Overdose and Poisoning

Question 1

Paracetamol Overdose

Answer 1

1. Establish timing and dosing of overdose to assign treatment group

(if 150MG/kg within 1hr = Activated charcoal and immediate treatment )
(if staggered overdose = immediate treatment)
(if 1-4hrs after ingestion, take bloods at 4hrs and compare to nomogram)
(if >4-8hrs take bloods immediately and compare to nomogram)
(if 8-24 hrs take bloods immediately and treat whilst waiting for result)

2. NAC (N-Acetylcystine/ Parvolex) in 3 infusions
3. 150mg/kg over 1 hr
4. 50mg/kg over 4hrs
5. 100mg/kg over 16hours
6. Have chlorphenamine ready in case of rash (common SE) only stop infusion in anaphylaxis- methionine alternative.
7. keep an eye on hypoglycemia

Question 2

Salicylate (asprin) poisoning

Answer 2

1. Correct dehydration
2. Heart monitor
3. Activated charcoal if early
4. Blood and Urine monitoring-
5. Correct acidosis with
   - Sodium Bicarbinate
   - Dialysis

Question 3

Opioid Overdose

Answer 3

NALOXONE
(IM first if risk of absconding)
0.4-2mg IV, repeat every 2 mins until breathing restored. 
Atropine to ease withdawral
Sedation 
Methadone for frequent users

Question 4

Warfarin

Answer 4

Vitamin K

Question 5

CO

Answer 5

High flow 100% O2
Mannitol is severe
Hyperbaric O2 in specalist centre

Question 6

Cyanide

Answer 6

Sodium nitrate / Sodium Thiosulphate

Question 7

Alcohol Poisoning

Answer 7

If ingested within 1hr NG aspiration and gastric lavage

Supportive Care:

• Temp*
• BM*
• Fluids*
• also track HR, BP and GCS (be ready to intubate)
• other bloods U&E, V/ABG, Blood Alcohol,
• ECG
• CT head

Question 8

Neuroleptic Malignant Syndrome following anti-psychotics

Answer 8

Discontinue drug 
DANTROLENE IV
Supportive measures 
-cooling
-intubate / ventilate
-IVI
-Dialysis 
Measure response in CK, Urinary myoglobin, U&E, ABG, FBC, and coagulation and support for at least 7/7