Poisoning Flashcards

1
Q

alcohol withdrawal Tx?

A

chlordiazepoxide

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2
Q

what to give a patient with nutritional deficits from alcohol?

A

thiamine/pabrinex/vit B complex

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3
Q

Tx for Wernicke’s encephalopathy?

A

Pabrinex (Vit B)

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4
Q

how to Tx withdrawal from alcohol/DTs?

A

chlordiazepoxide

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5
Q

how to prevent alcohol relapse?

A

acamprosate

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6
Q

Tx acute poisoning?

A
  • 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
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7
Q

when would you Tx paracetamol OD with NAC before waiting for blood results?

A

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).

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8
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)?

A

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
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9
Q

charcoal in paracetamol OD?

A

The minority of patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug

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10
Q

when to give NAC?

A
  • 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
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11
Q

over what time to infuse NAC?

A
  • 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
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