Drug Overdose and poisoning Flashcards
in accidental overdose who is mostly affected
mostly young children < 5 years
in deliberate overdose what percentage involved more than one poison
50%
in deliberate overdose what is approx.. Mortality Rate?
0.50%
what are some general considerations in a drug overdose or poisoning?
- get as much history as possible (patient witness relatives) 2. consider the circumstances (suicide note environment containers) 3. remember that a patient intentionally overdosing will often lie
accurate and early information of what can critically assist in management?
Identification of poison; time of ingestion; vomiting history
what are some investigations should you conduct on a drug overdose/poisoning
- specimen collection (blood; urine; gastric contents) 2. plasma biochemistries; 3. blood gases (acidosis; hypoxia) 4. chest x-rays
in the lecture on drug overdose/poisoning there was a checklist presented for what to do in regards to investigations; what was on it?
ALLWAYS check blood glucose; Do toxicology screening; always measure salicylate and paracetamol levels; urea and electrolytes; liver function test; Arterial blood gases; clotting; ECG and chest X-ray)
during a Drug overdose/poisoning what kind of care is critical?
Support care
during a drug overdose/poisoning support care is critical; what conditions are we trying to prevent?
Aspiration; hypoventilation; hypoxia; hypotension; arrhythmia
in the lecture on drug overdose/poisoning there was a checklist presented for what to do in regards to management what was on it?
Monitor airways (intubation); maintain normxia (intermittent positive pressure ventilation); correct hypotension or hypertension; monitor heart rate/ rhythm; maintain acid-base and electrolyte levels; treat seizures; beware of skin blistering; monitor body temperature
what are the four possible interventions in a poising/drug overdose?
- decrease further absorption; 2. increase elimination of existing poison; 3. administer antidote where applicable; 4. treat symptoms
what can be done to decrease further absorption of a toxin?
- emesis (By pharyngeal stimulation; adomorphine; epecac) however this is no longer recommended; 2. gastric lavage (evidence for the usefulness is questionable; and the treatment is limited to adults with 4hrs of overdose) 3. absorbents; 4. catharsis (whole bowel irrigation)
what kind of absorbents are used to decrease further absorption?
- activated charcoal (all purpose) or 2. Fuller’s Earth (useful for paraquat poisoning)
where does activated charcoal act? It is ineffective when?
Absorbs contents in the GI track; multi-dose can increase systemic clearance of a drug; it is ineffective for iron salts; cyanide; alkalis; heavy metals; and alcohols;
catharsis is limited to what kind of medicines; in what kind of patients is it contraindicated?
Limited to sustained-release and enteric coated medicines; Contraindicated in patients with paralytic ileus/ bowel obstruction
what drugs are used in cartharsis
Sorbitol and mannitol
what can be done to increase the elimination of a existing poison?
- Haemodialysis; 2. hemoperfusion; 3.Forced acid/alkaline diuresis
Hemoperfusion is useful for what kind of toxin?
Long-half life toxins
what are some issues with forced acid/alkaline diuresis?
can induce hypokalaemia and fluid overload
forced acid/alkaline diuresis can be useful for what?
both weak acids and bases
what can N-acetyl cysteine be used for an antidote to?
Paracetamol; carbon tetrachloride
What can Atropine be used for an antidote to?
Organophosphates
what can Benztropine be used for an antidote to?
Dystrophic effects of butyrophenones; phenothiazines; metoclopramide
what can Benzyl penicillin be used for an antidote to?
Amanita phalloides
