BNF - Chapter 16 - Emergency treatment of poisoning

Question 1

Where can you find more information on the treatment for poisoning?

Answer 1

Toxbase
or the
UK national poisons information

Question 2

Which drugs are cause a delayed-action poisoning?

Answer 2

• Aspirin
• Iron
• Paracetamol
• TCAs
• Co-phenotrope

Question 3

Fluid depletion without hypotension is common after what?

Answer 3

After prolonged coma and after aspirin poisoning due to vomiting, sweating and hyperpnoea

Question 4

What is given by mouth which can bind many poisons?

Answer 4

Charcoal activated. can bind many poisons in the gastro-intestinal system, thereby reducing their absorption.

The sooner it is given the more effective it is, but it may still be effective up to 1 hour after ingestion of the poison—longer in the case of modified-release preparations or of drugs with antimuscarinic (anticholinergic) properties.

Question 5

What do repeated doses of charcoal, activated by mouth enhance?

Answer 5

Enhance the elimination of some drugs after they have been absorbed; repeated

Question 6

Repeated doses of charcoal activated is given after over dosage with which drugs?

Answer 6

• Carbamazepine
• Dapsone
• Phenobarbital
• Quinine
• Theophylline

Question 7

Can charcoal activated be used for poisoning with metal salts including iron and lithium?

Answer 7

No

Question 8

What are the symptoms of aspirin (salicylate poisoning)?

Answer 8

hyperventilation, tinnitus, deafness, vasodilatation, and sweating.

Coma is uncommon but indicates very severe poisoning

Question 9

What is the antidote to aspirin (salicylate) poisoning?

Answer 9

Activated Charcoal

Question 10

What are the symptoms of opioid overdose?

Answer 10

Cause coma, respiratory depression, and pinpoint pupils

Question 11

What is the antidote to opioids?

Answer 11

Naloxone

Question 12

Is the effects of naloxone fully reversed in buprenorphine?

Answer 12

Partially reversed

Question 13

To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, what weight should you use?

Answer 13

use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).

Question 14

What is the antidote to paracetamol?

Answer 14

Acetylcysteine

Acetylcysteine prevents or reduces the severity of liver damage if given up to, and possibly beyond (in patients at risk of severe liver disease) 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of paracetamol ingestion, after which effectiveness declines.

Question 15

What is acute overdose of paracetamol?

Answer 15

Acute overdose involves ingestion of a potentially toxic dose of paracetamol in 1 hour or less

Question 16

What is the standard 21 hour regimen of acetylcysteine?

Answer 16

For the standard 21-hour regimen, acetylcysteine is given in a total dose that is divided into 3 consecutive intravenous infusions over a total of 21 hours.

Question 17

What is the antidote for tricyclic and related antidepressants?

Answer 17

Activated Charcoal

Question 18

Is overdose with antimalarial drugs easy to treat?

Answer 18

No - Overdosage with quinine, chloroquine, or hydroxychloroquine is extremely hazardous and difficult to treat. Urgent advice from the National Poisons Information Service is essential. Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).