The patient with deliberate self-harm

Question 1

What drug is given to reverse the effects of opiates?

Answer 1

Naloxone

Question 2

What features would you expect on an ECG of a TCA overdose patient?

Answer 2

Sinus tachycardia, prolonged PR intervals and QRS duration.

If severe, ventricular arrhythmias and bradycardia (pre-terminal event)

Question 3

How is TCA overdose managed?

Answer 3

If OD within last hour, activated charcoal to absorb drug from GI tract.
Sodium bicarbonate. iv lorazepam or diazepam if seizures are frequent/prolonged. iv Glucagon for severe hypotension

Question 4

How long after ingestion should paracetamol levels be monitored following a paracetamol OD?

Answer 4

4 hours

Question 5

What blood level of paracetamol indicates potentially severe liver damage?

Answer 5

> 150mg/kg

Question 6

Concurrent use of which drugs may increase toxicity in paracetamol OD?

Answer 6

CyP450 inducers - PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic use)
Sulfonylureas

Question 7

What regimen of Parvolex (N-acetyl Cysteine) should be given if a patient’s paracetamol level is above the treatment threshold line on the Paracetamol treatment graph?

Answer 7

3 consecutive NAC doses over 24 hours.
150mg/kg in 200ml 5% glucose over 15 mins.
50mg/kg in 500ml 5% glucose over 4 hours
100mg/kg in 1L 5% glucose over 16 hours

Question 8

When can NAC/Parvolex treatment for a paracetamol OD be stopped?

Answer 8

Once INR =< 1.3
AND
ALT < 2x the upper limit of normal