Overdose and poisoning Flashcards
A 25yo woman (55kg) presents to ED with nausea + vomiting. She says she has taken 20g of paracetamol 10hrs ago.
How should she be investigated + managed?
- ABC assessment
- start NAC IVI over 1hr (x3 for whole course)
- bedside tests:
- CBG: hypoglycaemia common in hepatic necrosis (measure hourly)
- ABG: acidosis can occur early - bloods:
- plasma paracetamol conc.
- U+Es and creatinine: ?renal failure
- LFTs: can rise v. high
- clotting studies: PT is v. good indicator of liver failure severity (check INR 12 hourly)
A 25yo woman (55kg) presents to ED with nausea + vomiting. She says she has taken 20g of paracetamol 10hrs ago.
24hrs later she is very unwell. Which criteria are used to determine whether she requires a liver transplant?
King’s college hospital criteria:
- arterial pH <7.3 or lactate >3mmol/L after 24hrs with adequate fluid resuscitation OR
- PT >100secs + creatinine >300umol/L + grade III or IV encephalopathy
A 55yo man with a history of severe depression is brought to ED by ambulance. He was found with 3 empty packets of amitriptyline next to him.
Which symptoms would he likely complain of? What signs might be found O/E?
- dry mouth + blurred vision
- agitation
- dilated pupils
- sinus tachycardia
- seizures
A 55yo man with a history of severe depression is brought to ED by ambulance. He was found with 3 empty packets of amitriptyline next to him.
Name 2 bedside investigations which are very important in TCA OD?
- ECG - risk of arrhythmias:
- sinus tachycardia
- widened QRS (>100ms: risk of seizures, >160ms: ventricular arrhtymias), prolonged QT - ABG: metabolic acidosis
A 55yo man with a history of severe depression is brought to ED by ambulance. He was found with 3 empty packets of amitriptyline next to him.
He is found to be hypotensive, with a HR of 180bpm and a QRS 160ms.
How would you manage him?
- ABC assessment
2. IV SODIUM BICARBONATE
An 82yo man with a history of heart disease + Alzheimer’s dementia is brought to ED after an accidental OD of bisoprolol.
He is confused, HR = 40, BP = 70/40.
How would you manage him?
- ABC assessment
- bradycardia: IV ATROPINE
- resistant cases/severe hypotension/HF/cardiogenic shock: IV GLUCAGON
A known IVDU is brought to ED unconscious, with pinpoint pupils and a RR of 4.
What treatment is required?
IV NALOXONE - stepwise dosage 1min apart if no response:
- 400ug
- 800ug x2
- 2mg
A 45yo woman presents to ED after taking a very large amount of aspirin.
What signs/symptoms might this cause?
What typical feature might bedside tests show?
Features:
- hyperventilation
- tinnitus + deafness
- vasodilation: sweating/pyrexia
- N+V
- hyper or hypoglycaemia
- lethargy, seizures, coma
ABG:
- first respiratory alkalosis (due to direct stimulation of medullary breathing centres)
- then metabolic acidosis
A 45yo woman presents to ED after taking a very large amount of aspirin. Her RR is 40, temp 39 and her GCS is 14.
How would you manage her?
- ABC
- if <1hr from ingestion of >125mg/kg: activated charcoal
- IV fluids + IV sodium bicarbonate (causes urinary alkalinisation to increase urinary excretion)
- if severe metabolic acidosis or plasma conc. >700mg/L: haemodialysis
A 60yo man who is known to have bipolar disorder is brought to ED after an OD of a substance. Which features would support an OD of lithium?
- coarse tremor
- polydipsia + polyuria
- vomiting
- diarrhoea
- ataxia
- abnormal reflexes
- cardiac arrhythmias e.g. bradycardia, 1st degree heart block
- acute confusion, seizures, coma
A 60yo man who is known to have bipolar disorder is brought to ED after an OD of a lithium. He is unconscious with abnormal reflexes. How would you manage him?
- supportive e.g. fluid and electrolyte balance
- consider whole bowel irrigation
- haemodialysis
