Substance misuse Flashcards
Toxidrome: Coma Dilated pupils Divergent squint Tachycardia Increased/Dec muscle tone Increased reflexes and extensor plantars
Tricyclic Overdose
Treatment for opioid overdose
IV naloxone 0.4 - 2mg
Repeat dose if no response in 2 minutes
Has a short half life so may require repeated doses
Observe for at least 6 hours from last dose of naloxone
Why is paracetamol overdose toxic?
Paracetamol is metabolised by P450
One metabolite produced is NAPQI - this is toxic
In an overdose there is not enough glutathione to metabolise the NAPQI
Toxic levels of NAPQI cause the overdose symptoms
What time frame do you give activated charcoal?
Less than 1 hour since digestion
Toxidrome:
Coma
Slow respiration
Pinpoint pupils
Opioid OD
Toxidrome:
Agitation
Tremor
Dilated pupils
Tachycardia
Amphetamine/Ecstacy OD
When do these symptoms occur in paracetamol overdose?
- RUQ pain
- Feeling worse
- N&V
- Sweat
24 - 72 hours
What occurs in first 24 hours of paracetamol OD?
N+V
Sweating
Abdominal pain
What happens between 3 and 5 days after paracetamol overdose?
Jaundice Confusion Bleeding - disturbed clotting factors Anuric Hypoglycaemia Hepatic encephalopathy Renal failure - loin pain, haematuria
How much paracetamol is potentially fatal?
12g
What increases toxicity of paracetamol overdose?
Induction of P450 agents P phenytoin C carbamazepine B barbiturates R rifampicin A chronic alcohol S sulphonylureas
When can parvolex be stopped?
INR < 1.3 and ALT < 2x upper limit of normal
What fluid do you give parvolex with?
Glucose
What website do you consult in overdose?
TOXBASE
What do you use to assess further risk?
SAD PERSONS
