Overdose and Poisoning Flashcards Preview

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Flashcards in Overdose and Poisoning Deck (17)
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1
Q

Management of paracetamol overdose

A
  • <8 hrs after oral paracetamol ingestion (taken over <1 hr)
    • Consider activated charcoal if ingested <1 hour ago of >150mg/kg
    • For obese patients calculate if toxic dose
    • Measure paracetamol level 4 hrs from ingestion - await before deciding to treat
    • If biochemical results suggest acute liver injury double check timing of overdose and consider treatment with N-acetylcysteine (NAC) IV
    • Once plasma level is known revise treatment using nomogram
  • 8-24 hrs after ingestion (taken over <1 hr)
    • Send urgent paracetamol level
    • Start NAC IV (do not wait on result)
    • If patient has ingested less than 150mg/kg await bloods before treatment
    • For obese patients calculate if toxic dose
    • If biochemical results suggest acute liver injury double check timing of overdose and consider treatment with N-acetylcysteine (NAC) IV
    • Discontinue NAC if plasma level below treatment line on nomogram
  • >24 hrs from ingestion (taken over <1 hr)
    • Treat with NAC IV if:
      • Measured concentration is >5mg/L at >24 hours ingestion (indicative of a very large overdose)
      • ALT is above the upper limit of normal
      • INR is >1.3 (in the absence of any obvious cause)
      • Patient has jaundice or hepatic tenderness
    • Monitor bloods as well as VBG/ABGs
    • Discontinue NAC if plasma level below treatment line on nomogram
  • Staggered overdose
    • Send for paracetamol level
    • Clinically significant toxicity is unlikely if, following at least 4 hours since the last paracetamol ingestion, the following criteria is met:
      • Paracetamol measured concentration is not detectable (<10mg/L)
      • INR ≤1.3
      • ALT is within normal limits
      • Patient asymptomatic (no symptoms to suggest liver damage)
    • If uncertain treat with NAC IV
2
Q

Management of salicylate poisoning

A
  • Haemodialysis in severe cases
3
Q

Management of opoid overdose

A
  • Naloxone
4
Q

Management of benzodiazepine overdose

A
  • Majority managed with supportive care
  • Flumazenil used in severe cases but can cause seizures
5
Q

Management of TCA overdose

A
  • IV bicarbonate may reduce the risk of seiures and arrhythmias
  • Class Ia and c antiarrhythmics should be avoided as they prolong depolarisation (i.e. Qunidine, Flecainide)
  • Class III antiarrhythmics also contraindicated as they prolonge QT interval (i.e. Amiodarone)
  • Dialysis is ineffective in removing tricyclics
6
Q

Management of lithium overdose

A
  • Mild to moderate may respond to volume resuscitation with normal saline
  • Haemodialysis may be needed in severe toxicity
  • Sodium bicarbonate sometimes used
7
Q

Management of warfarin overdose

A
  • Vitamin K
  • Prothrombin complex
8
Q

Management of heparin overdose

A
  • Protamine sulphate
9
Q

Management of beta-blocker overdose

A
  • If bradycardic give atropine
  • In resistant cases use glucagon
10
Q

Management of ethylene glyucol

A
  • Fomepizole - inhibits alcohol dehydrogenase
  • Ethanol can be used as it competes with ethylene glycol for the enzyme alcohol dehydrogenase - limits the formation of toxic metabolites responsible for haemodynamic/metabolic features
  • Haemodialysis in refractory cases
11
Q

Management of methanol poisoning

A
  • Fomepizole or ethanol
  • Haemodialysis
12
Q

Management of organophosphate insecticides

A
  • Atropine
13
Q

Management of digoxin overdose

A
  • Digoxin-specific antibody fragments
14
Q

Management of iron overdose

A
  • Desferrioxamine, a chelating agent
15
Q

Management of lead overdose

A
  • Dimercaprol, calcium edetate
16
Q

Management of carbon monoxide poisoning

A
  • 100% oxygen
  • Hyperbaric oxygen
17
Q

Management of cyanide poisoning

A
  • Hydroxocobalamin
  • Also a combination of amyl nitrate, sodium nitrate, and sodium thiosulfate