Tox Stuff Flashcards
Toxins that indicate dialysis
carbamazepine, lithium, potassium, metformin, salicylate, theophylline, valproate, toxic alcohols
Toxins eliminated by multidose AC
carbamazepine, dapsone, phenobarbitone, quinine, theophylline, amanita phalloides
Toxins eliminated by urinary alkalinisation
salicylates, phenobarbitone
Features of brown snake
VICC present, neuro rare, myotox not presentm ealry collapse/cardiac arrest
Tiger snake venom features
VICC present, neur rare, myotox rare
Death adder
VICC not present, neurotox common, myotox not present
Black snake venom
VICC not present, neurotox not present, myotoxicity common, common pain at bite site
Taipan
VICC present, neurotox common, myotox rare
Sea snake
VICC not present, neuro tox uncomon, myotox common
Sodium Channel Blockers
TCAs
Type 1a Antiarrhythmics Quinidie/Procainamide
Type 1c Antiarryhthmic flecainide, encainide
Local Anaesthetics: Bupivacaine/ropivacaine
Anti-Malarials: Quinine, hydroxychloroquine, chloroquine
Dextropropoxyphne
Propranolol
Carbamazepine
Indications for whole bowel irrigation
Lead, iron >60mg/kg, slow release potassium, arsenic, slow release calcium channel, body packing
Drugs causing QT prolongation
IA Anti-arrh: quinidine/procainamide
IC Anti-Arrh: Flecainide/Encainide
III Anti-Arrhy: Sotalol/Amiodarone
Anti Psychotics: Quetiapine, Haloperidol, amisulpride, chlorpromazine
TCAs: Amitryptiline, imipramine, doxepin
Miscellaneous Anti-Deps: Mianserin, citalopram, venlafaxine, moclobemide
Anti-Histamiines: Loratadine, Terfenadine, Diphenhydramine
Anti Malarials: Chlorogquine, hydroxychloroquine, quinine
Antibiotics: Eryhtromycin/Clarithromycin
Indications for AC in paracetamol OD
IR Paracetamol: Give if presents within 2hours and 200mg/kg or 10g
or 30g in a 4 hour period
SR Paracetamol: >10g or >200mg/kg within 4 hours
Expected blood abnormalities in VICC
INR> 3 or unrecordable, APTT markedly abnormal, Fibrinogen undetectable, D0Dimer markedly elevated 100x-1000x
Features of neuroleptic syndrome
CNS Dysfunction: Confusion, delirium, stupor, coma
Autonomic Instability: Hypertension, tachycardia, hyperthermia, respiratory irregulaities, arrhythmias
Neuromuscular: Lead pike rigidity, akinesia/bradykinesia, mutism/staring, dysarthria, dystonia, abnormal posture, involuntary movements, incontinence
Features of serotonin syndrome
Mental Status Changes: Apprehension, anxiety, agitation, psychomotor acceleration, confusion, delirium
Autonomic Stimulation: diarrhea, flushing, hypertension, hyperthermia, mydriasis, sweating, tachycardia
Neuromuscular Excitation: Clonus, hyperreflexia, increased tone, myoclonus, rigidity, tremor
Risk factors for neuroleptic malignant syndrome
high dose neuroleptic young male dose increase in last 5 days presence of organic brain disorder parenteral haloperidol/depot fluphenazine
Treatment options for neuroleptic malignant syndrome
bromocriptine - antidote
dantrolene - muscle relaxant
ECT - if refractory
Benzos - for agitation
Features of quetiapine OD by dose
Less than 3g: mild to moderate sedation, sinus tachycardia
More than 3g: CNS depression, coma, hypotension, seizures, delirium
Serotonin syndrome algorithm
Serotenergic Agent
Spontaneous Clonus = Serotonin syndrome
Inducible Clonus + (agitation or diaphoresis or hypertonia and pyrexia) = Serontonin syndrome
Tremor + Hyper-reflexia = Serotonin syndrome
Else not serotonin syndrome
Phases of paracetamol toxicity
Phase 1 (1st 24 hrs): Assymtpomatic. May have nausea/vomting. AST and ALT start to rise. Paracetamol levels elevated
Phase 2 (1-3 days): RUQ tenderness,. ALT/AST peak at 2-3 days 15000 to 20000. PT/INR elevated. Renail impairment and increased bilirubin
Phase 3 )3-4 days) : Fulminant liver failure with coagulopathy, jaundice, encephalopathy, multi organ failure.
Predictors of death: Elevated lactate despite resus, creatinin3 >300, worsening coagulopathy PT >100s and encepalopathy
Phase 4: Recovery of hepatic structure and function
Venlafaxine and seizure
<1.5g = 5% risk of seizure <3g = 10% risk of seizures 3-4.5g = 30% seizures >4.5g = 100% risk of seizures. Expect hypotension, QRS and QT prolongation >7g = severe hypotension and LV dysfunction
Enhanced Elimination drugs and methods
MultiDoseAC: Carbamazepine, theophylline, phenobarbitone, quinine, dapson, amanita mushroom
Urine Alkalisation: Salicylates, Phenobarbitone
Haemodialysis: Toxic alcohols, salicylate, theophylline, valproic acid, carbamazepine, metformin, potassium, lithium
NAC Dosing in Paracetamol Toxicity
200mg/kg first 4 hours
100mg/kg over 16 hours
Toxins where AC is not useful
Pesticides Hydrocarbons Acids/Alkalis Iron Lithium Solvents Toxic Alcohols
