Overdose Flashcards
Paracetamol OD Mx
<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
TCA OD Mx
IV bicarbonate
What are the ECG signs of a TCA overdose?
Sinus tachycardia
Widening of QRS complex
QT prolongation
What type of alkalosis/acidosis do you get in TCA overdose?
Metabolic acidosis
What are the early features of TCA OD?
Dry mouth, blurred vision, NV, dilated pupils, agitation, sinus tachycardia
What are the severe features of TCA OD?
Arrhythmias, seizure, coma
Salicyclate OD Mx
IV bicarbonate, haemodialysis
What kind of acidosis/alkalosis do you get in salicyclate OD?
Mixed respiratory alkalosis and metabolic acidosis
What are the features of salicyclate OD?
Tinnitus, hyperventilation, lethargy, sweating, NV, hypo/hyperglycaemia, seizures, coma
Beta blocker OD Mx
Atropine if bradycardic
Glucagon for resistant cases
Opiate OD Mx
Naloxone
Benzo OD Mx
Flumazenil (only if iatrogenic)
Lithium OD Mx
Mild-mod: normal saline
Severe: haemodialysis
Warfarin OD Mx
Vit K, prothrombin complex concentrate
Heparin OD Mx
Protamine sulphate
Ethylene glycol poisoning Mx
Fomepizole
Methanol poisoning Mx
Fomepizole, ethanol, haemodialysis
Digoxin OD Mx
Digoxin specific binding antibody
Iron OD Mx
Desferroxamine
Lead poisoning Mx
Dimercaprol
CO poisoning Mx
100% oxygen, hyperbaric oxygen
Cyanide
Hydroxocobalamin
How does warfarin work?
It prevents vitamin K being activated, activated vitamin K is a cofactor for clotting factors 2, 7, 9 and 10
When is warfarin indicated?
VTE (target 2.5, 3.5 if recurrent)
AF (target 2.5)
Mechanical heart valve
What are SEs of warfarin?
Purple toes
Haemorrhage
Skin necrosis
Teratogenic
What is the management of patient on warfarin with major bleed?
Stop warfarin
5mg vit K IV
Prothrombin complex concentrate
What is the management of a patient with INR >8, minor bleeding?
Stop warfarin
1-3mg vit K IV
Repeat dose if still too high after 24 hours, restart warfarin when INR <5
What is the management of a patient with INR >8 with no bleeding?
Stop warfarin
1-5mg vit K PO
Repeat dose if INR still too high after 24 hours, restart warfarin when INR <5
What is the management of patient with INR 5-8 with minor bleeding?
Stop warfarin
1-3mg vit K IV, restart warfarin when INR <5
What is the management of patient with INR 5-8 with no bleeding?
Withhold 1-2 doses of warfarin and reduce subsequent maintenance dose of warfarin
Is warfarin safe in breastfeeding?
Yes
