Poisonings And Overdoses

Question 1

Acute water intoxication produces what

Everything is a poison

Answer 1

Dilution all hyponatraemia
Delirium and stupor ensured
Beer drinkers potomania

Question 2

Most poisonings are supportive what can you add to ABCDE

Answer 2

FG

DONT EVER FORGET GLUCOSE

Stop it getting in eg activated charcoal or whole bowel irrigation
Mitigate effects - ABCDEFG inotropes, antidotes and specific risk factors
Help it her out - haemodialysis and certain antidotes

Question 3

Example if sedated patient could be drugs such as alcohol, benzos, antidepressants, analgesics, anticonvulsants , CNS disease such as mining it is or sepsis

Then add that it’s a male and have resp depression and miosis so what is this

Answer 3

Opiate intoxication

Question 4

What thinks should you think about if you can’t work out

Answer 4

Mushrooms

Question 5

What does an antidote do

Answer 5

Reverse effect of a poison
Antagonist

Some mitigate against toxicity

Question 6

Antidote for opiate drugs

Answer 6

Naloxone

Question 7

Antidote for benzos

Answer 7

Flumanezil

Question 8

Dignoxin antidote

Answer 8

Digoxin specific antibody Digifab

Question 9

Paracetamol antidote

Answer 9

Acetylcysreien

Question 10

Most useful test in poisoning

Answer 10

ECG
BLOOD GAS FOR PH AND LACTATE - acidosis can define treatment threshold
EARLY WARNING score

Question 11

What is activated charcoal

Answer 11

Very pourous carbon treated with oxygen - drug molecules get trapped if taken orally so patient will be not be exposed

Question 12

Activated charcoal only used in how log. Since ingestion

Answer 12

1 hour of ingestion

Question 13

When is multiple dose charcoal useful

Answer 13

Large enterhepatic circulation like carbamazepine
Slow release preps such as CCB - tablets have delayed absorption so Stay in bowel longer

Question 14

What is polyethylene glycol

What metals might you give this whole bowel irrigation for

Answer 14

Causes diarrhoea to flush the GI system

Lithium and iron

Question 15

Nasogastric polyethylene glycol used in lithium and iron and illicit drug trafficking but when not

Answer 15

Serious bowel pathology like ileus
Risk of aspiration
Severe nausea and vomitinghaemodynamic instability

Question 16

Gastric lavage - volume of fluid into stomach then aspirate to remove

Answer 16

Not used anymore

Question 17

Main risk of paracetamol overdose

Depletion of what

Answer 17

Liver failure Due to toxic metabolite and depletion of glutathione
Acetylcysteine is effective if given early

Makeees INR, UE AND ph

Question 18

Paracetamol overdose what happens

Answer 18

Asymptomatic
Nausea and vomiting and abdo pain
24hr
RUG pain deranged liver tests and raised INR
LIVER FIAKURE AND AKI

Question 19

In overdoses product NAPQI is produces as sulfate and glucuronide pathways are saturated when normally excreted

What normally prevents this

Answer 19

Glutathione

Question 20

What does acetylcysteine/parvolex do

Answer 20

Maintains and replenishes glutathione
Allows sager metabolism of NAPQI
3 consecutive infusions at 1,4,16 hours

Question 21

Side effects of NAC

Answer 21

rash and flushing
Bronchospasm
Usually stop if slower infusion
Antihistamines may help

Question 22

Investigation for aprcatamol

Answer 22

INR LFTS and UE

take paracetamol levels at 4 hours post ingestion or a present if later
Don’t take levels before this as inaccurate