poisoning from medicines and other fun stuff Flashcards
name some medications that can potentially lead to serotonin syndrome
citalopram, fluoxetine, sertraline (SSRIs)
What should be administered if opiate poisoning is suspected and the patient has a significantly impaired level of consciousness?
Naloxone: 0.1-0.4 mg IV every five minutes for an adult, or 0.8 mg IM every ten minutes for an adult.
See the paediatric drug dose tables for a child.
What is the IV administration protocol for sodium chloride if a patient shows signs of hypovolaemia?
1 litre IV for an adult; 20 ml/kg for a child.
Repeat as required.
What is the treatment for cyclic antidepressant poisoning with QRS prolongation?
8.4% sodium bicarbonate IV: 100 ml IV for an adult; 2 ml/kg IV for a child.
Also administer 0.9% sodium chloride IV: 1-2 litres for an adult; 20-40 ml/kg for a child.
What are the general principles in the treatment of poisoning?
Focus on:
* Supporting airway, breathing, and circulation
* Treating agitation
* Ensuring appropriate assessment and follow-up
See the ‘acute behavioural disturbance’ guideline for more information.
What commonly causes an altered level of consciousness following poisoning?
Benzodiazepines, antidepressants, antipsychotics, opiates, sedatives, or a combination of these.
Is naloxone indicated in the treatment of poisoning associated with an altered level of consciousness?
False.
Naloxone is only indicated if opiate poisoning is strongly suspected.
What potential complications can arise from naloxone administration?
Seizures, hypertension, pulmonary oedema, or severe agitation.
When should police assistance be requested in cases of poisoning?
If there is:
* Significant risk of injury
* Severe agitation causing life-threatening risk
* More than minimal restraint is required.
What are the symptoms of significant paracetamol poisoning?
Asymptomatic in the first 6-12 hours, followed by nausea, vomiting, and non-specific abdominal pain.
What is the treatment protocol for significant paracetamol poisoning?
Transport to an ED for serum paracetamol measurement, even if asymptomatic.
What are the symptoms of cyclic antidepressant poisoning?
Altered level of consciousness, seizures, tachycardia, tachydysrhythmias, and shock.
What is a potential treatment for toxicity from cyclic antidepressants?
Large dose of sodium ions may reduce toxicity.
Name three examples of atypical antipsychotics.
- Quetiapine
- Risperidone
- Olanzapine.
What signs and symptoms can indicate serotonin syndrome?
- Tachycardia
- Tachypnoea
- Hypertension
- Sweating
- Hyperthermia
- Tremor
- Rigidity
- Confusion
- Agitation
- Seizures.
What is the treatment approach for serotonin syndrome?
Supportive treatment including uncovering the patient, temperature measurement, cooling, and administering 0.9% sodium chloride IV if temperature > 39°C.
What is the preferred treatment for bradycardia and/or hypotension in beta-blocker and/or calcium channel blocker poisoning?
Adrenaline infusion.
Metaraminol is less preferred.
What is the mortality rate for colchicine poisoning?
High mortality rate; no effective treatments once absorbed.
What should be done if iron poisoning is suspected?
Transport to an ED without delay, even if asymptomatic.
What are the early gastrointestinal effects of iron poisoning?
Abdominal pain, vomiting, and diarrhoea.
What is the hospital treatment for iron overdose?
- Whole bowel irrigation
- Antidote therapy (desferrioxamine) if indicated.
common tricyclic antidepressants in NZ
Amitriptyline.
Desipramine (Norpramin).
Doxepin.
Imipramine.
Nortriptyline (Pamelor).
Protriptyline.
what suffix do most tricyclic antidepressants in nz have
line (amitriptyline)
mine (desiparamine)
What is Gamma hydroxybutyrate (GHB) associated with?
Deep unconsciousness, poor airway, poor breathing, intermittent apnoea.
What may patients require after taking GHB?
Assisted ventilation.
How quickly do patients typically improve after GHB ingestion?
20-30 minutes.
What can prolong recovery after GHB ingestion?
Ingestion of another sedative, such as alcohol.
What effects are associated with MDMA?
Altered level of consciousness, seizures, hyperthermia.
What effects can Ketamine cause?
Hallucinations, altered level of consciousness.
What are the potential effects of amphetamines and methamphetamine?
Severe hypertension, tachycardia, disturbed behaviour.
What severe behaviours may result from methamphetamine use?
Violence or attempted suicide.
What effects do cathinones (like mephedrone) have?
Hypertension, tachycardia, hallucinations, paranoia, panic attacks, disturbed behaviour.
What symptoms can cannabis and cannabinoids cause?
Mental dissociation, anxiety, tachycardia, palpitations, chest pain, nausea, vomiting.
What are ‘synthetics’ in the context of recreational drugs?
A mixture of synthetic chemicals added to dried plant material for smoking.
What effects can synthetics cause?
Altered level of consciousness, seizures, agitation, cardiac arrest.
What complications can cocaine use lead to?
Severe hypertension, tachycardia, intracranial haemorrhage, coronary artery spasm, myocardial ischaemia.
Are seizures common after recreational drug use?
Yes, particularly with synthetics.
How are seizures following recreational drug use usually characterized?
Self-limiting.
What is a common behaviour of patients after experiencing seizures due to recreational drug use?
Refusal of assessment and/or transport.
What must be considered when assessing patients who have seized?
The need for significant restraint and/or sedation.
When is it appropriate to manage a patient without transport to an ED?
If the patient has stopped seizing and can mobilize safely.
What advice should be given to family and friends of a recovering patient?
Provide supervision until the patient has fully recovered.
What can button or disc batteries cause if swallowed?
Severe injury to the oesophagus or bowel
May need to be surgically removed
What should be done if a patient is suspected to have swallowed a button battery?
Treat as if a battery has been swallowed
Button batteries can be mistaken for coins
What type of products can cause significant injury to the oesophagus upon ingestion?
Strong acid or alkali
Particularly alkaline products like dishwashing powders and bleach
What is a common symptom following the ingestion of strong acid or alkali?
Inflammation of the oropharynx
Significant injury and/or swelling is uncommon
What should be encouraged for a patient who has ingested strong acid or alkali, provided their airway is normal?
Sips of water
This should not induce vomiting
What is the most common cause of organophosphate poisoning?
Deliberate ingestion of insecticides
Skin contact with OP requires significant exposure
What enzyme activity is inhibited by organophosphates?
Cholinesterase
This leads to a build-up of acetylcholine
List some symptoms caused by the build-up of acetylcholine due to organophosphate poisoning.
- Salivation
- Lacrimation
- Defaecation and vomiting
- Urination
- Bradycardia
- Bronchoconstriction and bronchial secretions
- Muscle twitching and muscle weakness
What is the initial treatment for organophosphate poisoning?
Support of the patient’s airway, breathing and circulation, and treatment with atropine
Atropine reverses most effects of acetylcholine
What is the recommended atropine dosage for treating organophosphate poisoning?
1.2 mg atropine IV, repeat every five minutes until adequate atropinisation signs appear
Additional atropine may be needed
What indicates adequate atropinisation in a patient?
- Resolution of bradycardia
- Drying of secretions
- Resolution of wheeze
Is decontamination required prior to transport for a patient who has ingested an organophosphate?
No, unless OP chemicals are on the patient’s skin or clothing
Vomit will contain OP, so PPE should be worn
What is the consequence of nitrite poisoning?
Methaemaglobinaemia
Reduces oxygen binding to haemoglobin
List some symptoms of nitrite poisoning.
- Severe hypoxia unresponsive to oxygen
- Extreme tachypnoea
- Extreme tachycardia
- Agitation
- Dark brown blood if IV access is gained
What is the antidote for nitrite poisoning?
Methylene blue
Usually available in the emergency department
How does cyanide poisoning affect oxygen utilization?
Impairment at a mitochondrial level
Oxygen levels in blood and tissues remain normal
What are common sources of cyanide exposure?
- Industrial use (mining, electroplating, plastics)
- Pesticides
- Smoke from house fires with synthetic furnishings
What are some symptoms of cyanide poisoning?
- Anxiety
- Nausea
- Headache
- Tachycardia
- Tachypnoea
- Falling level of consciousness
- Cardiac arrest
What is the recommended PPE for treating cyanide poisoning?
Normal body fluid precautions
No specific decontamination required for ingested cyanide
What are some specific cyanide antidotes?
- Hydroxocobalamin
- Amyl nitrite
- Sodium thiosulfate
What should personnel do if there is a history of cyanide poisoning and the patient is symptomatic?
Administer the contents of cyanide antidote kits
Seek clinical advice if uncertain, but do not delay treatment
