Overdose in Adolescence Flashcards
What can diazepam/escitalopram overdose lead to?
SSRIs are generally safe in OD but can lead to prolonged QT, agitation, and serotonin syndrome
Ix of overdose
Primary assessment (ABC)
pathology, radiology, ECG.
There is establishment of toxidromes, general screening tests and some focused testing (alcohol and paracetamol, lithium etc)
What sign is a red flag in many psychiatric medication OD due to cardiotoxicity?
Tachycardia
Mx of SSRI overdose
usually caused by multiple medications (e.g. SSRI + MAO inhibitor)
- withdrawal of the offending drugs
- aggressive supportive care
- occasionally serotonin antagonists such as cyproheptadine
Signs of serotonergic syndrome
Cognitive – confusion, agitation, hypomania, hyperactivity
Autonomic – Hyperthermia, sweating, tachycardia, mydriasis, flushing, shivering
Neuromuscular – Clonus, hyperreflexia, ataxia, tremor. Clonus is symmetrical and esp noted in lower limbs
Discuss significance of QT interval on ECG
- what does it mean
- when is it prolonged
- Cx from abnormal QT
- QT interval is the time from the start of the Q wave to the end of the T wave
- represents the time taken for ventricular depolarisation and repolarisation
QTc prolonged if >440ms in men, >460ms in women.
QTc >500 is associated with increased risk of torsades de pointes.
Too short if less than 350ms.
A normal QT = less than 1/2 the preceding RR interval
What are the (2) most common types of self harm?
Cutting
Self-poisoning
How would you set up a sensitive interview environment & interview with an adolescent OD issue?
1. set up: ensuring pt is comfortably dressed mirrored body positioning sitting together (angled chairs) non-threatening arrangement equal eye level quiet room no interruptions if at all possible
- Interview
initially open ended interview style to build rapport
establish trust and bona fides
hear from pt bout a wide range of factors affecting events as she perceives them, leading to pt hospital admission, then moving to more direct information gathering
Key risk factors for an overdose event
- planned vs. impulsive
- intention to die
- first episode versus history of deliberate self harm
- history of impulsivity; ask about sexual history, financials, substance use
- alcohol / substance use disorder
Deliberate self-harm in young people is not strongly correlated with suicide. However, in adults the relationship is much stronger
Risk factors for self-harm & suicide in adolescents
- Sociodemographic & educational factors
- Individual negative life events & family adversity (e.g. bullying, adverse childhood experiences, parental separation/divorce)
- Psychiatric & psychological factors
How do you assess suicide risk?
SAD PERSONS
Sex: Male Age: less than 19 or >40 Depression Previous attempt EtOH Rational thinking lost Separated (break-up/widowed/divorced) Organised plan No supports Stated intent
What is special about Aspirin overdose?
Respiratory alkalosis -> acidosis later on
What should you check in an altered consciousness patient?
- Paracetamol
- Alcohol
- BSG
Because they are common & easily fixed.
If someone is on a chronic benzodiazepine, what should you be aware of with antidotes?
Flomazenil: blocks the receptors for benzodiazepine & the patient may have a withdrawal symptom.
The patient may have seizures (due to benzodiazepine withdrawal).
What is the antidote for paracetamol overdose?
N-acetylcystiene
