Principles of managing poisoned patients

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  • Created by: z
  • Created on: 17-03-16 17:53

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
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Diagnosis- feature clusters

  • 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
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Management

  • 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)
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Specific antidotes

  • acetylcysteine
    • glutathiane precursor for paracetamol OD
  • naloxone
    • opiates
  • flumazenil
    • GABA antagonist for benzodiazepine OD
  • search TOXBASE or guidelines if unsure
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