Overdoses part 1 Flashcards
What is a Dystonic reaction
idiosyncratic reaction NOT dose dependent 2/2 Phenothiazines (phenergan, compazine), Butyrophenones (haldol), and Reglan
–Sudden onset abnormal head, neck, and jaw posture
Spastic contracture of lips, tongue, face, throat
Trismus, torticollis, tongue protrusion
Oculogyric crisis (cant move eyes vertically
What are Sx of a dystonic reaction
hypotension, decerased LOC, miosis, seizure, coma, urinary retention
What are effects of an APAP OD
Centrolobular necrosis
Irreversible hepatic necrosis if pH <7.3, bili>4, Cr>3.4, or encephalopathy
-0-24: n/v, pallor, diaphoresis
-24-48: RUQ pain, high LFT
-72-96: LFT peak, coagulopathy, encephalopathy
-4-14d: recover or die
How do you treat APAP OD
N-acetyl cysteine w/in 8 hours (reduce NAPQI back to APAP)
can give PO or IV (smells like rotten eggs)
+/- reglan for nausea
How do you tract APAP OD
Rumack-Matthew Nomogram (s/p 4 hours after SINGLE ingestion)
What are effects of an ASA OD
Vomiting GGI bleed Hypotension Prolonged PT Agitation Lethargy Tachypnea Leukocytosis **Metabolic Acidosis + Respiratory Alkalosis**
How do you treat an ASA OD
Gastric lavage
Multi-dose charcoal q4hr
NS at 2-3x maintenance
NaHCO3 bolus + KCl D5W
When would you need to dialyze an ASA OD patient
Renal failure CNS toxicity Worsening Hypokalemia (cant make urine alkaline) Serum ASA >100mg
How can you track ASA OD
Done Nomogram for single ingestion (NOT liquid, chronic, or enteric coated)
What are anticonvulsants we studied
Phenytoid
Carbamazepine
Barbituates
Valporate
What are effects of Phenytoin OD
*Horizontal Nystagmus slurred speech ataxia hallucinations hyperreflexia seizure
How do you treat Phenytoin OD
Supportive MDAC (multi dose activated charcoal)
How should you never administer phenytoin
IM or with dextrose
What are effects of Carbamazepine OD
Anticholinergic
wide QRS
long PR/QT, bradycardya
How do you treat Carbamazepine OD
Supportive
MDAC
What are effects of Barbituate OD
CNS depression Hypothermia Hypoglycemia Aspiration PNA urine retention
How do you treat Barbituate OD
Supportive Glucose Narcan Charcoal Urinary alkalinization
What are Sx of Valporate OD
*Drowsy, Confused, AMS High ammonia Hyperglycemia slow reactive pin point pupils Hepatotoxic
How do you treat Valporate OD
Supportive
Charcoal
L-Carnitine (if high ammonia)
What are effects of Lithium toxicity (SS, low anion gap)
Hand tremor Fatigue no concentration Polyuria Anorexia, N/V/D Rash Seizure
How do you treat Lithium OD
Benzo (NOT dilantin)
Aggressive IV NS
Hemodialysis if >3.5)
charcoal does not work
What are effects of Ethanol OD
CNS depression slurred speech nystagmus hypoglycemia Metabolic acidosis + anion gap
How do you treat Ethanol OD
IV fluids (banana bag w/ MVI, thiamine, folate) **Charcoal does not work**
What are effects of Isopropanol OD (rubbing alcohol, paint thinner)
Increased Osmolar gap w/o changing anion gap!
How do you treat Isopropanol OD
IV fluids
ventilation
HD if hypotension refractory to fluids
charcoal does not work
What are effects of Methanol toxicity
CNS depress Blind Abd pain Hypotension Anion cap Metabolic acidosis + Osmolar gap
How do you treat Methanol OD (wood varnish)
IVF Fomepizole Ethanol 10% in D5W HD if blind or pH <7.15 *charcoal does not work*
What are effects of Ethylene Glycol OD (anti-freeze)
CNS depression Tachy tachy HTN Flank pain Renal failure Hypocalcemia (tetany, long QT) Anion gap Metabolic acidosis
What will you see on Urine Fluorescence in Ethylene Glycol toxicity
Calcium Oxalate crystals
How do you treat Ethylene Glycol OD
IVF Fomepizole Ethanol 10% in D5W HD is severe met acidosis w/ nephrotoxicity *charcoal does not work*
What are effects of CCB OD
*AV Dissociation, Increased PR interval hypotension bradycardia ileus High Na/hyperglycemia
How do you treat CCB OD
WBI CaCl (or CaGluconate) bolus in central line Glucagon Epinephrine Insulin and glucose NaHCO3 (if wide QRS) Pacemaker
What is the only dialyzable BB
Atenolol
What are effects of BB OD
Hypotension bradycardia coma Increased PR and QRS High K, hyperglycemia
How do you treat BB OD
Glucagon
Insulin-glucose
Epinephrine
pacemaker
What are effects of Digoxin Toxicity
*Proximal Atrial tachycardia w/ block Vision change (see yellow halos) Acute: High K + GI Sx in Chronic: Low K + arrhythmia Vtach in different directions n/v, weak, syncope, AMS
How do you treat Digoxin OD
Avoid Ca
Digibind (if K>5.5, heart block, plant, or animal toxicity)
Vasopressor, atropine, external pacing
When are digoxin levels falsely elevated
newborns
pregnant moms
chronic renal failure
hepatobiliary disease
What are effects of TCA OD
Anticholinergic effects
cardiac arrest, arrhythmia, hypotension, pulm edema, mydriasis
Increased QRS&QT, RAD, sinus tach
How do you treat TCA OD
Fluids NaHCO3 Alpha agonist (NO dopamine) Benzos, Barbituates Vent support charcoal Avoid CCB, BB, physiostigmine
TCA + ___= death
Procainamide (class Ia)
What is the MC arrhythmia in TCA OD
Supraventricular with wide QRS
What are effects of Cyanide OD
Tachycardia+HTN–> Bradycardia+hypotension–> asystole
HA–>Sz–>coma
Dyspnea–>apnea
How do you treat Cyanide OD
100% O2
Hydroxocobalamin
+/- Cyanide kit (amyl nitrate + sodium nitrite + sodium thiosulfate)
What are effects of carbon monoxide OD
Asymptomatic
*Cherri red skin
HA, n/v, no dexterity, flu Sx
(must test carboxyHgb level)
How do you treat carbon monoxide OD
Hyperbaric oxygen in COHgb>40%, preggers, neuro sx, coma, ischemia on ECG, refractory despite O2
What are effects of hypoglycemia
Diaphoresis, Nausea, AMS
Whipple’s Triad: hypoglycemia (<60) + Sx of hypoglycemia + Resolution of Sx w/ glucose admin
What agents can cause hypoglycemia
Insulin Sulfonylurea Bigaunides (metformin, glucophage) -->met acidosis Thiozolidinediones Benzoc acid
How do you treat hypoglycemia
Glucose replacement Feed patient Glucagon (not for alcoholic, young, old, or malntr) Octreotide Charcoal
How do you treat Dystonic reactions
Benadryl (3-4 days to prevent recurrence)
Benztropine (not kids)
Repeat: brief overview of effects of dystonic reactions
Hypotension Miosis decreased LOC brady/tachy sz coma urinary retention
What is the MCC of peds morality 2/2 poisoning
eat da poop
jk shawn, it’s iron
What are effects of Iron OD (stages)
I (6-12h): GI; vomit, diarrhes, abd pain, pallor, lethargy, Metabolic acidosis, hypoglycemia, leukocytosis
II (6-24): hypovolemia, Metabolic acidosis, lethargy, hypotension
III: organ failure; periph neuropathy, encephalopathy, myocardial depresison, renal/hepatic fail, ischemic bowel
How do you treat Iron OD
\+ KUB or >20 ingested= Lavage WBI 2oz MOM per g ingested Deferixamine If ASx s/p 6 hr, Dc home
What is your popcorn lab finding in iron OD
Basophilic stippling (WBC) on microscopy Vin Rose urine
What does alkali ingestion cause
Liquid Necrosis
What does Acid ingestion cause
Coagulation Necrosis (eschar)
Any caustic ingestion causes what effect
Visible burn dysphonia drooling coughing vomiting
How do you manage a caustic ingestion
ABC, routine tox labs, upright CXR
Endoscopic eval
NG tube, steroids, or abx
no charcoal
