Poisoning And Drug Abuse 💉 Flashcards
Investigations?
Blood and urine samples
Drug levels
Coma: blood Nd urine screen
What are some clinical signs and likely posisons of Constricted pupils ?
Opioids
Orangophosphorus insecticides
Nerve agents
Dilated pupils caused by?
TCA
Amfetamines
Cocaine
Convulsions caused by?
TCA Theophylline Opioids Mefenamic acid Isoniazid Amfetamines
Dytonic reactions?
Metoclopromide
Phenothiazines
Delirium + hallucinations caused by what drugs?
Antimuscarinic drugs,
Amfetamines
Cannabis
Recovering from TCA overdose
Vision loss caused by what drugs?
Methanol
Quinine
Divergent strabismus caused by what drugs?
TCA
CO
Methanol
Nystagmus caused by what drugs?
Phenytoin
Carbamezapine
Hypertonia and hypereflexia caused by what drugs?
TCAs
Anyimuscurinics
Tinnitus and deafnesscaused by what drugs?
Salicylates
Quinine
Hyperventilation caused by what drugs?
Salicylates
Pheno herbicides
Theophilline
Hyperthermia caused by which drugs?
MDMA (ecstasy)
Blisters?
Usually in comatose immobile pts
Lips and skin cherry red when?
CO poisoning
What do u do in e,ergency resuscitation?
Lateral position with lower leg straight and upper flexed- reduces aspiration risk
Clear airway, intubate if gag reflux absent
Give 60% oxygen face mask
Artificial ventilation sometimes needed
Treat hypotension, arrythmias, convulsions.
ABGs- resp function
Measure temp with low reading rectal thermometer and treat hypothermia
Prevention of further abdorption
- Gastric lavage: repteated instillation and aspiration of small amounts of water or saline (200-300mL ,38*) via orogastric tube. Danger: aspiration ❌.
CI in: paraffin, petrol, corrosives: risk of pneumonitis. - Activated charcoal 50g - absorbs unabsorbed poison
Aspirin, digioxin, paracetamol, barbiturates. Up to 1hr previously - Vomitting induction
- Haemo dialysis- severe- lithium, ethanol, methanol, ethylene, salicylate Blood >700mg/L
Aspirin= salicylate
Most commonest way of suicide?
Self poisoning esp with 1. Paracetamol cz ppl did it before, and antidoe worked, so next next time, they’ll take more.
- NSAIDS
- Asprin
- Antidepressants
- Benzodiazepines
2o poison alcohol
CHECK: any drugs? Friends, witness, CVS and Resp exam + conscious level !
What happens in aspirin overdose?
Salicylate- stimulates resp centre, deeper, more breathes –> resp alkalosis
Compensation: renal so metabolic acidosis- excreting bicarbonate and K+
Also intervene with carbs, protens fat metabolism
So increased lactate,mpyruvate and ketone bodies–> more acidosis
Mx- IV vit K to coorect hypoprothrombinaemia
Gastric lavage
Urine alkalization
Hemodialysis if severe
Paracetamol poisoning- what happens?
May cause fatal hepatic necrosis.
- Coverted to -> N-acetyl-p-benzoquinoneimeine (NAPQI)
- Normally inactivated by conjugation by gluathione.
Large overdose: gluathione is depleted
NAPQI binds covalently on liver membranes–> causing necrosis.
Marked necrosis: 15 tablets (7.5g) and death with 15g.
Best Liver guide severityD INR ot PT
How do u manage paracetamol poisoning?
Bloods: FBC, INR, ALT/AST, U+Es, glucose.
Gastric lavage or activated charcoal 50g if Presents within 1hr
Give IV NAC (N-acetylcysteine) in 5% dexteose
Whats SE could NAC has?
Urticarial rash
Angio oedema
Bronchospasms
Hypotension
Stopping infusion, giving antihistamine , restart infusion once reaction has settled.
What do we do in NSAIDS ovedose?
Symptomatic and supportive tx
B blockers overdose?
Bradycardia! Give Atropine or if resistant- IV glucagon proven to have a +ve inotropic effect on heart
Benzodiazepines overdose?
Give flumazenil 0.5mg IV + benzodiazepine antagonist if breathing depressed
What hapoens in opioids overdose? Give examples
Diamorphine (heroin) , codeine, buprenorphine, –> physical dependancy - acute withdrawal sx
Profuse: sweating, tachycardia, dilated pupils, leg cramps, Diarrhoea, Vomitting –> give methadone (pharm prepanof opioid)
Overdose:pinpoint pupil.
Resp depression, coma,
NALOXONE- opioid antagonist 1.2mg IV every 2mins until breathing adequate
What is the antidote of cocaina?
Nada
What about Lysergide?
LSD- potent hallucinogen- severe psychotic states in which life might be at risk.
Even in overdose, severe physiological rcts do not seem to occur.
Sedative, diazepam.
Severe: phenothiazides.
Cocaina,?
Injection, inhalation (crack), ingestion
Stimulates CNs, overodse: CVS+Resp depression
Euphoria,magitation, tachycardia
Diazepam for agitation
B blovkers may exacerbate hypertenion
Active cooling for hyperthermia
What is ecstasy?
Methamfetamine
Dance drug
SE: convulsions, hyperpyrexia, coagulopathy, rhabdomyalisis, liver, renal F, death.
Tx: rehydration, diazepam for severe agitation,
Hyperthermia: dantrolene
Why thenearly drinkingbin alcoholics?
To avoid withdrawal sx like sweating, nausea, agitation
What are the safe limits for alcohol?
21 units for M
14U for F
1 unit: 1 glass of wine, half a pint of beer.
Increase risk >36 M, and >24 F
Whatbare some useful blood tests for alcohol abuse?
Elevated serum GGT + MCV.
To demosntrate high intake: blood and urine
What are some physical complications of alcohol abuse and dependance?
- CVS- direct toxic effect- arrythmias and cardiomyopathies.
- Neurological: acute intoxication-> ataxia, falls, head injuries, intracranial bleeds. Long term: polyneuropathy, myopathy, cerebellar degeneration,dementia and epilepsy ❗️
What happens in werinkes encephalopathy? Whats the Classic triad of WE? Werinkes
WE result of thiamine VitB1 deficiency so also in starvation and prolonged vomiting.
Classic triad of WE- confusion, ataxia, ophtalmoplegia
Last 2 less often.
Usually- acute confusion, drowisness, pre-coma, coma.
Thiamine short lived,mso daily doses might be needed.
Give thiamine prior to glucose because glucose oxidation is a thiamine intensive process and may drive the last reserves of thiamine intracellulary, aggrevating the neurological effect. So at risk of precipitating it.m
Whats Korsakoffs syndrome?
Off survivors of WE 20% die and some survivors develop it.
Gross defect in short memory asc with confabulation (productioon of memories to fill in the gaps)
What other patients are at risk of WE?
Wt loss
Signs of undernutrition
Alcohol withdrawal requiring hosp admission
What are the alcohol withdrawal sx?
Early mild: 6-12hrs- tremor, N, sweating.
Reduce diazepam dose.
Mild: can be outpatients, as long as attends daily for meds and monitpring and social support.
Later: 2-3D but can take up to 2W.
Generalised tonic clonic seizures
Delirium tremens with fever, tremor, tachycardia, agitation, visual hallucinations- pink elephants.
URGENT TX ❗️‼️
After withdrawal, relapse is prevented.
Local alcohol servises, psychiatry, 15mins counselinh.
GABA analogue- oral acamprosate - reduces relapses by 50%.
Naltrexone- opioid antagonist - modifies effects of alcohol by blunting its pleasurable effects and reducing its craving.
Reduces relapse rate but not yet licensed in the UK.
What is the emergency management of delerium tremens?
Admit
Treat or prevent WE by administration of B1 before glucose
Treat infx
Correct dehydration and electrolyte imbalance
Prophylactic phenytoin if hx of fits
10-20mg diazepam, repeat if needed , or lorazepam 2-4mg
Maintenance tx: diazepam 10mg every 6hrs, for 4 doses
