Overdose and Poisoning Management Flashcards
Paracetomol
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
Salicylate
urinary alkalinization with IV bicarbonate
haemodialysis
Opiod
Naloxone
Benzodiazepines
Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.
Tricyclic antidepressants
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
arrhythmias: class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias
Lithium
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion
Warfarin
Vitamin K, prothrombin complex
Heparin
Protamine sulphate
Beta-blockers
if bradycardic then atropine
in resistant cases glucagon may be used
Ethylene glycol
fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
haemodialysis also has a role in refractory cases
Methanol poisoning
fomepizole or ethanol
haemodialysis
Organophosphate insecticides
atropine
Digoxin
Digoxin-specific antibody fragments
Iron
Desferrioxamine, a chelating agent
Lead
Dimercaprol, calcium edetate
