Principles of managing poisoned patients

Investigation

temp:
- hyperthermia: cocaine, amphetamines, ectasy, serotonergic drugs (SSRIs)
U&Es, creatinine
glucose
LFT
clotting
creatine kinase
specific drug assays
- - save blood (EDTA bottle) and urine if not sure
- specific drug blood concs:
  - paracetamol, slicylate, iron, lithium, methanol/ethylene glycol, ethanol, theophylline
urine toxological analysis
- drugs of abuse screening
- plain tube

1 of 4

coma, miosis, reduced RR
- opiates
agitation, delirium, mydriasis, hyperthermia, tachycardia, arrythmias
- ectasy, amphetamines, cocaine
nausea, vomiting, tinnitus, deafness, sweating, hyperventilation, metabolic acidosis
- salicylates
coma, hypertonia, mydriasis, tachycardia
- TCAs
coma, convulsions, arrythmias
- severe TCA
blindness
- methanol, quinine

2 of 4

symptomatic and supportive measures (e.g. ventilation)
reducing absorption
- gastric lavage (only benefit if w/in 1 hour of ingestion)
- single dose activated charcoal (w/in 1 hr of overdose: does NOT bind alcohols, glycols, acids/alkalis, iron, lithium)
- whole bowel irrigtion (body packers)
enhancing elimination
- multpile dose activated charcoal (carbamazepine, quinine, theophylline, dapsone; acts by binding drug in lumen, keeping free drug conc low so absorbed drugs moves down conc gradient out of blood into lumen)
- urine alkalisation (salicylate: IV sodium bicarb to achieve urine pH 7.8-8.5)
- extracorporeal elimination (dialysis, if poisoning Cx w/ RF; specifically for ethanol, ethylene glycol, methanol, salycilate)
- chelating agents (heavy metal poisoning: sodium calcium edetate fo Pb poisoning)

3 of 4

4 of 4