G - Give Specific Antidotes and Treatments Flashcards
Describe: Urine Alkalinization Treatment for ASA Overdose (3)
- urine pH > 7.5
- fluid resuscitate first, then 3 amps NaHCO3/L of D5W at 1.5x maintenance
- add 20-40mEq/LKCl if patient is able to urinate
Describe: Protocol for Warfarin Overdose (5)
Describe tx: Acetaminophen (2)
- Decontaminate (activated charcoal)
- N-acetylcysteine
What’s the toxic dose of Acetaminophen?
Toxic dose >200 mg/kg (>7.5 g adult)
Is Acetaminophen overdose clinically silent? (1)
Often clinically silent; evidence of liver/renal damage delayed >24 h
How to monitor acetaminophen overdose? (8)
- Monitor drug level 4 h post-ingestion
- Liver enzymes
- INR, PTT
- BUN, Cr
- Hypoglycemia
- Metabolic acidosis
- Encephalopathy poor prognosis
- Dialysis may be required to manage in very high overdoses
Describe tx: Acute Dystonic Reaction (2)
-
Benztropine: 1-2 mg IM/IV then 2 mg PO x 3 d
- Benztropine (Cogentin®) has euphoric effect and the potential for misuse
- OR Diphenhydramine 1-2 mg/kg IV, then 25 mg PO qid x 3d
Describe tx: Anticholinergics (2)
- Consider decontamination (activated charcoal)
- Supportive care
Describe tx: ASA (2)
- Consider decontamination (activated charcoal)
- Alkalinize urine; want urine pH >7.5
Describe monitoring of ASA overdose (3)
- Monitor serum pH and drug levels closely
- Monitor K+ level; may require supplement for urine alkalinization
- Hemodialysis may be needed if intractable metabolic acidosis, very high levels, or end-organ damage (i.e. unable to diurese)
Describe tx: Benzodiazepines (3)
- Consider decontamination (activated charcoal)
- Flumazenil
- Supportive care
Desribe tx: β-blockers (5)
- Consider decontamination (activated charcoal, consider whole bowel irrigation for extended-release ingestion)
- IV glucagon
- IV calcium chloride
- IV high-dose insulin (with dextrose)
- IV intralipid
Describe tx: Calcium Channel Blockers (6)
- Consider decontamination (activated charcoal, consider whole bowel irrigation for extended-release ingestion)
- IV glucagon
- IV calcium chloride
- IV high-dose insulin (with dextrose)
- IV intralipid
- Order ECG, electrolytes (especially Ca2+, Mg2+, Na+, K+)
Describe tx: Cocaine (4)
- Decontaminate (activated charcoal) if oral
- Aggressive supportive care
- β-blockers are contraindicated in acute cocaine toxicity
- Intralipid for life-threatening symptoms
Describe tx: CO poisoning (3)
- Supportive care
- 100% O2 ; may require hyperbaric O2
- Order ECG, VBG. Consider lactate and troponin depending on specific presentation
Describe tx: Cyanide (1)
Hydroxocobalamin
Describe tx: Digoxin (6)
- Consider decontamination (activated charcoal)
- Digoxin-specific Ab fragments
- 10-20 vials IV if acute; 3-6 if chronic
- 1 vial (40 mg) neutralizes 0.5 mg of toxin
- Use for life-threatening dysrhythmias unresponsive to conventional therapy, 6 h serum digoxin >12 nmol/L, initial K+ >5 mmol/L, ingestion >10 mg (adult)/>4 mg (child)
- Common dysrhythmias include VFib, VTach, and conduction blocks
Describe tx: Ethanol (4)
- Thiamine 100 mg IM/IV
- Manage airway and circulatory support
- Mouthwash = 70% EtOH; perfumes and colognes = 40-60% EtOH
- Order serum EtOH level and glucose level; treat glucose level appropriately
Describe tx: Ethylene Glycol/ Methanol (4)
- Fomepizole (4-methylpyrazole) 15 mg/kg IV load over 30 min, then 10 mg/kg q12h OR
- Ethanol (10%) 10 mL/kg over 30 min, then 1.5 mL/h
- CBC, electrolytes, glucose, ethanol level
- Consider hemodialysis
Describe tx: Heparin (2)
- Protamine sulfate 25-50 mg IV
- For unfractionated heparin overdose only
Describe tx: Insulin IM/SC/ Oral Hypoglycemic (2)
- Glucose IV/PO/NG tube
- Glucagon: 1-2 mg IM (if no access to glucose)
__ carries highest risk of hypoglycemia among oral agents
Consider ___ for oral hypoglycemics in these cases; consult local Poison Information Centre
Consider octreotide for oral hypoglycemics (50-100 μg SC q6h) in these cases; consult local Poison Information Centre
Describe tx: MDMA (4)
- Consider decontamination (activated charcoal)
- Supportive care
- Monitor CK; treat rhabdomyolysis with high flow fluids: aggressive external cooling for hyperthermia
- Review medical history if possible for serotonergic use
Describe tx: TCAs (5)
- Consider decontamination (activated charcoal)
- Aggressive supportive care
- Sodium bicarbonate (NaHC03) bolus for wide QRS/seizures
- Also consider cardiac and hypotension support, seizure control
- Intralipid therapy
___ antidote contraindicated in combined TCA and benzodiazepine overdose
Flumazenil antidote contraindicated in combined TCA and benzodiazepine overdose
