Corrections - Paracetamol & Alcohol, Overdoses Flashcards
Why is urea raised disproportionately to creatinine in dehydration?
As some urea is reabsorbed with the increased water reabsorption that occurs in dehydration.
What scoring system is used to assess alcohol withdrawal severity?
The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale
Presentation of serotonin syndrome?
1) neuromuscular excitation:
- hyperreflexia
- myoclonus
- rigidity
2) autonomic nervous system excitation:
- hyperthermia
- sweating
3) altered mental state: confusion
Management of serotonin syndrome?
1) supportive including IV fluids
2) benzodiazepines
3) more severe cases: use serotonin antagonists e.g. cyproheptadine and chlorpromazine
What is a transaminitis (elevated ALT and AST) in the 10,000s most commonly caused by?
Paracetamol overdose
Pathophysiology in carbon monoxide poisoning?
1) Carbon monoxide binds readily to haemoglobin, forming carboxyhaemoglobin –> reduced oxygen-carrying capacity
2) In carbon monoxide poisoning the oxygen saturation of haemoglobin decreases leading to an early plateau in the oxygen dissociation curve.
What may questions regarding carbon monoxide poisoning hint at?
Questions may hint at badly maintained housing e.g. student houses.
Features of carbon monoxide poisoning?
1) headache (90%)
2) N&V (50%)
3) vertigo (50%)
4) confusion (30%)
5) subjective weakness (20%)
6) severe toxicity:
- ‘pink’ skin and mucosae
- hyperpyrexia
- arrhythmias
- extrapyramidal features
- coma
- death
Why may a pulse ox be falsely high in carbon monoxide poisoning?
Due to similarities between oxyhaemoglobin and carboxyhaemoglobin.
1st line investigation in carbon monoxide poisoning?
VBG or ABG
Management of carbon monoxide poisoning?
1) 100% high-flow oxygen via a non-rebreather mask: target sats 100%
2) hyperbaric oxygen
What is the single most important prognostic factor in paracetamol overdose?
ABG pH (indicative factor of a poor outcome requiring liver transplantation).
What is the liver transplantation criteria in paracetamol overdose regarding pH?
pH <7.3 more than 24 hours after ingestion
What type of urinary incontinence can TCAs cause?
Overflow
What is the King’s criteria for liver transplantation (paracetamol liver failure)?
1) arterial pH <7.3, 24 hours after ingestion
Or all of the following:
2) prothrombin time > 100 seconds
3) creatinine > 300 µmol/l
4) grade III or IV encephalopathy