Poisoning Flashcards
What do you for paracetamol overdose
-over 100 is above treatment line
activated charcoal if ingested < 1 hour ago N-acetylcysteine (NAC) liver transplantation
What is the treatment for Salicylate overdose
urinary alkalinization is now rarely used - it is contraindicated in cerebral and pulmonary oedema with most units now proceeding straight to haemodialysis in cases of severe poisoning
haemodialysis
What is the treatment for Opioid/opiates
Naloxone - 400micrograms can give up to 2 grams
What is the treatment for BZD’s
Flumazenil
What is the treatment for tricylic adepressants
V 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
dialysis is ineffective in removing tricyclics
What is the treatment for 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 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
What is the treatment for warfarin overdose
vit K, prothrombin complex
What is the treatment for heparin overdose
protamine sulphate
What is the treatment for beta blocker overdose
if bradycardic then atropine
in resistant cases glucagon may be used
What is the treatment for ethylene glycol (antifreeze)
ethanol has been used for many years
works by competing with ethylene glycol for the enzyme alcohol dehydrogenase
this limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning
fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
haemodialysis also has a role in refractory cases
What is the treatment for methanol poisoning
fomepizole or ethanol
haemodialysis
What is the treatment for Organophosphate insecticides
atropine
What is the treatment for digoxin poisoning
digoxin-specific antibody fragments
What is the treatment for iron overdose
desferrioxamine - a chelating agent
What is the treatment for lead overdose
dimercaprol, calcium edetate
