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Poisoning & overdose Flashcards

1
Q

What is flumazenil

A

Benzodiazepine antagonist

Precipiates withdrawal if dependent

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2
Q

Uses of flumazenil

A

May sometimes be used as an alternative to ventilation in children who are naive to benzo’s or in COPD to avoid need for ventilation

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3
Q

What are the most important things to find out with OD/poisoning

A 
Likely agents involved + coagents
Date and time of ingestion
Quantity
Route of exposure
Single OD/staggered/chronic
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4
Q

General examination of person who has ODed

A

Puncture wounds
Injuries
Self harm

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5
Q

Clinical signs of heroin OD

A 
Coma
Constricted pupils
Reduced resp rate
Reduced level of consciousness
Hypotension
Bradycardia
Delayed gastric emptying
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6
Q

Clinical signs of ecstasy OD

A 
Delirium
Tachycardia
Agitation
Dilated pupils
Hyperthermia
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7
Q

Organophosphate drug

Signs of OD

A

Malathion
Excessive cholinergic stimulation
Miosis, hypersalivation, vomiting, lacrymation, bradycardia

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8
Q

When are samples of ingested substance necessary?

A 
If poisoning is suggested to be from:
•	Ethylene glycol
•	Iron salts
•	Lithium salts
•	Methanol
•	Paracetamol
•	Salicylates (aspirin)
•	Theophyline
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9
Q

Aims of effective management of poisoning

A
  • Reduce absorption (activated charcoal if within 1 hr, whole bowel irrigation if drug smugglers)
  • Give an antidote
  • Increase elimination (multiple dose activated charcoal if drug undergoes enterohepatic circulation, urine alkylation for salicylates, dialysis)
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10
Q

What is activated charcoal ineffective for?

A

Alcohol + ionised drugs

  • Inorganic acids
  • Strong alkalis
  • Iron salts
  • Lithium salts
  • Methanol
  • Ethanol
  • Ethylene glycol
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11
Q

What is used in paracetamol poisoning?

A

Acetyl-cysteine

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12
Q

What is atropine used for?

A

Treatment of cholinergic excess (malathion poisoning)

To block PNS action of bradycardia (ß-blockers, digoxin)

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13
Q

What is used to treat iron poisoning

A

Desferrioxamine

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14
Q

How do you treat digoxin toxicity?

A

Using digoxin-specific antibdy fragments (Fab fragments)

Bind to digoxin, blocking uptake-> renal excretion

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15
Q

Use of fomepizole

A

Used to manage methanol and ethylene glycol poisoning

Blocks alcohol dehydrogenase, limiting toxic metabolites

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16
Q

Management of warfarin poisoning

A

Vitamin K (Phytomenadione)

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17
Q

What is used in ß-blocker toxicity

A

Glucagon

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18
Q

How much paracetamol can cause liver toxicity?

A

As little as 7g

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19
Q

When do you measure plasma-paracetamol level?

A

4-15hrs after ingestion

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20
Q

What factors are associated with a poor prognosis after paracetamol ingestion?

A

Prolonged prothrombin time
Raised creatinine
Low blood pH

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21
Q

When does maximal liver damage occur in an untreated paracetamol OD patient?

A

72-96hrs post ingestion

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22
Q

Pathophysiology of paracetamol liver damage

A

Metabolism pathways become oversaturated, build up of free radicals
Glutathione depletion
Free radicals cause liver damage

23
Q

When should acetyl-cysteine be administered?

A

Within 10hrs of ingestion
Only after plasma levels are known (treatment line) (unless late presenation or staggered OD
Course of 21hrs infusion

24
Q

Action of N-acetyl cysteine

A

Replenishes stores of glutathione

25
What happens if Acetylcyteine gives rash/bronchospasm
Pause infusion Give antihitamine and bronchodilator Restart infusion
26
Symptoms of iron overdose
``` N+V + diarrhoea Grey/black stools GI ulceration GI haemorrhage Haematemesis Rectal bleeding CV collapse ```
27
Management of iron OD
``` Admit if >20mg elemental iron/kg Gastric lavage/aspiration if<1hr post ingestion Take serum iron level Desferrioxamine ABGs, LFTs, Abdo Xray (radio opaque) ```
28
Management of opioid OD
Fluids | Naloxone infusion
29
Signs of salicylate poisoning
``` N+V Dehydration Deafness/tinnitus Sweating/vasodilation Hyperventilation Tachycardia Metabolic acidosis ```
30
How does aspirin cause metabolic acidosis?
Disrupts cellular metabolism by uncoupling oxidative phosphorylation-> metabolic acidosis. (respiratory compensation)
31
When does someone need to be admitted for aspirin OD?
>125mg/kg or symptoms
32
Management of salicylate OD (6 points)
1. Activated charcoal within 1 hr 2. IV fluids for hypotension and dehydration 3. Measure plasma salicylate level and repeat every 2-3hrs 4. Consider urine alkylisation if more than 500mg/kg bodyweight (Use sodium bicarbonate to maintain urine pH 7.5-8.5) 5. Monitor potassium 6. Consider haemodialysis is severe (eg coma, pulmonary oedema, severe acidaemia)
33
TCA OD dangers
TCAs can cause cardiotoxicity in overdose (esp Dosulepin) | -> Tachycardia, wide QRS, wide QT, RBB
34
Signs of TCA OD
``` Antichoinergic effects Drowsiness Blurred vision Dry mouth Hot dry skin Urinary retention Tachycardia & arrhythmias Convulsions, coma Hypokalaemia ```
35
Signs of SSRI OD
``` N+V Agitation Tachycardia Convulsions Serotonin syndrome ```
36
How do you treat serotonin syndrome
Cooling 5HT antagonists Benzodiazepines for convulsions
37
Signs of serotonin syndrome
``` Autonomic instability Coagulopathies Hyperthermia Neuropsychiatric effects Neuromuscular hyperactivity Renal failure Rhabdomyolysis ```
38
Amphetamines are used to treat:
Narcolepsy Nasal decongestant (pseudoephedrine) Obesity ADHD
39
Signs of amphetamine/cocaine OD
``` Agitation and rapid speech Convulsions Hallucinations Hyperthermia Cardiac arrhythmias Rhabdomyolysis Dilated pupils Hypertension & tachycardia Loss of desire to sleep or eat ```
40
Large amounts of cocaine can cause->
Vasoconstriction Aortic dissection Stroke Chronic use= myocardial fibrosis, cardiomyopathy, cerebral vasculitis, fetal death
41
Treatment of cardiac ischaemia after cocaine use
Nitrates Diazepam Aspirin
42
Which drugs could a tachycardia be caused by?
``` Salbutamol Antimuscarinics Tricyclics Quinine Phenothiazine ```
43
Which drugs cause respiratory depression?
Opiates | Benzodiazepines
44
Which drugs cause hypothermia
Phenothiazine | Barbiturates
45
Which drugs can cause hyperthermia?
Amphetamines, cocaine, quinine, tricyclics, serotonin agonists
46
Which drugs cause hypoglycaemia?
Insulin, oral hypoglycaemics, alcohol, salicylates, beta blockers
47
Which drugs cause hyperglycaemia?
Organophosphates Theophyllines MAOi
48
Which drugs can cause metabolic acidosis?
Alcohol, ethylene glycol, methanol, paracetamol, carbon monoxide
49
What Qs need to be asked in a psychiatric assessment after an overdose?
* Intentions at time: Planned? Precautions against being found? Seek help afterwards? Was method dangerous? Suicide note? * Present intentions: Still feel suicidal? Wish it had worked? * Problems leading to act: still issues? * Was the act aimed at someone? * Is there a psychiatric disorder? (depression, alcoholism, personality disorder, schizophrenia, dementia) * Resources: friends, family, work, coping mechanisms
50
Name 13 risk factors that increase the chance of a future suicide
* Original intention was to die * Present intention is to die * Presence of psychiatric disorder (eg depression, command hallucinations) * Alcoholism/drug abuse * Poor resources (socially isolated) * Previous suicide attempts/self harm * Unemployed * Homelessness * Chronic pain/disabling illness * Male * >50yrs old * Plan * Said goodbye to friends, made a will, wrote a suicide note, funeral plan
51
Name 8 protective factors against future suicide
* Strong networks of friends and family * Having a major long term goal * Having a pet * Having a future event to look forward to (child’s graduation, wedding, holiday) * Having a strong religious faith that does not sanction suicide and affirms life * Having a dependent * Being in a loving relationship * Using suicide and crisis hotlines/seeking support
52
Define self harm
Intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned • Different from suicide as there is no desire to die. • Usually 12-25yr olds • Indication of an underlying mental illness or emotional instability
53
Why do people self harm?
* Seen as a maladaptive coping mechanism * Physical pain easier to deal with than emotional distress * Sensation seeking/antidissociation (every thing else seems numb in depression) * Self punishment * To communicate distress to others (BPD) * Release anger/tension/emotional pain
54
Give 5 examples of self harm behaviour
* Cutting, scratching * Burning, scalding * Ingestion of toxic substances

Acute Care (11 decks)

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