Poisoning part 2 Flashcards
Which poisons may have delayed action
Aspirin
Iron
Paracetamol
TCAs
Co-phenotrope
What is the time frame for activated charcoal and when may it be given repeatedly
Within 1 hour of ingestion
Consider repeating if:
Carbamazepine
Dapsone
Phenobarbital
Quinine
Theophylline
When is activated charcoal contraindicated
Petroleum
Corrosive substances
Alcohols
Malathion
Cyanides
Metal salts e.g. iron, lithium
When might haemodialysis be indicated
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline
Valproate
Ethylene glycol
When is alkalisation of urine indicated
Salicylate poisoning
Features and management of acute alcohol intoxication
Ataxia
Dysarthria
Nystagmus
Drowsiness
→ coma hypotension, acidosis
Supportive:
Maintain clear airway
Reduce risk of aspiration
Measure glucose and correct
Features and management for aspirin poisoning
Hyperventilation
Tinnitus & deafness
Vasodilation
Sweating
Measure plasma salicylate, pH and electrolytes
within 1 hour → activated charcoal
IV sodium bicarbonate (alkalinisation of urine → enhance urinary excretion)
* must correct plasma potassium before
Haemodialysis (severe metabolic acidosis or high concentration)
Features of opioid poisoning and management
Coma
Respiratory depression
Pinpoint pupils
Naloxone hydrochloride (+ close monitoring and repeated injections)
Features and management for paracetamol poisoning
Toxicity occurs with levels >75mg/kg
Nausea and vomiting
Hepatocellular necrosis
Renal tubular necrosis
2-3 days after → N&V + R subcostal pain (hepatic necrosis)
Calculate the total dose ingested (If body weight >110 → use 110kg)
<1 hour → activated charcoal
Use paracetamol treatment graph
N-acetylcysteine up to 24h (most effective within 8 hours)
- Consider >24h if tests suggest acute liver injury
Features and management for TCA poisoning
Dry mouth, blurred vision (Dialted pupils), urinary retention
Hypotension
Hypothermia
Hyperreflexia
Upgoing plantars
Convulsions
Respiratory failure
Arrhythmia
Metabolic acidosis
Supportive:
Clear airway
<1 hour → activated charcoal
Convulsion → IV lorazepam
Arrhythmia → IV sodium bicarb
Features of SSRI poisoning and management
N&V
Agitation
Tremor
Nystagmus
Drowsiness
Sinus tachycardia
Convulsions
Supportive:
<1 hour → activated charcoal
Convulsion → IV lorazepam
What is serotonin syndrome and what are the complications
Excessive serotonin in the synapses of the brain
From using antidepressants: side effect, in combination, overdose
Complications: DIC | rhabdomyolysis | renal failure/metabolic acidosis | seizures
What are the symptoms of serotonin syndrome
Altered mental state: agitation, confusion coma
Neuromuscular changes: myoclonus, hyperreflexia, hypertonia, tremor
Autonomic dysfunction: tachycardia, HTN, hyperthermia, diaphoresis, mydriasis (dilated pupil)
What is the management for serotonin syndrome
- Admit to hospital
- Stop offending medications
- Supportive measures (ABCDE) - airway management, renal care, IV fluids, temperature control
- Cyproheptadine (antihistamine + serotonin antagonist)
Features of phenothiazine poisoning
Hypotension
Hypothermia
Sinus tachycardia + arrhythmias
Dystonic reaction
Convulsions
Management of antipsychotic poisoning
Supportive
<1 hour → activated charcoal
Features and management for benzodiazepine poisoning
Drowsiness
Ataxia
Dysarthria
Nystagmus
Respiratory depression
<1 hour → charcoal
CONSIDER flumazenil
Features and management for beta blocker poisoning
Bradycardia
Hypotension
Syncope
Heart failure
CNS: drowsiness, confusion, convulsions, hallucinations
Respiratory depression
Bronchospasm
Supportive
<1 hour → activated charcoal
Hypotension → IV fluids, vasopressors/inotropes
Consider IV glucagon for hypotension (Esp if acidotic)
Acidosis → sodium bicarbonate
Bradycaria → atropine, dobutamine
Bronchospasm → nebs
Features and management for calcium channel blocker poisoning
Nausea & vomiting
Dizziness
Agitation
Confusion
Coma
Metabolic acidosis
Hyperglycaemia
<1 hour → activated charcoal
Calcium chloride/gluconate IM
Bradycardia → atropine
Features and management for iron salts poisoning
Nausea and vomiting
Abdominal pain
Diarrhoea
Haematemesis
Rectal bleeding
Hypotension + hepatocellular necrosis
Metabolic acidosis
Iron chelation with desferrioxamine mesilate
Measure serum-rion concentration
Features and management of lithium poisoning
may be triggered by dehydration, NSAIDS, ACEi, diuretics, celecoxib use
Coarse tremor (fine in therapeutic levels)
Hyperreflexia
Nystagmus
CNS: ataxia, confusion, seizures
GI: N&V, renal failure
Polyuria, polydipsia
Haemodialysis
Features of amphetamine posioning and management
Wakefulness
Excessive activity
Paranoia
Hallucinations
Hypertension
THEN exhaustion, convulsions, hyperthermia, coma
Early → diazepam/lorazepam
Late → tepid sponging, anticonvulsants, artificial respiration
Features of cocaine poisoning and management
Agitation
Tachycardia
Hypertension
Hyperthermia
Dilated pupils
Hallucinations
Hypertonia and hyperreflexia
Chest pain, arrhythmia
Diazepam
Features and management of ecstasy posioning
Delirium, Coma, Convulsions
Ventricular arrhythmias
Hyperthermia, hypotension
Rhabdomyolysis
Acute renal failure
Hyponatraemia
Acute hepatitis
DIC
ARDS
Hyperreflexia, intracerebral haemorrhage
Supportive
Convulsions/agitation → Diazepam
Features and management of theophylline poisoning
Agitation, restlessness
Dilated pupils
Tachycardia, arrhythmias
Hyperglycaemia
Haematemesis
Hypokalaemia
Repeated activated charcoal
Vomiting → ondansetron
Hypokalaemia → potassium chloride
Convulsions → diazepam
Temporarily: beta blocker (helps with tachycardia, hypoK, hyperglycaemia)
Management for cyanide poisoning
High flow oxygen
Antidote: Dicobalt edetate
Suspected significant poisoning → hydroxycobalamin
Management for ethylene glycol and methanol poisoning
Fomepizole
Alt: ethanol
Management for heavy metal poisoning
Antidotes: DMSA, unithiol, sodium calcium edetate, dimercaprol
Management for carbon monoxide poisoning
High flow oxygen ± artificial respiration
Cerebral oedema → mannitol IV
Consider hyperbaric oxygen treatment
Features and management for organophosphorus insecticides
Anxiety, restlessness
Dizziness, headache
miosis
Nausea, vomiting, abdo pain, diarrhoea
Hypersalivation
bradycardia
Muscle weakness → flaccid paralysis
Atropine sulfate ± pralidoxime chloride
