Overdoses Flashcards

Question

How does MDMA toxicity present?

Answer 1

- Mixed amphetamine and serotonin like syndrome - Bruxism (teeth grinding) is very common - Hyponatraemia can occur due to mixed direct SIADH from MDMA activity and excessive water intake - Hepatotoxicity can occur, more common with chronic use

Answer 2

Acute and not on lithium - Direct GI irritation causing N/V, diarrhoea and pain - Rare to have neuro complications, need renal impairment, dehydration or hyponatraemia Acute and on lithium - The most dangerous form - GI symptoms as above - Much higher risk of neuro toxicity - increased tremor, hyperreflexia, ataxia, AMS, seizures, coma - Dysrhythmias Chronic overdose - No GI symptoms but high risk of neuro symptoms - SILENT syndrome, nephrogenic DI, electrolyte abnormalities, prolonged QT, bradycardya - More likely complications during treatment

Answer 3

- The leading cause of overdose related intubation in Australia - Seizures in 5% - Tachycardia (anticholinergic) but hypotension (alpha antagonism) - >3gm is severe toxicity - peak 6hrs for IR, 24hrs for SR - Watch for urinary retention Adrenaline is relatively contraindicated, alpha antagonism of quetiapine can lead to Adrenaline causing mainly beta effects, leading to worsened tachycardia and vasodilation

Answer 4

Basics - Mix of SNRI, SDRI and anticholinergic activity - Typically prescribed for nicotine withdrawal, depression and ADHD - IR formulations take 6hrs to peak and SR 24hrs, leads to delayed toxicity Neurotoxicity - delerium, seizures, coma - sympathetic stimulation (mimics amphetamines) - Can be a brain death mimic - Non-epileptic myoclonic jerks Cardiac toxicity - prolonged QT/QRS from K+ channel blockade - direct myocardial depression, leads to severe LV failure, bradycardia and collapse

Answer 5

Quinine/Quinidine overdose Skin - Rash, photosensitivity, flushing CNS - Blindness, deafness, tinnitus CVS - Long QRS, tachyarrhythmias

Answer 6

Stage 1 (1-12 hrs) - Ethanol like symptoms - Euphoria, ataxia, slurred speech, reduced GCS Stage 2 (6-24hrs) - HAGMA, tachypnoea, tachycardia, hypertension, coma Stage 3 (24-72hrs) - Worsening acidosis - ARF, hypocalcaemia - Seizures, coma, death Diagnosis - Calcium oxalate crystaluria - Measure serum and blood gas lactate, some VBG analysers interpret EG as lactate, thus there will be a large lactate gap - increased OG, HAGMA Electrolytes - Hypocalcaemia is pathognomonic - Also get hyperkalaemia, hypomagnesaemia and hypoglycaemia Treatment - Fomepizole/Ethanol - Dialysis - Sodi bic and hyperventilation to combat acidosis - IV Pyridoxine 50mg - Thiamine IV 300mg Long term - Cranial and peripheral neuropathies

Answer 7

Early (0-1hrs) - N/V/D, abdo pain - Fasciculations, seziures - High Hr and BP (nicotinic) - Bronchorrhoea/constriction Late (1-4hrs) - Bradycardia, hypotension (muscarinic) - Paralysis, coma - Hypoventilation/apnoea Toxic doses oral - <0.5mg/kg = minor - 0.5 - 5 = mod-severe - >5mg/kg = lethal - lethal toxicity at 1mg/kg if mucosal or IV Treatment - Wash skin/remove clothes - Atropine IV - Supportive care

Answer 8

Toxicity - <60mg/kg = minor GI - 60-120mg/kg = systemic toxicity - >120mg/kg = lethal - Strongest Fe tabs have 105mg/pill Timeline - 0-6hrs = GI irritation, may be severe with significant fluid losses/bleeding - 6-12 pseudo-improvement - 12-48hrs = HAGMA, vasodilatory shock, hepatorenal failure - Chronic = GI strictures/cirrhosis Treatment - AXR to assess for amount - WBI +/- endoscopy - Desferrioxamine Discharge - If asymptomatic at 6hrs (IR) or 12hrs for SR - asymptomatic and Fe <60umol/L - Gastro F/U considered

Answer 9

Toxicity - >5gm is severe - >8gm is life threatening - Delayed up to 16hrs with SR - >2gm ingestion need to be monitored for >16h-24hrs Clinical - Seizures - Serotonin toxicity - Cardiac depression (>8gm) - QT/QRS prolongation - tachycardia, HTN, mydriasis, sweating, delirium Decontamination - AC if within 4hrs - Consider WBI with >8gm ingestions Treatment - Benzos for seizures - If >8gm then early intubation even if asymptomatic currently - Inotropes for LV support

Answer 10

Toxicity - 0.1-0.5mg/kg = potentially severe toxicity, GI symptoms - 0.5-0.8mg/kg = 10% Mortality - >0/8mg/kg= Highly likely death from multiorgan failure Clinical - 2-24hrs = N/V/D, leukocytosis, fluid shifts and loss - 2-7 days = Multiorgan failure and pancytopaenia - >7 days = rebound leukocytosis, alopecia and possible recovery Treatment - Immediate AC followed by MDAC - Supportive measures - Consider early intubation for non-compliant or vomiting patients to facilitate NG and MDAC

Answer 11

Toxicity - >0.5mg/kg in those not on warfarin Clinical - Delayed bleeding 24-48hrs - INR >5 = high risk of haemorrhage Decontamination - AC +/- MDAC with large ingestions Treatment - Haemorrhage = Vit K, FFP, Prothrombinex VF - No haemorrhage but INR >2 = 10mg PO vitamin K (250mcg/kg) for 7 days with repeat INR's - No haemorrhage but INR <2 = repeat INR at 25 and 48hrs

Answer 12

Toxicity - 1 tab in children - Children/non-diabetics more vulnerable - Hypoglycaemia can last days - Can occur at therapeutic doses in the elderly/renal impairment Management - Oral complex carbohydrates - Octreotide SC/IV, 50mcg bolus then 25mcg/hr - IV dextrose only if hypoglycaemic, hyperglycaemia will stimulate further insulin release Disposition - Needs at least 18hrs monitoring - Need to be euglycaemic for at least 12hrs post octerotide/glucose infusion ceasing - Don't discharge overnight