Toxicology

Question 1

What does ABCDE stand for?

Answer 1

Airways. Breathing. Circulation. Disability. Exposure.

Question 2

State 3 things to check out for with airways.

Answer 2

1) Is the airway protected? 2) What’s the GCS? 3) Are there any clues for poison - smell (alcohol), colour, tablet residue, burns.

Question 3

State 2 things to look for in breathing.

Answer 3

1) Are they breathing? 2) The rate - opiates 3) Pattern - Kussmaul’s sign (deep laboured breathing pattern) 4) Added sounds - Paraquat (plant killer) lead to lung damage

Question 4

State 2 things to look out for in circulation.

Answer 4

1) Pulse 2) BP 3) IV access 4) Pacemaker 5) Intravenous drug abuser

Question 5

State 2 things to look out for in disability.

Answer 5

1) Small pupils - opiates, organophosphates, cholinergics 2) Large pupils - alcohol, anti-cholinergics, amphetamines, beta-blockers

Question 6

When is activated charcoal used?

Answer 6

To treat drug overdose/poisoning - GI decontamination.

Question 7

How does activated charcoal work?

Answer 7

By trapping chemicals and preventing their absorption.

Question 8

When can’t activated charcoal be used?

Answer 8

When KLEN-PREP is used (this is a bowel cleansing agent which flushes everything out the intestines).

Question 9

State 3 common drugs.

Answer 9

Paracetamol. Opiates. Tricyclic depressants. Salicylates. Cocaine.

Question 10

State a risk of paracetamol.

Answer 10

Severe liver damage (ALT > 1000 iu/litre) - 6g fatal.

Question 11

State 2 features of a paracetamol overdose.

Answer 11

Loin pain. Haematuria. Proteinuria. Nausea/vomiting.

Question 12

State a treatment of a paracetamol overdose.

Answer 12

If within 4 hours - Activated charcoal and Measure the INR (clotting time), U&E, liver function test e.g. ALT.

If less than 8 hours - start IV acetylcysteine.

Question 13

Give an example of an opiate.

Answer 13

Heroin. Methadone.

Question 14

State a symptom of a paracetamol beyond 2-3 days.

Answer 14

Hepatic necrosis. Right subcostal pain. Coma. Severe metabolic acidosis.

Question 15

State a feature of an opiate overdose.

Answer 15

Drowsy/unconscious patient. Dysfunctional breathing and respiratory rate.

Question 16

State a treatment of an opiate overdose.

Answer 16

Intravenous naloxone.

Question 17

State a treatment of an opiate overdose.

Answer 17

Naloxone (intravenously) if respiratory depression - competitive antagonist.

Question 18

Give another name for tricyclics.

Answer 18

Antidepressants e.g. amititripyline, amoxapine.

Question 19

State a peripheral effect of a tricyclic overdose.

Answer 19

Sinus tachycardia. Hot dry skin. Dry mouth. Urinary retention. Hypothermia.

Question 20

State a central effect of a tricyclic overdose.

Answer 20

Dilated pupils. Ataxia (group of disorders that affect balance). Nystagmus (eyes make repetitive uncontrolled movements). Coma. Seizure. Respiratory depression.

Question 21

State a feature of a tricyclic overdose on an ECG.

Answer 21

Prolonged PR and QRS interval. Increased QT. Ventricular dysrhythmias.

Question 22

State the management of a tricyclic overdose.

Answer 22

1) Flumazenil (treat effects of a benzodiazepine overdose)
2) Check airway and maintain ventilation (NaHCO3 if acidotic)
3) Consider naloxone to reverse respiratory stress

Question 23

State a management of dysrhythmias.

Answer 23

Correct hypoxia/acidosis (aim for pH of 7.45-7.50). Na loading. ECG monitoring is required (QRS interval guide to cardiac toxicity).

Question 24

State a feature of an aspirin overdose.

Answer 24

Hyperventilation. Sweating. Tremor. Nausea/vomiting.

Question 25

State a metabolic feature of an aspiring overdose.

Answer 25

Hypo/hyper-glycaemia. Hypokalaemia. Respiratory alkalosis. Metabolic acidosis.

Question 26

State a management of an aspirin overdose.

Answer 26

ABCDE. Salicylate (paracetamol) level at 4hrs (> 700 lethal).

Question 27

State a treatment for an aspirin overdose.

Answer 27

Rehydrate. Monitor glucose. Correct acidosis. K+ levels.

Question 28

State a treatment for an aspirin overdose if levels >500mg/L.

Answer 28

Alkalize urine - increase poison elimination by administering intravenous NaHCO3.

Question 29

State a treatment for an aspirin overdose if levels >700mg/L.

Answer 29

Consider haemodialysis - way of replacing some of the functions of the kidney (may lead to renal failure/pulmonary oedema).

Question 30

State an effect of cocaine on the ECG.

Answer 30

QRS widening. QT prolongation.

Question 31

State a clinical feature of a cocaine overdose.

Answer 31

Feeling of euphoria followed by irritability. Hyperadrenergic state (agitation, anxiety, dilated pupils, hyperthermia, cardiac arrhythmias).

Question 32

State a treatment for a cocaine overdose.

Answer 32

ABCDE. Benzodiazepine - for agitation. Alpha/beta-blocker e.g. labetolol for hypertension/myocardial toxicity. Malignant hypertension e.g. nitroprusside. For MI e.g. GTN (vasodilator), benzodiazepine.

Question 33

State an agent that results in hypoglycaemia in overdose.

Answer 33

Insulin. Sulphonylureas.

Question 34

State symptoms of insulin and sulphonylureas.

Answer 34

Agitation. Sweating. Confusion. Hypotension. Drowsiness. Coma.

Question 35

State a treatment of insulin/sulphonylureas overdose.

Answer 35

Prolonged infusions of hypertonic dextrose (may increase insulin production). Octreotide to inhibit release of insulin from pancreas.