Overdose

Question 1

What are the symptoms of a paracetamol overdose?

Answer 1

Nausea
Vomiting
Loin pain
Haematuria
Proteinuria
Jaundice
Coma
Severe metabolic acidosis

Question 2

What investigations should be performed in a paracetamol overdose?

Answer 2

FBC
U&E
Clotting screen
LFTs
VBG
Serum paracetamol level

Question 3

What is the definition of a staggered paracetamol overdose?

Answer 3

If all the paracetamol tablets are not taken within 1 hour

Question 4

What can be given if a patient presents within an hour of overdose?

Answer 4

Activated charcoal

Question 5

What is the main treatment of paracetamol overdose?

Answer 5

N-acetylcysteine

Question 6

What parameters are used to predict mortality in paracetamol overdose?

Answer 6

Arterial pH < 7.3
Serum creatinine > 300
PT time > 100 seconds
Bilirubin > 18
INR > 6.5

Question 7

What are the features of tricyclic overdose?

Answer 7

Dry mouth
Blurred vision
DIlated pupils
Agitation
Seizures
Vomiting

Question 8

What ECG changed are common in tricylic overdose?

Answer 8

Sinus tachycardia
Widening of QRS
QT prolongation

Question 9

What investigations are performed in tricyclic overdose?

Answer 9

FBC
U&E
CRP
LFTs
VBG
ECG

Question 10

What is the management of tricylic overdose?

Answer 10

IV sodium bicarbonate
Activated charcoal within 2-4 hours of overdose
IV fluids
Invasive ventilation

Question 11

How is an anaphylactoid reaction to N-acetylcysteine managed?

Answer 11

Stop the infusion
Restart infusion at a slower rate

Question 12

What is a staggered paracetamol overdose?

Answer 12

Taking paracetamol over more than a 1 hour period

Question 13

When should acetylcysteine be given regardless of plasma concentration?

Answer 13

Staggered overdose
Presenting 8-24 hours after ingestion of more than 150mg/kg paracetamol
Patients who present more than 24 hours after ingestion, with jaundice or hepatic tenderness