Overdoses Management Crash Course Flashcards
How is paracetamol OD managed?
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
How is Salicylate OD managed?
urinary alkalinization with IV bicarbonate
haemodialysis
How is opioid/opiate OD managed?
Naloxone
How is benzodiazepine OD managed?
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.
How is TCA OD managed?
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) c/I as they prolong depolarisation.
- Class III drugs such as amiodarone should also be avoided as they prolong the QT interval.
- Response to lignocaine variable and it should be emphasized that correction of acidosis is the 1st line in management of tricyclic induced arrhythmias
dialysis is ineffective in removing tricyclics
How is lithium OD managed?
- Mild-moderate toxicity may respond to volume resuscitation with normal saline
- Haemodialysis may be needed in severe toxicity
Sodium bicarbonate is sometimes used. By increasing the alkalinity of the urine it promotes lithium excretion
How is warfarin OD managed?
Vitamin K, prothrombin complex
How is heparin OD managed?
Protamine sulphate
How is beta-blocker OD managed?
if bradycardic then atropine
in resistant cases glucagon may be used
How is Ethylene glycol OD managed?
Fomepizole
- Now 1st-line
- Inhibitor of alcohol dehydrogenase
Ethanol
- Been used for many years
- Competes with ethylene glycol for the enzyme alcohol dehydrogenase
- Limits formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning
Haemodialysis also has a role in refractory cases
How is methanol poisoning managed?
fomepizole or ethanol
haemodialysis
How is Organophosphate insecticides managed?
atropine
Role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit
How is Digoxin OD managed?
Digoxin-specific antibody fragments
How is Iron OD managed?
Desferrioxamine, a chelating agent
How is Lead OD managed?
Dimercaprol, calcium edetate
