Signs & Symptoms

Question 1

Amphetamine / MDMA toxicity

Answer 1

Sympathomimetic toxidrome
- Tachycardia, labile BP and arrhythmias
- hyperreflexia, myoclonus and miss Russia
- agitation and paranoia
- hyperthermia, diaphoresis and rhabdomyolysis

Specific Treatment
- benzos and beta blockers

Question 2

Anticholiergic toxidrome

Answer 2

• Tachycardia and arrhythmia
• myoclonus, seizures and mydriasis
• delirium
• urinary retention
• hyperthermia, flushed dry skin

Question 3

Aspirin OD

Answer 3

Biphasic symptoms

1) hyperventilation (central resp stimulant), tinnitus and vasodilation

2) raised anion gap metabolic acidosis, non cardiogenic pulmonary oedema, low GCS

Treatment:
- Bicarbonate
- RRT if level >700

Question 4

Beta blocker OD

Answer 4

Bradyarrhythmias
High grade AV block
Hypotension

Low GCS, delirium seizures

Hypoglycaemia

Sotolol can cause VT

Question 5

Calcium channel blocker OD

Answer 5

Bradyarrhythmia
High grade AV block
Refractory Hypotension
Cardiac arrest

Low GCS, seizures

Hyperglycaemia

Treatment
- atropine/isoprenaline
- pacing may be necessary
- calcium replacement
- high dose euglycaemic insulin therapy
- intralipid

Question 6

Digoxin toxicity

Answer 6

Any type of arrhythmia or conduction abnormality
- reverse upstroke of ECG

Nausea, vomiting, yellow vision

Treatment
- correct K and Mg
- treat arrhythmias (amioderone)
- digibind

Question 7

Ethylene glycol (antifreeze)

Answer 7

Hyperthermia
Hypoglycaemia
High anion gap metabolic acidosis

GCS depression with hypoventilation

Toxicity due to hepatic metabolites

Treatment
- supportive
- ethanol is competitive for metabolic pathway
- haemodialysis if severe

Question 8

Lithium OD

Answer 8

Very narrow therapeutic window

Low GCS and seizures

Polyuria, polydipsia (nephrogenic DI)
Vomiting diarrhoea
Tremor

Treatment
- supportive
- RRT if levels >2

Question 9

Methanol toxicity

Answer 9

Nausea vomiting, abdo pain and GI bleeding

Visual disturbance

HAGMA

Toxicity due to hepatic metabolites

Treatment
- supportive
- ethanol competition
- RRT if severe, AKI, Visual /cognitive impaired

Question 10

Organophosphate poisoning

Answer 10

Cholinergic toxidrome, rapid onset

SLUDGE
- Salivation
- Lacrimation
- Urination
- Diarrhoea
- GI pain
- Emesis

TREATMENT
- strict isolation (lipid soluble for skin contact)
- atropine to treat bradycardia and bronchorrhoea
- pralidoxime only effective if <24hrs from exposure
- supportive with IV fluids ++

Question 11

SSRI overdose

Answer 11

Tachycardia and low GCS with tremor

Biggest risk is developing serotonin syndrome

Can be treated supportively if simple OD
- Discharge if asymptomatic 3 hours post OD

Question 12

Contraindications to LP (NICE)

Answer 12

• Signs suggesting raised intracranial pressure, or reduced or fluctuating level of consciousness
• Relative bradycardia and hypertension
• Focal neurological signs
• Abnormal posture or posturing
• Unequal, dilated or poorly responsive pupils
• Papilloedema
• Abnormal ‘doll’s eye’ movements
• Shock
• Extensive or spreading purpura
• After convulsions until stabilised
• Coagulation abnormalities, or coagulation results outside the normal range, or platelets below 100 x 10° L-1 or receiving anticoagulant therapy
• Local superficial infection at the lumbar puncture site
• Compromised respiratory function

Question 13

Fat embolism syndrome

Answer 13

Respiratory distress
- hypoxia & tachycardia, possible ARDS

Neurological signs
- confusion and agitation
- coma

Petechial rash in 50-60% of cases
- upper body, chest and neck