Acute Poisoning

Question 1

What is the best online resource for managing acute poisoning?

Answer 1

www.toxbase.org

Question 2

Plasma toxicity:

What levels always need to be checked in the blood? - 3

Answer 2

Paracetamol and salicylate levels

Glucose

Question 3

Management:

How does activated charcoal work?

What is gastric lavage?
What type of products should this not be done with?

Answer 3

Reduces GI absorption of many drugs

Check guidelines a sit can only be used with certain drugs!

Emptying stomach

Petroleum or corrosives such as bleach, alkalis etc. - can cause more damage to upper airways

Question 4

History:

What should be determined?

Answer 4

What

How much

When it was ingested

Number of tablets

Were there any other
medicines or chemicals near them?

Question 5

Opiods - examples

What it would cause if overdosed?

Answer 5

Morphine 
Codeine 
Methadone 
Oxycodone 
Heroin 

Bradycardia
Hypotension
Decreased RR
Pin point pupils

Question 6

Cholinergics - examples

What it would cause if overdosed?

Answer 6

Organophosphates, pilocarpine

Diarrhoea 
Urination 
Miosis - constricted pupils  
Bradycardia 
Emesis 
Lacrimation 
Lethary 
Salivation

Question 7

Anticholinergics - examples

What it would cause if overdosed?

Answer 7

Antihistamines
Tricyclic antidepressants

Hyperthermia 
Facial flushing 
Dry skin 
Dilated pupils - mydriasis 
Delirium 
Tachycardia 
Urinary retention

Question 8

Sympathomimetic - examples

What it would cause if overdosed?

Answer 8

Cocaine
Amphetamines

Tachycardia 
Hypertensive 
Hyperthermic 
Dilated pupils 
Risk of seizures

Question 9

Antidotes for beta-blockers

Answer 9

Atropine IV for bradycardia, hypotension, heart block and heart failure

Glucagon
Adrenaline/dopamine infusions

Question 10

Antidotes for carbon monoxide

Answer 10

High flow oxygen

Mannitol for cerebral oedema

Question 11

Antidotes for digoxin

Answer 11

Atrophine if bradycardia

Digoxin specific antibody used in severe cases

Question 12

Antidotes for Opiods

Answer 12

IV naloxone

Question 13

Antidotes for Methanol/ethylene glycol

Answer 13

Fomepizole

Question 14

Iron Poisoning

How does it present?

Management:

What type of flushing is used?
Meds?

Answer 14

N&V
Haematemesis 
Diarrhoea 
Altered mental status 
Hypotension 

Gastric lavage / endoscopy to remove tablets
Whole bowel irrigation may help
Supportive care - IV fluids and sodium bicarbonate to correct acidosis
Chelation with IV desferrioxamine

Question 15

Salicylate poisoning

What is the most common salicylate?

What is it associated with in children?

Presentation

Answer 15

Aspirin

Reyes syndrome

Tinnitus 
Hearing loss 
Stimulation of respect centres leading to tachypnoea and reap alkalosis 
Metabolic acidosis
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Question 16

Salicylate poisoning

Answer 16

Resus with boluses 
Correct hypoglycaemia 
Potassium IV if hypokaemia 
Sodium bicarbonate for acidosis 
Activated charcoal effective in absorbing aspirin

Question 17

Paracetamol overdose

Presentation?

Answer 17

N&V 
Jaundice 
Enlarged tender liver 
Hypoglycaemia 
Hypotension 
Encephalopathy 
Coagulopathy 
Coma

Question 18

Paracetamol overdose

Management

Answer 18

Admit those ingesting a big amount and do serum P levels

Acetylcysteine given when confirmed