Poisonings And Overdoses Flashcards
Acute water intoxication produces what
Everything is a poison
Dilution all hyponatraemia
Delirium and stupor ensured
Beer drinkers potomania
Most poisonings are supportive what can you add to ABCDE
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
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
Opiate intoxication
What thinks should you think about if you can’t work out
Mushrooms
What does an antidote do
Reverse effect of a poison
Antagonist
Some mitigate against toxicity
Antidote for opiate drugs
Naloxone
Antidote for benzos
Flumanezil
Dignoxin antidote
Digoxin specific antibody Digifab
Paracetamol antidote
Acetylcysreien
Most useful test in poisoning
ECG
BLOOD GAS FOR PH AND LACTATE - acidosis can define treatment threshold
EARLY WARNING score
What is activated charcoal
Very pourous carbon treated with oxygen - drug molecules get trapped if taken orally so patient will be not be exposed
Activated charcoal only used in how log. Since ingestion
1 hour of ingestion
When is multiple dose charcoal useful
Large enterhepatic circulation like carbamazepine
Slow release preps such as CCB - tablets have delayed absorption so Stay in bowel longer
What is polyethylene glycol
What metals might you give this whole bowel irrigation for
Causes diarrhoea to flush the GI system
Lithium and iron
Nasogastric polyethylene glycol used in lithium and iron and illicit drug trafficking but when not
Serious bowel pathology like ileus
Risk of aspiration
Severe nausea and vomitinghaemodynamic instability
Gastric lavage - volume of fluid into stomach then aspirate to remove
Not used anymore
Main risk of paracetamol overdose
Depletion of what
Liver failure Due to toxic metabolite and depletion of glutathione
Acetylcysteine is effective if given early
Makeees INR, UE AND ph
Paracetamol overdose what happens
Asymptomatic
Nausea and vomiting and abdo pain
24hr
RUG pain deranged liver tests and raised INR
LIVER FIAKURE AND AKI
In overdoses product NAPQI is produces as sulfate and glucuronide pathways are saturated when normally excreted
What normally prevents this
Glutathione
What does acetylcysteine/parvolex do
Maintains and replenishes glutathione
Allows sager metabolism of NAPQI
3 consecutive infusions at 1,4,16 hours
Side effects of NAC
rash and flushing
Bronchospasm
Usually stop if slower infusion
Antihistamines may help
Investigation for aprcatamol
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
