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Psychiatry > Poisoning And Overdose > Flashcards

Poisoning And Overdose Flashcards

1
Q

Opiates - reversal agent

A

Naloxone

  • competitively binds to opioid receptors causing a blockade
  • IV fastest action
  • half life of naloxone is much less than that of opioids, so overdose can return once naloxone wears off
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2
Q

Opioids - who is most likely to overdose

A

Heroin users who have recently been incarcerated/gone ‘cold-turkey’ and return to heroin use
- take the same dose they were on before cessation, but in the absence of tolerance

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3
Q

Benzodiazepines - clinical features of overdose

A 
Agitation
Euphoria
Blurred vision 
Slurred speech
Ataxia
Slate-grey cyanosis
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4
Q

Benzodiazepines - management

A

Flumazenil - can act as a reversal agent, but is not always recommended
- reduces sedative/drowsy effect
- half-life much less than that of the benzo’s, so overdose can continue after the reversal agent has worn off
- competitively binds to benzodiazepines
Causes dangerous withdrawal in long-term abusers

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5
Q

Beta-blockers - management

A

Glucagon
- positively inotropic agents are not in effective management
Correct hypocalcemia with calcium

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6
Q

Cannabis - signs and symptoms of overdose

A 
Dry cough
Increased appetite 
Social withdrawal
Paranoia 
Altered perception of time
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7
Q

Sympathomimetics e.g. cocaine - clinical features of overdose

A 
Tachycardia 
Mydriasis 
Euphoria 
Formication - insects crawling on my skin 
Agitation
Tremor 
Arrhythmias
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8
Q

Sympathomimetics e.g. cocaine - treatment

A

Benzodiazepines

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9
Q

Antidotes - common overdoses

A 
Anti-freeze (ethylene glycol) - ethanol 
Cyanide - dicobalt edetate 
Lead poisoning - sodium calcium edetate 
Organophosphate poisoning - atropine 
Heparin - protamine sulphate
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10
Q

Carbon monoxide - signs and symptoms

A 
Inebriation 
Coma
Hyporeflexia 
Tachycardia 
Pulmonary oedema 
Shock
Metabolic acidosis
Headache
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11
Q

Carbon monoxide - management

A

Hyperbaric oxygen

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12
Q

Paracetamol overdose - clinical features

A 
Nausea
Vomiting 
Renal failure - oliguria and metabolic acidosis 
Hepatic necrosis 
- jaundice and RUQ pain
- encephalopathy 
- hypoglycaemia 
Asymptomatic until acute liver failure occurs (24-72 hours later)
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13
Q

Paracetamol overdose - investigations

A 
Paracetamol levels (and salicylate)
- accurate over 4 hours after ingestion 
Bloods 
- LFTs
- PT (indication of acute liver failure)
- U&Es
- glucose 
- INR
ABG for metabolic acidosis
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14
Q

Paracetamol overdose - management <8 hours after ingestion

A

Activated charcoal
- if >12g or >150mg/kg ingested
- most effective within an hour of overdose
Acetylcysteine
- promotes conjugation of circulating paracetamol
- only given if plasma paracetamol levels are known, and are above the treatment line
- best effect <12 hours after ingestion
- administration continued for 24 hours regardless of levels

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15
Q

Paracetamol overdose - management >8 hours after ingestion

A

Acetylcysteine

  • if >12g or 150mg/kg ingested (don’t wait for plasma paracetamol levels)
  • administer with 5% dextrose
  • 5% of patients have an allergic rash
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16
Q

Paracetamol overdose - management >24 hours after ingestion

A

Consult toxbase and seek expert advice

17
Q

Aspirin overdose - clinical features

A 
>125mg/kg is not toxic 
250mg/kg is mildly toxic
- tinnitus
- lethargy 
- dizziness 
- nausea/vomiting 
>500mg/kg
- dehydration 
- sweating/warm extremities 
- bounding pulse 
- deafness 
- hyper/hypoglycemia
- confusion and disorientation 
- coma (rare)
18
Q

Aspirin overdose - life threatening features

A

Pulmonary oedema
Metabolic acidosis
Salicylate concentration >700mg/l

19
Q

Aspirin overdose - investigations

A 
Bloods 
- salicylate concentration (not an indicator of severity - accuracy best >4 hours)
- U&amp;Es
- glucose
- plasma potassium (hypokalaemia likely)
Urine pH
ABG - metabolic acidosis
20
Q

Aspirin overdose - measuring severity

A 
Stage 1
- alkalotic blood and alkalotic urine
Stage 2
- alkalotic blood and acidotic urine 
Stage 3
- acidotic blood and acidotic urine
21
Q

Aspirin overdose - management

A

Activated charcoal (>125mg/kg ingested <1 hour ago)
Gastric lavage (>500mg/kg ingested <1 hour ago)
Aggressive rehydration
Consider glucose
- intracellular glucose often deplete even when blood glucose is normal
Sodium bicarbonate
- to increase the alkalinity of the urine (increases excretion of salicylate)
- if >500mg/kg ingested
- be aware hypokalemia reduces effectiveness of urine alkalinity
Haemodialysis - for severe cases

22
Q

Aspirin overdose - indications for haemodialysis

A 
Plasma salicylate >700mg/kg
Renal failure
Heart failure 
Coma 
Convulsions 
Severe metabolic acidosis (pH <7.2)
CNS symptoms continue despite correction of acidosis

Psychiatry (17 decks)

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