Ingestion of possible toxic substance Flashcards
Toxidrome of cholinergic drugs
Organophosphates
Salivation
Sweating
Bronchospasm
Toxidrome of anti cholinergic drug
Dry flushed skin
Mydriasis
Toxidrome of tricyclics antidepressant drugs
Seizures
Wide QRS complex
Common toxic or potentially toxic substance that are ingested accidentally
Common unintentional ingestion
- Drugs - paracetamol, sedatives, antidepressant
- Household agents - Bleach, disinfectants, Dishwasher tablets
Common intentional ingestion a
Paracetamol
Alcohol
Sedatives
Antidepressants.
Presentation of intoxications
ALOC
Cardiac arrhythmia
Seizures
Mx of ingestion of toxins
ABCD
Discuss with national poisons centre
Monitor HR, RR, rhythm, AVPU
Advice on safety at home
Charcoal for aspirin, paracetamol, phenytoin, carbamazepine if ingested in the last hours.
Antidotes if required eg halo one for opiates, vitamin K for warfarin.
Q to ask on Hx for accidental ingestion in young children
What was ingested, when and estimate of the quantity.
Inspect container.
Risk factors for overdose in children
Children in care Emotional upset Child abuse or bullying Psychiatric illness Suicidal thoughts Other self harming behaviour.
Paracetamol poisoning
Symptoms - N and V settle in less 24hr, Hepatic necrosis starts 3-4 days later with RUQ pain and later encephalopathy.
Liver failure and kidney failure signs
Rarely causes liver failure - need 20 to 30 tablets, eg greater than 150mg/kg or 10g
If greater then 150mg/kg ingest start Tx immediately
- IV N-acetlycysteine
- Oral methionine
If less
- Paracetamol levels 4 hrs after ingestion and plot on nomogram.
- If above Tx line then start N-acetlycysteine and continue for 24hrs.
Reduces risk of liver damage’
If significant OD then Ix of serial LFT, Coagulation, to monitor liver functions and U and E to monitor Renal function.
Really bad cases with acidosis, encephalopathy, or severe coagulopathy need urgent liver transplant.
Public health measures that can be taken to reduce the risk of accidental ingestion
Kidsafe house in Brisbane which demonstrate accident prevent.
Opiates Overdose
Symptoms - Sedation - hypotension - Bradycardia - hypothermia - Respiratory suppression - Miosis, and - decrease GI motility - Coma, Cardiac arrest and death Tx - Naloxone - Short half life - supportive therapy
Benzodiazepines overdose
Drowsiness Lethargy Ataxia Confusion mild depression of vital Tx ABCD
Withdrawal symptoms of opiates
weakness, anxiety, anorexia, insomnia, gastric distress, headache, sweating and hot and cold flashes. Peak at day 6 Resolve by 2 weeks Tx Stop - Supportive therapy Slow - Taper Swap - Methadone.
Benzodiazepine withdrawal
Symptoms - Anxiety - depression - Diarrhoea, constipation bloating - insommia - Irritability - muscle arche - perceptual disturbance - Panic attacks - Seizures Tx - Stop - Hospitalisation, supportive care. - Swab - longer half - Slow - reduce. For every year take 1month to withdraw.
