Poisoning

Question 1

How is poisoning classified?

Answer 1

Intended = alcohol, illicit drugs, self harm

Unintended

Question 2

Name some common poisons that can be taken/administered

Answer 2

Paracetamol

Hypnotics (diazepam, zoplicone)

Salicylates

Ecstasy

Amitriptyline (tricyclic)

Opiates

Other anti-depressants

Cocaine

Question 3

How might a poisoned pt present?

Answer 3

Clinical findings = alcohol on breath, track marks, blisters (barbiturates)

Neurological = UMN signs (anti-cholinergics), coma, dystonic movements

Pupils = dilated (amphetamines), constricted (opiates)

Ventilation = hypo (opiates, CO), hyper (salicylates)

ABG = acidosis, alkalosis

Bloods = hypokalaemia (beta-agonist), hyponatraemia (ecstasy), hypoglycaemia (insulin, alcohol)

Question 4

How are poisoned pts managed?

Answer 4

ABCDE

History

Symptoms/signs

Bloods/ABG

Renal

ECG

Activated charcoal

Antidotes when indicated

Gastric lavage – need to present within 1 hours of taking the tablets

Question 5

Name some overdose antidotes

Answer 5

Naloxone = opiates

Flumazenil = benzodiazepine

Atropine = bradycardia in beta-blocker

N-acetylcystine = paracetamol

Glucagon = beta-blocker

Digiband = digoxin

Question 6

How does paracetamol cause hepatotoxicity?

Answer 6

NAPQI prod = used up glutathione = damage to the liver = toxic liver