Overdose

Question 1

Paracetamol OD Mx

Answer 1

<1h –> activated charcoal
NAC if staggered OD, time of ingestion unclear, plasma levels within treatment threshold (at/over line connecting 100mg/L at 4h and 15mg/L at 15h)
NAC is infused over 1 hour

Question 2

TCA OD Mx

Answer 2

IV bicarbonate

Question 3

What are the ECG signs of a TCA overdose?

Answer 3

Sinus tachycardia
Widening of QRS complex
QT prolongation

Question 4

What type of alkalosis/acidosis do you get in TCA overdose?

Answer 4

Metabolic acidosis

Question 5

What are the early features of TCA OD?

Answer 5

Dry mouth, blurred vision, NV, dilated pupils, agitation, sinus tachycardia

Question 6

What are the severe features of TCA OD?

Answer 6

Arrhythmias, seizure, coma

Question 7

Salicyclate OD Mx

Answer 7

IV bicarbonate, haemodialysis

Question 8

What kind of acidosis/alkalosis do you get in salicyclate OD?

Answer 8

Mixed respiratory alkalosis and metabolic acidosis

Question 9

What are the features of salicyclate OD?

Answer 9

Tinnitus, hyperventilation, lethargy, sweating, NV, hypo/hyperglycaemia, seizures, coma

Question 10

Beta blocker OD Mx

Answer 10

Atropine if bradycardic

Glucagon for resistant cases

Question 11

Opiate OD Mx

Answer 11

Naloxone

Question 12

Benzo OD Mx

Answer 12

Flumazenil (only if iatrogenic)

Question 13

Lithium OD Mx

Answer 13

Mild-mod: normal saline

Severe: haemodialysis

Question 14

Warfarin OD Mx

Answer 14

Vit K, prothrombin complex concentrate

Question 15

Heparin OD Mx

Answer 15

Protamine sulphate

Question 16

Ethylene glycol poisoning Mx

Answer 16

Fomepizole

Question 17

Methanol poisoning Mx

Answer 17

Fomepizole, ethanol, haemodialysis

Question 18

Digoxin OD Mx

Answer 18

Digoxin specific binding antibody

Question 19

Iron OD Mx

Answer 19

Desferroxamine

Question 20

Lead poisoning Mx

Answer 20

Dimercaprol

Question 21

CO poisoning Mx

Answer 21

100% oxygen, hyperbaric oxygen

Question 22

Cyanide

Answer 22

Hydroxocobalamin

Question 23

How does warfarin work?

Answer 23

It prevents vitamin K being activated, activated vitamin K is a cofactor for clotting factors 2, 7, 9 and 10

Question 24

When is warfarin indicated?

Answer 24

VTE (target 2.5, 3.5 if recurrent)
AF (target 2.5)
Mechanical heart valve

Question 25

What are SEs of warfarin?

Answer 25

Purple toes
Haemorrhage
Skin necrosis
Teratogenic

Question 26

What is the management of patient on warfarin with major bleed?

Answer 26

Stop warfarin
5mg vit K IV
Prothrombin complex concentrate

Question 27

What is the management of a patient with INR >8, minor bleeding?

Answer 27

Stop warfarin
1-3mg vit K IV
Repeat dose if still too high after 24 hours, restart warfarin when INR <5

Question 28

What is the management of a patient with INR >8 with no bleeding?

Answer 28

Stop warfarin
1-5mg vit K PO
Repeat dose if INR still too high after 24 hours, restart warfarin when INR <5

Question 29

What is the management of patient with INR 5-8 with minor bleeding?

Answer 29

Stop warfarin

1-3mg vit K IV, restart warfarin when INR <5

Question 30

What is the management of patient with INR 5-8 with no bleeding?

Answer 30

Withhold 1-2 doses of warfarin and reduce subsequent maintenance dose of warfarin

Question 31

Is warfarin safe in breastfeeding?

Answer 31

Yes