now proceeding straight to

Haemodialysis in cases of severe poisoning.

7

What is the best management in lithium poisoning? (3)

Mild-moderate toxicity may respond to volume resuscitation with normal saline.

Haemodialysis may be needed in severe toxicity.

Sodium bicarbonate is sometimes used, but there is limited evidence to support this (by increasing the alkalinity of the urine it promotes lithium excretion)

8

What is the best management in heparin poisoning?

Protamine sulphate

9

What is the best management in beta-blocker poisoning? (2)

If there is bradycardia, then atropine.
In resistant canses, glucagon may be used.

10

What is the best management in ethylene glycol poisoning? (3)

Ethanol has been used for many years. It works by competing with ethylene glycol for the enzyme alcohol dehydrogenase. This limits the formation of toxic metabolites (e.g. glycoaldehyde and glycol acid) which are responsible for the haemodynamic/metabolic features of poisoning.

Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.

Haemodialysis also has a role in refractory cases.

11

What is the best management in methanol poisoning? (2)

Fomepizole or ethanol.

Haemodialysis.

12

What is the best management in organophosphate insecticide poisoning? (2)

Atropine.

Pralidoxime - the role is still unclear, and meta-analyses to data have failed to show any clear benefit.

13

What is the best management in digoxin poisoning?

Digoxin-specific antibody fragments.

14

What is the best management is iron poisoning?

Desferrioxamine, a chelating agent.

15

What is the best management in lead poisoning? (2)

Dimercaprol.

Calcium edetate.

16

What is the best management in carbon monoxide poisoning? (2)

100% oxygen.

Hyperbaric oxygen.

17

What is the best management in cyanide poisoning? (2)

Hydroxocobalamin

Also combination of amyl nitrate, sodium nitrate and sodium thiosulfate.