Toxicology Flashcards
Broadly speaking what are the types of management for toxicity?
Decreased Absorption
- gastric lavage
- activated charcoal
- whole bowel irragation
Increased Elimination
- Urine Alkalinisation
- Haemodialysis
Reducing the rate of metabolite breakdown
Creating chemical complexes to bind with
Outwith medical management, what other assessment should be done into someone presenting with an overdose?
Psychiatric assessment
In paracetamol overdose - what important investigations should be done and how is it treated?
LFTS Coagulation studies U&Es Paracetamol levels ABG - Acidosis can occur
- Activated Charcoal within 1 hour
- Acetylcysteine
- supportive care
- Antiemetics
What are some of the clinical sign seen with Aspirin overdose?
Hyperventilation
Bounding pulse
Peripheral vasodilation
Severe:
Pyrexia
Cerebral oedema
Bleeding - hypoprothrombinemia
How is Aspirin overdose treated?
Activated charcoal
- gastric lavage within 1 hour
Rehydration
Sodium Bicarbonate
Haemodialysis
What are some signs and symptoms of TCA overdose?
Convulsions
Mydriasis
- dilated pupils
- dry mouth
Arrhythmias
Urinary retention
Upper reacting planters
How is TCA overdose managed?
Supportive
Ventilatory
Anti-arrhythmic
Convulsion management
Which drug is used to treat Benzodiazepines?
Flumazenil
What is the definitive Carbon Monoxide poisoning test?
Carboxyhemoglobin Level
What are the typical symptoms of digoxin toxicity?
Bradyarrhythmias
- AV block
Yellow/ greenish vision
Ventricular Bigeminy
How is digoxin toxicity treated?
Digibind
Arrhythmia management
Monitor K+
What are the initial symptoms of opioid overdose?
Confusion Myoclonus Vivid dreams Hallucination Hypothermia Constipation
What are the signs and symptoms of severe Opioid toxicity?
Bradypnoea
Pinpoint pupils - Miosis
Altered GCS
How should sever opioid overdose be treated?
Naloxone
Oxygen therapy
**remember to ventilate the patient
*patient should be observed up to 6 hours after last naloxone
How is Beta blocker overdose treated?
Atropine
Fluids
Glucagon
How is ethylene glycol managed?
Fomepizole
- 1st line
Alcohol
- 2nd line
How is Carbamoxide poisoning treated?
100% oxygen
Hyperbaric chamber
How is warfarin overdose managed?
Vitamin K
Prothrombin complexes
What drug is given to reverse Heparin?
Protamine
At what levels should warfarin intervention be at?
INR 5-8 = Vitamin K
INR >8 , no bleeding = Vitamin K high dose orally
INR >8, Bleeding = IV Vitamin K
INR >8, large bleeding = IV Vitamin K, Prothrombin Complex concentrate or FFP if needed
What criteria is used to assess the need for specialist help in paracetamol poisoning regarding liver functioning?
Kings college hospital criteria in acute liver failure - pH <7.3 Or - PT >100s - Creatinine Encephalopathy >3
if these then liver transplant should be considered.
How is Beta blocker overdose managed?
Atropine
if this fails then:
- Glucagon + 5% glucose
consider
- transcutaneous pacing
What is the symptoms of anticholinesterase - nerve agents? and how are they treated?
SLUDGE
- salivation
- lacrimation
- urination
- Defecation
- G.I upset
- emesis
Atropine
What is the King’s college criteria for paracetamol overdose?
<7.3 pH
INR> 100
Renal failure
Encephalopathy
What do you want to know when someone comes in with overdose?
What have they taken? washed down with?
When was it taken?
How much?
How is the diagnosis of serotonin syndrome made?
Using the:
- Hunter Serotonin Toxicity Criteria
What is the main symptom in Anti-histamine overdose?
Hallucination
Monitor them closely.
- supportive treatment.
Benzodiazepines
What are the presenting symptoms of SSRI toxicity and how is it treated?
Serotonin syndrome
Hyperthermia
Hypertension
Agitation
Diarrhea
Treatment:
- IV magnesium (high risk of Detorde de pointes)
- Cooling
- Benzodiazepines
What criteria is used to assess for serotonin syndrome?
Hunter serotonin syndrome criteria
How is cyanide poisoning treated?
Sodium nitrite
Hydroxocobalamin
- B12
What are the symptoms of organic phosphate poisoning? and how is it treated?
DUMBELS
- Diarrhoea
- Urination
- Miosis
- Bronchorrhea - excessive secretions
- Emesis
- Lacrimation
- Salivation
**you become wet
Pralidoxime - binds to acetylcholinesterase
How do you test the levels of TCA?
Urine sample
What are the contraindications to a gastric lavage?
Ingestion of hydrocarbons
Ingestion of corrosive substances
If the airway cannot be protected
How does TCA overdoses present and how are they managed?
Mydriasis Urinary retention Tachyarrhythmias - which can go into VT Seizures Metabolic acidosis
Management:
- sodium bicarbonate (helps to manage the arrhythmias)
- Cardiac input
- Benzodiazepines
What is the serious toxic dose of paracetamol requiring intervention?
150mg/kg
How long after paracetamol ingestion do you wait to measure levels and why?
4 hours if satisfied a non staggered dose has been taken or timing of ingestion is known.
measured 4 hours later because levels are inaccurate before
Generalised management of Cocaine overdose?
Diazepines
- for agitation and M.I and narrow complex tachy’s
GTN spray
Sodium bicarbonate
- for metabolic acidosis
Dantrolene for muscle relaxant
