Poisoning Flashcards
alcohol withdrawal Tx?
chlordiazepoxide
what to give a patient with nutritional deficits from alcohol?
thiamine/pabrinex/vit B complex
Tx for Wernicke’s encephalopathy?
Pabrinex (Vit B)
how to Tx withdrawal from alcohol/DTs?
chlordiazepoxide
how to prevent alcohol relapse?
acamprosate
Tx acute poisoning?
- cannula and catheter, strict fluid balance, IV fluids, analgesia
- correct electrolytes
- ↓ absorption if w/n 1 hr:
1) gastric lavage (i.e. ‘stomach pumping’ unless caustic/acid content
2) whole bowel irrigation (Li+/Fe)
3) charcoal (dx-dependent) - ↑ elimination: IV fluids +
1) NAC (if paracetamol >4 hrs is above Tx line)
2) naloxone (if ↓RR or GCS)
3) flumazenil (benzos) - psychiatric management
when would you Tx paracetamol OD with NAC before waiting for blood results?
if taken >150 mg/kg (should be considered potentially toxic - give NAC!)
to avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).
King’s College Hospital criteria for liver transplantation (paracetamol liver failure)?
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
- prothrombin time > 100 seconds
- creatinine > 300 µmol/l
- grade III or IV encephalopathy
charcoal in paracetamol OD?
The minority of patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug
when to give NAC?
- staggered overdose
- or doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration
- or the plasma paracetamol concentration is on or above a single treatment line between (100 mg/L at 4 hours) and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
over what time to infuse NAC?
- over 1 hour (rather than the previous 15 minutes)
- reduce the number of adverse effects
- commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release)
- generally treated by stopping the infusion, then restarting at a slower rate