poisoning Flashcards
(38 cards)
man admitted to A&E with hypotonia, hyporeflexia, hypotension (80/40mmHg).
found with empty box of diazepam 5mg tabs.
what other info is needed?
any other agent/s involved including co-agents e.g. alcohol, paracetamol
route of exposure
date + time of ingestion
quantity ingested
if exposure is single OD/ staggered/ chronic
The px swallowed single OD of mother’s diazepam. took 14 5mg tabs, approx 2 hrs ago.
Hes not taking any other meds and doesnt usually take benzodiazepines. no PMH.
What med to administer as antidote for benzos?
Flumazenil
Benzodiazepine antidote/ antagonist?
Flumazenil
when is flumenazil most likely advised?
in a px with a benzodiazepine OD and history of COPD as potential alternative to ventilation
toxidromes (symptoms) of amitryptiline poisoning
coma
hypertonia
dilated pupils
urinary reternsion
sinus tachycardia
hyperreflexia
tricyclic antidepressants have significant anticholinergic activity –> tachycardia….
cardiotoxic in OD
toxidromes (symptoms) of heroin poisoning
coma
reduced resp rate
constricted pupils
classical opioid triad.
not all features need to be rpesent in cases of poisoning
toxidromes (symptoms) of ecstasy poisoning
delirium
tachycardia
agitation
dilated pupils
hyperthemia
amfetamine derivatived cause sympathetic overdrive
toxidromes (symptoms) of phenobarbital poisoning
coma
hypotonia
hyporeflexia
hypotension
barbiturates have sig depressive activity- some used an anaesthetic agents
samples should be sent to measure concs for suggestive poisoning with which agents?
ethylene glycol
iron salts
lithium salts
methanol
paracetamol
salicylates (e.g. aspirin)
theophylline
risk factors for OD?
alcohol intake
age
marital status
psychiatric disease
px admitted to A&E. taken 32 Tylex capsules8 hrs previously. drowsy but otherwise unwell.
check BNF first…
what test best predicts severity of paracetamol poisoning?
plasma paracetamol conc
where to seek further advice for management plan. poisoned px
TOXBASE
or NPIS
tests used in investigation of iron poisoning?
ABGs
LFTs
serum iron conc
abdominal x ray
FBC
INR (prothrombin time)
…
16yo girl 50kg presents to A&E following OD of 20 ferrous sulphate tabs (elemental iron content 65mg/ tab).
she has nausea, vomiting, diarrhoea
what level of toxicity would be expected?
total amount ingetsed: 20 tabs x 65mg tab = 1300mg
amount elem iron ingested on mg/kg basis: 26mg/kg.
moderate iron tox
… 4 hour serum iron conc: 4.8mg/L
mild nausea but px improves. can px be dischharged?
no… see notes
2 things initially presc for opioid poisoning?
naloxone
IV fluids
what effect may Flumazenil have in px with benzodiazepine dependance?
may precipitate withdrawal symptoms
effective management of poisoning should aim to… (3)
- reduce absorption
- give antidote
- increase elimination
what does activated charcoal do?
+ timeframe
bind to many poisons in GIT to reduce absorption…
if given with/ soon (1 hour) after ingestion
activated charcoal is NOT effective at adsorbing which drigs? and give examples
strongly ionised drugs or alcohols…
- inorganic acids
- strong alkalis
- iron salts
- li salts
- methanol/ ethanol
- ethylene glycol
acetylcysteine is an antidote for…
paracetamol poisoning
atropine is an antidote for…
= anticholinergic for cholinergic excess.
also to inhibit action of parasympathetic action of vagus nerve in poisonings that cause bradycardia (beta blockers, digoxin, CCBs)
desferrioxamine is an antidote for…
iron poisoning
