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Medicine > Poisoning and overdose > Flashcards

Poisoning and overdose Flashcards

1
Q

Paracetamol overdose symptoms

A

No symptoms
Nausea and vomiting
Loin pain
Haematuria and proteinuria
Jaundice
Abdominal pain
Coma
Severe metabolic acidosis

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2
Q

<4h since paracetamol ingestion

A

Activated charcoal given while paracetamol still in GI tract

Prevents it being absorbed by small bowel

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3
Q

4-15h since paracetamol ingestion

A

Take level, treat according to nomogram

If above line, NAC required

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4
Q

16h since paracetamol ingestion

A

Start N Acetyl cysteine straight away

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5
Q

NAC should be started regardless of nomogram if

A
  • If a patient presents after 16 hours
  • there is uncertainty about timing
  • or has a staggered overdose
    then NAC should be started regardless of the nomogram
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6
Q

NAC can also be administered immediately if there is an increased risk of toxicity. This occurs in the following:

A

Patient on long-term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states: eating disorders, malnutrition and HIV

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7
Q

Aspirin overdose clinical features

A

hyperventilation, tinnitus, deafness, vasodilatation, and sweating. Coma
respiratory alkalosis and a metabolic acidosis.

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8
Q

Management aspirin overdose

A

Activated charcoal if ingestion <1 hours ago
IV fluid, sodium bicarbonate and potassium chloride
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
Haemodialysis

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9
Q

Digoxin poisoning clinical features

A 
Yellow green colour disturbance
Visual haloes
Dizziness
Nausea and vomiting
Palpitations ( due to arrhythmias)
Bradycardia typically without hypotension
Confusion 
Hyperkalemia 
reverse tick ST depression with first degree heart block
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10
Q

Management digoxin poisoning

A 
Immediate digoxin level
IV fluids
Correct electrolyte abnormalities
Continuous cardiac monitoring
Give digibind if :
Level > 15ng/ml after 6 hours of last dose
Level >10ng/ml within 6 hours of last dose
Symptomatic
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11
Q

Benzodiazepine poisoning clinical features

A

drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma

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12
Q

Benzodiazepine poisoning management

A

Charcoal, activated can be given within 1 hour of ingestion
benzodiazepine antagonist flumazenil [unlicensed indication] can be hazardous, particularly in mixed overdoses involving tricyclic antidepressants or in benzodiazepine-dependent patients.Should be used with caution as it may precipitate seizures.

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13
Q

Antidepressant poisoning clinical features

A

CNS effects : Delirium/confusion/agitation, sedation, seizures, coma, hyperreflexia, extensor plantar responses,
CVS effects: Sinus tachycardia, hypertension, hypotension (due to alpha2-adrenoreceptor blockade), broad complex tachycardia (can develop bradycardia pre-arrest)hypothermia
Anticholinergic effects: Can occur at time or presentation or be delayed and prolonged. Agitation, restlessness, delirium, mydriasis (big pupil), dry mouth , warm skin, tachycardia, ileus, urinary retention, respiratory failure
Dilated pupils and urinary retention also occur.
Metabolic acidosis may complicate severe poisoning; delirium with confusion, agitation, and visual and auditory hallucinations are common during recovery

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14
Q

Antidepressant poisoning Management points:

A

Intravenous lorazepam or intravenous diazepam for convulsions
Activated charcoal given within 1 hour of the overdose reduces absorption of the drug
The use of anti-arrhythmic drugs is best avoided, but intravenous infusion of sodium bicarbonate can arrest arrhythmias or prevent them in those with an extended QRS duration

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15
Q

Iron overdose clinical presentation

A

abdominal pain, nausea, vomiting, diarrhea, and haematemesis within 30 minutes to 6 hours of ingestion.rectal bleeding
Shock ,metabolic acidosis, Hepatotoxicity and coagulopathy

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16
Q

Iron overdose treatment

A

desferrioxamine mesilate chelates iron.

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17
Q

Lithium poisoning

A

Restlessness
Vomiting, diarrhoea
ataxia, weakness, dysarthria, muscle twitching, and tremor
Convulsions, coma, renal failure, electrolyte imbalance, dehydration, and hypotension

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18
Q

Lithium poisoning management

A

Conc > 2 mmol/litre may need treatment with haemodialysis if neurological symptoms or renal failure are present
In acute overdosage may only need to take measures to increase urine output (e.g. by increasing fluid intake but avoiding diuretics). Otherwise, treatment is supportive (electrolyte balance, renal function, and control of convulsions)

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19
Q

Stimulant-drug poisoning

A

wakefulness, excessive activity, paranoia, mydriasis, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma

Early stages can be controlled by diazepam or lorazepam

20
Q

Theophylline poisoning

A

vomiting,agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia
haematemesis, convulsions, and supraventricular and ventricular arrhythmias,hypokalaemia

21
Q

Theophylline poisoning management

A

Activated charcoal
Ondansetron may be effective for severe vomiting
Potassium chloride for hypokalaemia
Lorazepam/diazepam for seizures
Short-acting beta-blocker can be administered IV to reverse severe tachycardia, hypokalaemia, and hyperglycaemia.

22
Q

Organophosphorus insecticides poisoning features

A

They inhibit cholinesterase activity, thereby prolonging and intensifying the effects of acetylcholine.
SLUD Salivation, lacrimation, urination, diarrhoea
small pupils ,muscle weakness and fasciculation
Convulsions, coma, pulmonary oedema with copious bronchial secretions

small pupils

23
Q

Organophosphorus insecticides poisoning management

A

clear airway, wash skin, frequent removal of bronchial secretions, and adequate ventilation and oxygenation; gastric lavage may be considered provided that the airway is protected.
Atropine sulfate will reverse the muscarinic effects of acetylcholine
Pralidoxime chloride, a cholinesterase reactivator if severe as adjunct

24
Q

Cyanide poisoning symptoms

A

N&V if small doses, rapid LOC, apnoea, seizures, cardiac arrest

25
Q

Cyanide poisoning management

A

Oxygen
Dicobalt adetate
sodium nitrate and sodium thiosulfate if f dicobalt edetate is not available.
hydroxycobalamin for snoke inhalation

26
Q

Calcium channel blockers poisoning

A

N&V, dizziness, agitation, confusion, and coma Metabolic acidosis and hyperglycaemia

27
Q

Calcium channel blockers poisoning management

A

Charcoal, activated
calcium chloride or calcium gluconate is given by injection
atropine sulfate is given to correct symptomatic bradycardia.
In severe cases, an insulin and glucose infusion may be required in the management of hypotension and myocardial failure.

28
Q

Beta-blockers poisoning

A
  • bradycardia, hypotension, syncope, conduction abnormalities, and heart failure
  • drowsiness, confusion, convulsions, hallucinations
  • respiratory depression, and bronchospasm
  • Mild hypoglycemia and hyperkalemia
29
Q

Beta-blockers poisoning management

A

Fluid
Glucagon for severe hypotension
insulin to promote glucose use
For symptomatic bradycardia, give IV atropine sulfate; dobutamine or isoprenaline
IV sodium bicarbonate for correction of metabolic acidosis
Treat bronchospasm with nebulised bronchodilators and corticosteroids
Temporary cardiac pacemaker can be used to increase the heart rate

30
Q

Ethylene glycol poisoning features

A

Nausea and vomiting
Haematemesis
Seizures
Ataxia
Ophthalmoplegia
Papilloedema
Raised anion gap metabolic acidosis
Pulmonary oedema
Acute tubular necrosis
Hypocalcaemia
Hyperkaelemia
Hypomagnesaemia

31
Q

Ethylene glycol/antifreeze poisoning treatment

A

Gastric lavage or NG aspiration if <1 hour since ingestion
Fomepizole (competitive inhibitor of alcohol dehydrogenase) - prevents metabolism of ethylene glycol into toxic metabolites.
Alcohol (ethanol) can be used if Fomepizole is unavailable.
Haemofiltration can be used in severe cases

32
Q

Carbon Monoxide poisoning symptoms

A

Confusion
Nausea and vomiting
Cherry red skin
Tachycardia
100% oxygen saturations on pulse oximetry

33
Q

Carbon monoxide poisoning management

A

100% oxygen via face mask - helps unbind CO from the haemoglobin molecule
Hyperbaric oxygen - controversial
Cerebral oedema may occur in severe poisoning and is treated with an intravenous infusion of mannitol.but widely considered gold standard

34
Q

Opiod overdose symptoms

A

coma, respiratory depression, and pinpoint pupils, confusion, cyanosis if severe
Naloxone is antidote

35
Q

Neuroleptic malignant syndrome

A

Reaction to antipsychotics characterised by rigidity
Confusion
autonomic dysregulation
pyrexia

36
Q

Serotonin syndrome

A

Neurological features
- altered mental state, tremor, ataxia and hyperreflexia.
Autonomic features
- tachycardia, hypertension, diarrhoea, and hyperthermia
also rhabdomyolysis, renal failure, and coagulopathies may develop.

37
Q

Iron overdose treatment

A

desferrioxamine mesilate chelates iron.

38
Q

Theophylline poisoning management

A

Activated charcoal
Ondansetron may be effective for severe vomiting
Potassium chloride for hypokalaemia
Lorazepam/diazepam for seizures
Short-acting beta-blocker can be administered IV to reverse severe tachycardia, hypokalaemia, and hyperglycaemia.

39
Q

Local anaesthetic management

A

Supportive
IV lipid emulsion in severe cases

40
Q

Methanol poisoning features

A

initially present with intoxication
nausea, vomiting, abdominal pain, and seizures. Vision loss

41
Q

Methanol poisoning management

A

Ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites
Haemodyalysis

42
Q

Lead poisoning features

A

irritability and fatigue
loss of appetite and weight loss
abdominal pain
vomiting, constipation
hearing loss
developmental delay and learning difficulties
High blood pressure

43
Q

Sedative hypnotic toxidrome

A

caused by ethanol, benzodiazepines, baclofen and other drugs that alter GABA transmission. It presents similarly to someone who is very intoxicated, with slurred speech, ataxia and disinhibition but can lead to respiratory and central nervous system depression.

44
Q

Opioid toxidrome

A

Morphine is an example of a drug that can exhibit opioid toxidrome symptoms in overdose. Central nervous system and respiratory depression are common, as well as hypotension and ‘pinpoint’ pupils.

45
Q

Serotonergic toxidrome

A

tca,classic symptoms of altered Glasgow Coma Scale (GCS), respiratory depression and ECG changes

46
Q

anticholinergic toxidrome

A

tca
warm, flushing, dry skin and mouth, mydriasis, delirium

Medicine (72 decks)

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