Toxicology

Question 1

What is used for the treatment of nerve gas/sarin poisoning?

Answer 1

Hint - Reactive Ach swimming

Pralidoxime reactivates the acetyl cholinesterase enzyme and should be used within the first few hours

Question 2

Name some of the complications of paracetamol overdoses? When are they usually seen?

Answer 2

Hint - Hb, temp, BM, pH, GCS, INR

Usually after 36 hours
Acute Haemolytic Anaemia
Hypothermia
Hypoglycaemia 
Metabolic Acidosis
Delirium
Acute Hepatic Failure

Question 3

What is the pathogenesis behind paracetamol overdose?

Answer 3

Hepatotoxicity is driven by oxidative metabolites combining with sulphahydryl of hepatocyte proteins causing centrilobular necrosis. The metabolites are usually scavenged by glutathione but in large ODs this process is overwhelmed

Question 4

When are tryptase levels checked post anaphylaxis and why?

Answer 4

Mast cell tryptase peaks at 1-2 hours post event so sampling should occur at

• after event
• 1-2 hours post
• one about 24 hours after