EMCC Flashcards
the depletion of stores of which antioxidant amino acid results in organ ( liver and kidney) damage in paracetamol overdose?
glutathione
normally
paracetamol –>. (metabolised to NAPQI)–> liver produces glutathione –> inactivates NAPQI
OD:
too much paracetamol –> glutathione treleased –> inagctiveates some NAPQI –> glutathione stores depleted –> inactivation stops
paracetamol OD Sx are of broad range. considering these Sx, what are the differentials of paracegtamol OD>
Acute gastritis/gastroenteritis: N&V, abdominal pain.
Renal colic: loin pain, haematuria, N&V
Liver diseases (hepatitis or cirrhosis): jaundice, abdo pain, coma.
Metabolic acidosis: caused by conditions like kidney disease, lactic acidosis or diabetic ketoacidosis. ( metabolic acidosis is paracetampol DO Sx
what graph is used to plot paracreetamol levels
nomogram
give paracetamol management at
<1hr ago, dose >150mg/kg
<4hrs ago
4-8 hrs, dose >150mg/kg
8-24hrs >150mg/kg
>24hrs
staggered OD
<1hr ago,>150mg/kg
Activated charcoal
<4hrs ago
take para level @4hrs, tx as appropriate
4-8 hrs, >150mg/kg
start N-Acetylecysteine if there will be a >8hr delay in obtaining para level
8-24hrs >150mg/kg
N-Acetylcysteine immediately
> 24hrs
N-Acetylcysteine immediately if pt:
- jaundiced
- RUQ tenderness
-raised ALT
INR >1.3
Paracetamol concentration is detectable
staggered OD
N-Acetylcysteine immediately
also start immediately if pt at risk of toicity (e.g. alcoolic, malnutrition etc.)
give 5 signs of TCA OD
- Drowsiness
- Confusion
- Cardiac arrhythmias
- Seizures
- Vomiting
- Headache
- Flushing
- Dilated pupils
What ECG finding is suggestive of TCA OD
QT interval prolongation
TCA OD Mx
Administer IV Sodium Bicarbonate
Consider activated Charcoal within 2-4 hours of the overdose
Consider invasive ventilation, IV Fluids, ICU
what progression of cardiac changes is typical in TCA OD
classic progression: sinus tachycardia, to widened QRS and then ventricular arrhythmias.
Key aspirin overdose Sx
respiratory alkalosis ( stimulating the respiratory centres in the brain) followed by a metabolic acidosis
- Nausea and vomiting
- Tinnitus
- Fever
- Confusion
- Tachycardia
what 2 investigations are important in aspirin overdose?
(VBG): acid-base imbalance. (start off with respiratory alkalosis, progresses to metabolic acidosis
Salicylate levels: blood test for excess aspirin
4 steps in managing aspirin overdose
- Activated charcoal: ( if ingestion <1hr)
- IV fluids: sodium bicarbonate, potassium chloride.
(a. good kidney function b.alkalise the urine to increase salicylate excretion.)
- Dialysis: extremely high blood levels of aspirin.
- Monitor for complications: renal function, pulmonary and cerebral oedema.
what 2 OD should be managed with activated charcoal where OD <1hr?
paracetamol
aspirin
opioid drugs ( except tramadol) are to be avoided in people with which organ damage?
renal disease , renally cleared so risk of toxicity higher in ESKF
tramadol is primarily cleared through the live so is a safer alternative
5 S&S of opiate toxicity
- Sedation
- Confusion
- Respiratory depression
- Hypotension
- Constipation
opioiod overdose triad
miosis, resp depression, reduced conciousness
