Overdose Flashcards
Anticholinesterase toxicity (e.g. organophosphate)
Bradycardia, miosis, salivation
Manage with:
Atropine
Pralidoxime
TCA overdose effects, management
- Anticholinergic
- CNS (e.g. seizures)
- Cardio (e.g. prolonged QRS, hypotension) - blocks fast sodium channels and decreases myocardial conduction velocity (like class IA quinidine); QRS >100 ms associated with increased risk for ventricular arrhythmia
Therefore, ABC supportive care and cardiac monitoring
1. Hypotension - treat with isotonic saline boluses, then vasopressors if necessary
2. QRS/arrhythmia - treat with sodium bicarbonate if QRS >100 ms (also improved hypotension) - sodium overcomes blockade while alkalinization makes TCA less active
Conjunctival injection
Marijuana
Psychomotor impairment can last up to a day, beyond period of euphoria
Yawning
Opioid withdrawal
Nystagmus, ataxia
Phencyclidine intoxication
Usually also violent behavior, agitation, didssociation
Alcohol + cocaine coingestion
Creates metabolite cocaethylene - prolongs and enhances cocaine sympathomimetic effects
PCP intoxication - pathophysiology, treatment
- NMDA agonist (excitatory, psychotic)
- Dopamine, NE, serotonin receptors
- Sigma receptor complex (psychotic, anticholinergic)
Treat with benzos
Benzo overdose treatment
Flumazenil - competitive antagonist
Hydroxocobalamin
Cyanide poisoning - would expect lactate >10
Fomepizole
Ethylene glycol or methanol poisoning - inhibits ADHase
Ethylene glycol or methanol poisoning - treatment
- Fomepizole
- NaCO3
- Hemodialysis
Illicit drugs associated with hypertension
Cocaine and other stimulants (MDMA/Ecstasy), PCP, marijuana
MDMA leads to what two toxicity profiles?
Sympathomimetic toxicity
Serotonin syndrome - includes drug-induced SIADH
Acute iron poisoning - signs
Iron directly injures GI mucosa by free radical production and lipid peroxidation, causing:
Abdominal pain, hematemesis, melena, diarrhea, green/black stool from tablets
Shock (multiple causes)
Anion gap metabolic acidosis
Liver necrosis (1-2 days later)
Hydroflouric acid burns - concerns and treatment
Hypomagnesemia/hypocalcemia (binding); resulting K release from cells into blood
Cardiac arrhythmia
Direct cardiotoxic effect
Treat with irrigation and calcium gluconate gel/intradermal injection or iv for cardiac arrhythmia