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Acute Care + Anaesthetics > Poisons > Flashcards

Poisons Flashcards

1
Q

What needs to be asked when taking a history for poisoning?

A

Intentional or accidental?
What has been consumed?
How long ago?
How much?

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2
Q

What are the general principles of management of poisoning?

A

ABCDE
Reduce absorption –> decontamination
Alter metabolism –> antidotes
Increase elimination –> kidneys

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3
Q

Which investigations can be done for poisoning?

A

Test blood level of substance (only a few)
Associated pathology –> renal failure, rhabdomyolysis, hyperkalaemia
ABGs –> acid/base derangement, ventilatory failure
ECG

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4
Q

Which substances can be tested for in the blood to confirm toxicity/guide therapy?

A

Paracetamol
Salicylates
Ethylene glycol
Lithium

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5
Q

Why in an ECG useful and which important abnormality must be checked for?

A

May demonstrate signs of cardio toxicity and will guide management
–> QTc (increase risk of malignant arrhythmia)

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6
Q

Which methods of gut decontamination can be used for certain toxins?

A

Activated charcoal
Bowel irrigation
(forced emesis not recommended)

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7
Q

Where should you look for management of specific toxins?

A

Toxbase

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8
Q

What is the antidote for paracetamol?

A

N-acetylcysteine

Methionine

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9
Q

What is the antidote for tricyclic antidepressants?

A

Sodium bicarbonate

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10
Q

What is the antidote for beta blockers?

A

Glucagon

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11
Q

What is the antidote for ethylene glycol + methanol?

A

Ethanol

Fomepizole

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12
Q

What is ethylene glycol?

A

Antifreeze

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13
Q

What are the antidotes for cyanide?

A

Hydroxycobalamin
Sodium nitrate
Sodium thiosulphate

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14
Q

What is the antidote for iron salts?

A

Desferrioxamine

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15
Q

What is the antidote for opioids?

A

Naloxone

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16
Q

What are the antidotes for organophosphates?

A

Atropine

Pralidoxime mesylate

17
Q

What are the methods of increasing elimination to treat poisoning?

A

Urinary alkalinisation
Haemodialysis
Haemofiltration

18
Q

Give an example of using urinary alkalinisation to treat poisoning

A

Treat aspirin overdose with sodium bicarbonate –> increases elimination via kidneys

19
Q

Give some examples of poisonings that can be treated with haemodialysis

A

Alcohols e.g. methanol
Lithium
Aspirin

20
Q

Which poisonings can be treated with haemofiltration?

A

Theophyllines

Carbamazepine

21
Q

How much paracetamol ingestion warrants referral to hospital for assessment?

A

> 75mg/kg

22
Q

How is paracetamol metabolised in therapeutic doses?

A

Mostly converted to non-toxic metabolites
But 5% converted to highly reactive intermediary metabolite –> NAPQI
NAPQI is detoxified by conjugation with glutathione in the liver

23
Q

What happens to paracetamol metabolism in paracetamol overdose?

A

Excess paracetamol –> more NAPQI
Hepatocellular supplies of glutathione become depleted + NAPQI remains in toxic form
–> widespread hepatocyte damage + death –> acute liver necrosis

24
Q

What are the initial features of paracetamol poisoning?

A

Nausea and vomiting –> extremely common

Very rarely –> coma + severe metabolic acidosis (extremely high plasma paracetamol)

25
Q

What are the later features of paracetamol poisoning?

A

In severe cases:

  • abdominal pain (12-36 hours)
  • hepatic necrosis after 2-3 days: RUQ pain + tenderness, N&V, jaundice, AKI, hepatic encephalopathy
26
Q

What are the indications for starting treatment for paracetamol poisoning?

A

Blood paracetamol levels checked at 4 hours + plotted on graph
–> commence treatment if level is above line

27
Q

How quickly should treatment for paracetamol poisoning be started and what should be done if the patient presents late?

A

Should commence within 8 hours of ingestion

If presentation delayed (>8 hours) start treatment and await blood results

28
Q

Which blood tests should be done following treatment for paracetamol overdose?

A

LFTs
U&Es
INR

29
Q

Which blood test is the most accurate indictor of synthetic liver function following paracetamol overdose?

A

INR

30
Q

How should the blood tests following paracetamol overdose treatment be interpreted?

A

If bloods normal –> treatment can be stopped

If bloods deranged –> N-acetyl cysteine treatment must be continued

31
Q

What is the antidote for benzodiazepines?

A

Flumazenil

Acute Care + Anaesthetics (9 decks)

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