Toxicology

Question 1

Indications of haemodialysis in salicylate poisoning

Answer 1

1-severe toxicity indicated by acedemia, renal failure or LOC
2-serum level rising >4.4 mmol/L despite urinary alkalanization and decontamination
3-very high initial levels > 7.2 in acute and >4.4 in chronic toxicity
4-urinary alkalanization not feasible
5-lower threshold in the elderly with levels > 4.4

Question 2

Referral for liver transplant indications in paracetamol poisoning

Answer 2

1-INR > 3.5 at 48 hours, > 4.5 at anytime
2-Oliguria or creatinine > 200 micromol/L
3-Encephalopathy
4-Persistent metabolic acidosis despite adequate resuscitation pH < 7.3 or lactate > 3.5
5-SBP < 80 mmHg despite resuscitation
6-Hypoglycemia