Poisons and poisoning

Question 1

What are the two types of poisoning?

Answer 1

Acute overdose

Chronic exposure

Question 2

What are the five things used to diagnose poisoning?

Answer 2

History, pupils, skin, odour and clinical chemistry

Question 3

Why is a patient history both helpful and unhelpful?

Answer 3

Patients rarely lie about poisoning but they can be unreliable (sedation and amnesic drug effects)

Question 4

What can pupils tell you about poisoning?

Answer 4

Constricted= opiates, clondine or anti-cholinesterases
Dilated=  atropine, tricyclic antidespressants, MDMA

Question 5

What can the skin tell you about poisoning?

Answer 5

Sweating increased= amphetamine
Sweating decreased= atropine
Bulla= carbon monoxide

Question 6

Which poisons can be identified by smell?

Answer 6

Ethanol
Garlic smell= arsenic or organophosphates
Almonds= cyanide

Question 7

Give three poisons that can be tested for in the blood

Answer 7

Paracetamol
Digoxin
Theophylline

Question 8

Give three poisons that can be tested for in the urine

Answer 8

Salicylate
Opioids
Tricylics

Question 9

How is poisoning treated?

Answer 9

Airway
Breathing
Circulation

Question 10

How can absorption of the poison by decreased?

Answer 10

Emesis
Gastric lavage
Activated charcoal (50g every 4 hours)

Question 11

How can elimination of the poison by increased?

Answer 11

Activated charcoal
Haemoperfusion
Haemodialysis
Diuresis

Question 12

What are some specific antidotes for certain poisons?

Answer 12

N-acetyl-cysteine: paracetamol
Naloxone: morphine
Flumazenil: benzodiazepines
Ethanol: methanol