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CPTP stage 4 > Poisoning > Flashcards

Poisoning Flashcards

1
Q

Which are the 2 most groups most likely to present with poisoning?

  • accidental/ deliberate
  • more common in males/ females
A

Young children (1-5yo)
More common in Males.
Accidental.

Adolescents
Equal rates in Males and Females.
Deliberate self-harm

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2
Q

4 top poisons causing death in UK

A
  1. Paracetamol
  2. TCAs
  3. Opiates (heroin, methadone)
  4. Carbon monoxide (smoke from housefires)
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3
Q

State whether the following are depressants or stimulants:

  1. BZDs
  2. opioids
  3. cocaine
  4. MDMA
  5. theophylline
A
  1. BZDs: depressant
  2. opioids: depressant
  3. cocaine: stimulant
  4. MDMA: stimulant
  5. theophylline: stimulant
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4
Q

Which poison should be tested for in everyone who presents with overdose?
Why?

A

Paracetamol

Cos most common overdose method + won’t show early signs

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5
Q

Features of BZD overdose

A
  1. CNS depression (ataxia, nystagmus, dysarthria)
  2. Respi depression
  3. Hypothermia
  4. Rhabdomyolysis
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6
Q

ECG features in BZD overdose

A
  1. Heart block (1st/2nd degree)

2. QT prolongation

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7
Q

Treatment for BZD overdose

A
  1. Flumazenil

2. Activated charcoal, MDAC

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8
Q

Late clinical features of paracetamol overdose (including metabolic disturbances)

A
  1. RUQ liver pain
  2. Jaundice, encephalopathy
  3. Coagulopathy
  4. Raised creatinine

Metabolic disturbances

  1. Hyperglycaemia
  2. Metabolic acidosis
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9
Q

Which investigations are best for predicting prognosis after a paracetamol overdose.

What levels of this indicate poor prognosis

A

PT and INR

POOR PROGNOSIS

  • PT or INR rising after day 3
  • PT >180s at any time
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10
Q

What investigative features (including ABG) indicate that someone requires a liver transplant after paracetamol overdose

A
  1. Metabolic acidosis
  2. Raised lactate
  3. Encephalopathy (3 or 4 ie worsened confusion, coma)
  4. Creatinine >300umol/L
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11
Q

Treatment for paracetamol overdose

A
  1. Activated charcoal
  2. N-acetylcysteine
  3. Haemodialysis (if v high paracetamol concentration >700mg/L)
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12
Q

How long/ what method should N-acetylcysteine be given for?

A

IV for 21h

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13
Q

How does N-acetylcysteine work

A

Can be converted by body into glutathione so that it can then detoxify NAPQI (toxic metabolite of paracetamol)

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14
Q

Common complication of N-acetylcysteine.

How is this managed?

A

Anaphylactoid reaction
-urticaria, wheeze, hypotension

Give antihistamine + reduce dose of N-acetylcysteine

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15
Q

What level of paracetamol ingestion requires treatment with N-acetylcysteine

A

> 150mg/kg

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16
Q

How long after paracetamol overdose can blood tests be done to determine whether or not to treat

A

4h after overdose

17
Q

Overdose with what drug should be considered in a pt with metabolic acidosis + respiratory alkalosis

A

Aspirin

18
Q

Symptoms of mild/ moderate aspirin overdose

A
  1. Tinnitus
  2. Sweating, vomiting, dizziness
  3. Hyperventilation
19
Q

Symptoms of severe aspirin overdose

A
  1. Agitation, delirium, coma, fits
  2. Arrhythmias
  3. Pulmonary/ cerebral oedema
  4. Heart/ renal failure
20
Q

Metabolic complications of severe aspirin overdose

A
  1. Metabolic acidosis
  2. Respiratory alkalosis
  3. Hypoglycaemia
  4. Hypokalemia
21
Q

Treatment for aspirin overdose

A
  1. Charcoal, MDAC

2. Sodium bicarbonate (prevents CNS penetration, enhances elimination by alkalinising urine)

22
Q

Symptoms of opioid overdose

A
  1. Pin point pupils
  2. CNS, respiratory depression
  3. Hypotension, tachycardia
  4. Hallucinations
  5. Rhabdomyolysis
  6. Non-cardiac pulmonary oedema
23
Q

Metabolic complications of opioid overdose

A
  1. Respiratory acidosis

2. Metabolic acidosis

24
Q

Treatment for opioid overdose

A

Nalozone (opioid receptor antagonist)

25
Q

Half life of naloxone

A

40-60min

26
Q

Complications of naloxone

A

ACUTE WITHDRAWAL SYNDROME

  • arthralgia
  • tremor, irritability, palpitations
  • DnV, cramps
  • rhinorrhoea
27
Q

Symptoms of TCA overdose due to anticholinergic effects

A
  1. Pupil dilation
  2. Dry eyes
  3. Urinary retention
  4. Tachycardia
  5. Agitation, delirium
  6. Fits, coma
  7. Hypertonia, hyper-reflexia
28
Q

Symptoms of TCA overdose due to sodium channel blocking effects

A
  1. Heart block
  2. Heart arrhythmias
  3. Prolonged QT/ wide QRS
29
Q

What signs on ECG indicate poor prognosis in TCA overdose

A

QRS >120ms (3 small sq) = urgent action required

QRS >160ms (4 small sq) = high risk of arrhythmia

30
Q

Treatment for TCA overdose

A
  1. Charcoal, MDAC
  2. Sodium bicarbonate (treat arrythmia, correct acidosis)
  3. BZD for fits
31
Q

Early features of iron overdose

A
  1. NnV, abdo pain
  2. Bloody diarrhoea
  3. Massive GI fluid loss
32
Q

Late features of iron overdose

A
  1. Black offensive stools
  2. Reduced GCS, coma, fits
  3. Shock
  4. Liver/ renal failure
  5. Gastric strictures
33
Q

Features of severe iron poisoining (list by ABCDE)

A

C: shock, hypotension
D: reduced GCS/ fits; hypergycaemia
E: metabolic acidosis/ rectal bleed/ vomiting blood

34
Q

Treatment for iron overdose

A
  1. Desferrioxamine (binds to iron)

2. Gastric lavage if large OD (charcoal won’t work)

35
Q

When is Desferrioxamine used

A

For severe iron OD

  • iron conc >3mg/L +
  • features of severe poisoning
36
Q

2 antidotes for alcohol poisoning

A
  1. Methanol

2. Ethylene glycol

CPTP stage 4 (21 decks)

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