Drug/Medication Overdoses Flashcards
from when would you take a paracetamol level
4 hours after ingestion
investigations for a paracetamol overdose
serum paracetamol level LFTs lactate ABG INR
treatment of paracetamol overdose
if ingested in last hour = charcoal
NAC within 8 hours of ingestion if above treatment line
If presenting 8 or more ours after start NAC anyway empirically
NAC IV for 21 hours
if ALT doubles or more then more NAC is needed
side effects of NAC
nausea and vomiting
indications for liver transplant
arterial Ph less than 7.3 lactate over 3 despite fluids PT greater than 100 encephalopathy creatinine over 300
what is a paracetamol overdose
more than 75mg/kg
or more than 4g
what is an aspirin overdose
more than 150mg/kg
6.5mg aspirin
investigations of aspirin overdose
ABG - resp alkalosis followed by metabolic acidosis
serum salicylate
treatment of aspirin overdose
sodium bicarbonate infusion - alkaline diuresis
haemodialysis if unstable with renal failure long QT seizures or salicylate level over 100
what is dangerous about a tricylic overdose
tricyclics have a narrow therapeutic index so become CVS and CNS - hypotension, tachycardia, arhythmias, seizures
symptoms of TCA overdose
hypotension tachycardia arhytmia seizure anticholinergic - flushed, dilated pupils, urinary retention
ecg changes in TCA overdose
broad QRS
long QT
prolonged PR
AV block
ABG result in TCA overdose
metabolic acidosis
treatment of TCA overdose
supportive + charcoal if less than 2 hours ago
sodium bicarbonate if any QRS prolongation given until less than 100ms then sodium bicarb infusion
benzo if seizure
symptoms of SSRI overdose
triad of neuromuscular excitation, autonomic effects and altered mental state
e.g. hyperreflexia, headache, sweating, anxiety, agitatio, tahcycardia, clonus, tremor, pyrexia
