Toxicology

Question 1

Drugs that can be haemodialysed

Answer 1

BLISTMED
Barbiturates, lithium, isoniazid, salicylates, theophylline, metformin/methanol, ethylene glycol, dabigatran

Question 2

Beta blocker poisoning presentation

Answer 2

Hypotension, sinus bradycardia, QRS prolongation, hypoglycaemia

Sotalol & propranolol most toxic

QT prolongation with sotalol
Seizures if with lipophilic BB (e.g. propranolol)

Question 3

Beta blocker poisoning management

Answer 3

Activated charcoal if within 2 hours of IR prepration/4 hours if XR preparation

Atropine

Adrenaline (1st line) or high dose insulin euglycaemia therapy/HIET (2nd line)

Question 3

Beta blocker poisoning management

Answer 3

Activated charcoal if within 2 hours of IR prepration/4 hours if XR preparation

Atropine

Adrenaline (1st line) or high dose insulin euglycaemia therapy/HIET (2nd line)

Question 4

Acute digoxin poisoning presentation

Answer 4

Effects mediated by blockade of Na/K/ATPase pump

Can take up to 6 hours (due to distribution time)
ECG changes: ST depression with characteristic ‘reverse tick’
Bradyarrhythmias
Non-specific findings - lethargy, confusion, GI upset
Hyperkalaemia (due to Na/K/ATP block)

Question 5

Acute digoxin poisoning management

Answer 5

Decontamination with activated charcoal if within 2 hours of ingestion

Digoxin immune Fab (DigiFab)
- In potentially lethal poisonings (cardiac arrest, arrhythmias, severe hyperkalaemia)

Atropine can be used for bradycardia with hypotension

Question 6

Anti-cholinergic syndrome presentation & treatment?

Answer 6

Delirium
Hyperthermia
Mydriasis
Dry skin and MM

Treatment: physostigmine (acetylocholinesterase inhibitor) - works peripherally & centrally

Neostigmine and pyridositgmine do not cross BBB