Treating Toxicity

Question 1

What is more likely to occur in poisoning, hypertension or hypotension?

Answer 1

Hypotension

Treat by elevating foot of bed and giving IV sodium chloride or a colloid to increase plasma volume.

Question 2

If someone is having a convulsion as a result of an overdose/ poisoning, what can be done?

Answer 2

Leave if under 5 mins
IV diazepam or lorazepam (NB benzo’s should NOT be given by IM route)
If IV not available:
Buccal midazolam (not licensed for adults or children unfer 3 months)
Rectal diazepam

Question 3

What is activated charcoal effective at reversing?

Answer 3

Poisons in the GI system, reduces absorption, the sooner its given the better, efficacy reduced after 1 hour after ingestion of poison.
Repeated doses of charcoal effective for: Carbamazepine, phenobarbital, quinine, theophylline, dapsone.

Question 4

Symptoms of aspirin poisoning? How to treat?

Answer 4

hyperventilating
tinnitus!!!
deafness !!!
sweating

TREAT USING CHARCOAL, SODIUM BICARBONATE TO INCREASE URINARY EXCRETION, CORRECT K+ CONC BEFORE GIVING THIS.

Question 5

What are the early symptoms of paracetamol poisoning? what is the antidote?

Answer 5

Nausea and vomiting
Liver damage at its max 3-4 days after

Acetylcysteine - most effective when given up to 8 hours after ingestion

Question 6

How to treat antidepressant overdose?

Answer 6

Activated charcoal to limit absorption

Sodium bicarbonate to stop arrhythmias

Question 7

How could you treat Dystonias resulting from overdose of phenothiazines and related drugs?

Answer 7

Procyclidine

or Diazepam

Question 8

Overdose of benzo’s?

Answer 8

Flumazenil

Question 9

Overdose of beta blockers?

Answer 9

Atropine IV- corrects bradycardia

Question 10

How do we treat Calcium channel blocker overdose?

Answer 10

Charcoal
Calcium chloride
Calcium gluconate
Atropine for bradycardia

Question 11

How to treat Lithium toxicity?

Answer 11

Heamodyalisis

increase fluid intake to increase urine output (but don’t use diuretics)

Question 12

How to manage Cocaine overdose?

Answer 12

IV Diazepam to reduce agitation
Cooling measures for hyperthermia
Similar treatment for ecstasy (MDMA) poisoning

Question 13

What is the treatment for an Iron overdose?

Answer 13

desferrioxamine mesilate

Question 14

What are the signs of lithium toxicity? What about if it is severe (i.e. plasma conc over 2.0)?

Answer 14

Vomitting 
Diarrhoea 
Ataxia (uncontrolled body movement)
Tremor
Twitching
Slurred speech 

Severe:
Convulsions
Coma
renal failure
hypotension

Question 15

What are the signs of Theophylline toxicity?

Answer 15

Hint: theophylline comes from the same family as caffeine. Think what happens when you took too many pro plus?!
Agitation
Restlessness
Dilated pupils
Tachycardia 
Vomiting 
Hyperglycaemia 

Severe hypokalaemia may also develop

Question 16

How is theophylline toxicity managed?

Answer 16

Repeated doses of activated charcoal
Manage hypokalaemia with Infusion of potassium chloride
Short acting beta blocker e.g. esmolol for severe tachycardia

Question 17

Somebody has been stung by a bee and has had a severe anaphylactic reaction to it. How should this be managed?

Answer 17

Epipen

IM adrenaline/ epinephrine

Question 18

Signs of digoxin toxicity?

Answer 18

Nausea & vomiting & diarrhoea
abdominal pain
dizziness & confusion, delirium
vision disturbance (blurred or yellow vision). 
Cardiac disturbance: irregular heartbeat
ventricular tachycardia

Question 19

What is the antidote for digoxin toxicity?

Answer 19

DigiFab

A digoxin specific antibody

Question 20

What is the reversal agent for heparin toxicity?

Answer 20

Protamine sulphate injection

Question 21

What is methaemoglobinaemia? What is the reversal agent?

Answer 21

Higher than normal level of methemoglobin in the blood caused by oxidative stress. Methemoglobin results in a reduced ability to release oxygen to tissues and thereby hypoxia (tissue death) occurs.
Reversal agent: Methylthioninium chloride injection

Question 22

Treatment of iron poisoning?

Answer 22

Desferrioxamine mesilate (Deferoxamine) 
Used for hemochromatosis, a disease of iron accumulation that can be either genetic or acquired