Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Drug Toxicity - clinical assessment |Metabolic acidosis |Aspirin or Salicylates toxicity |Ethylene glycol toxicity |Ethanol toxicity |Methanol toxicity |Ricin toxicity |Carbon Tetrachloride Toxicity |Renal Tubular Acidosis |Lactic acidosis |Iron Toxicity |Tricyclic Antidepressant Toxicity |Opiate Toxicity |Carbon monoxide Toxicity |Benzodiazepine Toxicity |Paracetamol (Acetaminophen) toxicity |Amphetamine toxicity |Beta Blocker toxicity |Calcium channel blockers toxicity |Cannabis toxicity |Cyanide toxicity |Digoxin Toxicity |Lithium Toxicity |NSAIDS Toxicity |Ecstasy toxicity |Paraquat toxicity |Quinine toxicity |SSRI Toxicity |Theophylline Toxicity |Organophosphate (OP) Toxicity |Toxin elimination by dialysis |Drug Toxicity with Specific Antidotes |Assessing Coma and Management |Methylthioninium chloride (Methylene blue) |Methaemoglobinaemia
Many of these agents may also cause coma or delirium and so clinical signs may assist when history is unavailable.
General Measures when there is diagnostic uncertainty |
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Clinical assessment | Possible cause |
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Pink rosy colour | Cyanide, carbon monoxide |
Cyanosis | Methaemoglobinaemia, e.g. dapsone, amyl nitrite |
Nausea, vomiting | Paracetamol overdose, opiates, NSAIDs, Iron toxicity, Salicylates. |
Small pupils | Opiates (Coma small pupils), Gamma hydroxybutyrate, Pontine bleed from cocaine, Cholinergic syndrome (Insecticides). |
Large pupils | Cocaine, Tricyclic antidepressants, Amphetamines, Anticholinergic syndrome - Atropine, 'Belladonna'. |
Severe hypertension | Cocaine, amphetamines. |
Severe hypotension | Tricyclic antidepressants, Haloperidol |
Bradycardia | Digoxin, Beta Blockers, Calcium channel blockers, opioids. |
Tachycardia | TCA, Theophylline, Digoxin, Antihistamines |
Hypoglycaemia | Insulin, Sulphonylureas, Alcohol, Quinine, Salicylates. |
Hyperglycaemia | Organophosphates, Theophyllines, MAOIs |
Hyperventilation | Salicylates |
Renal failure | Renal failure, Salicylates, paraquat, ethylene glycol. |
Hyperthermia | Serotonin syndrome, Salicylates, Cocaine, Ecstasy, MAOIs, Theophylline. |
Hypothermia | CNS depressants, Opioids, Exposure, phenothiazines e.g. Chlorpromazine, barbiturates |
RUQ pain/Jaundice | Paracetamol poisoning, Organic solvents. |
Abdominal pain | Iron poisoning, lead toxicity, NSAIDs. |
Seizures | Mefenamic acid, TCAs, Opioids, Theophylline, Cocaine, Alcohol. |
Rhabdomyolysis | Amphetamines. |
Myoclonic jerks | GHB, GBL. |
Chest pain | Cocaine, Carbon monoxide |
Oral ulcers | Corrosives, paraquat |
Elevated osmolar gap | Acetone, Mannitol, methanol, Acetone, ethanol, ethylene glycol. |
Anion gap metabolic acidosis | Methanol, metformin, renal failure, Diabetic/Alcoholic Ketoacidosis, Iron, isoniazid, Lactic acidosis, Ethylene glycol, cyanide, carbon monoxide, toluene, Salicylates |
Always check local/national poisons advice and senior help
Drug | Antidote |
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Digoxin | Digoxin specific Fab antibodies (Digibind) |
Iron salts | Desferrioxamine 15 mg/kg/hr IV |
Opioids | Naloxone 0.4-2.0 mg IV may need repeated depending on half life of opiate. Naloxone has a short half life |
Paracetamol (US Tylenol) | Oral methionine or IV N-acetyl cysteine |
Phenothiazine dystonic reactions | Benztropine 1-2 mg IV |
Warfarin | Vitamin K 5 mg slow IV and Prothrombin complex concentrates or Fresh Frozen Plasma if PCC not available |
Heparin | Protamine |
Ethylene glycol | Alcohol or fomepizole |
Methanol | Alcohol or fomepizole and folinic acid |
Benzodiazepines | Flumazenil 200 mcg over 15 seconds then 100 mcg at minute intervals. Use only with severe respiratory depression. It may provoke seizures. Most benzodiazepine overdoses are 'slept off' with simple observation of ABCs |
Beta-Blockers | Severe bradycardia consider Atropine 1-3 mg IV and/or Glucagon 2-10 mg IV bolus |
Tricyclic antidepressant | IV sodium bicarbonate |
Salicylates | IV sodium bicarbonate |
Sulphonylureas | Glucose, Octreotide |
Organophosphate | Atropine 2 mg IV every 2 minutes until pulse > 70/min and Pralidoxime 30 mg/kg |
Methotrexate/Trimethoprim | Leucovorin/Folinic acid |
Insulin/oral hypoglycaemics | Dextrose |
Calcium channel blockers | Calcium Chloride/Gluconate |
Carbon monoxide | 100% Oxygen or hyperbaric oxygen |
Drugs causing Methaemoglobinaemia | Methylene blue |
Caesium/Thallium poisoning | Prussian blue |
Cyanide | Cyanide Kit - Amyl nitrate, Sodium nitriate, Sodium thiosuphate, hydroxycobalamin |
Arsenic | Dimercaptosuccinic acid (Succimer), Dimercaprol |
Nerve agents | Atropine 2 mg IV every 2 minutes until pulse > 70/min and Pralidoxime 30 mg/kg |
Salicylates, methotrexate and the herbicide 2,4-D. | Urinary alkalinisation using IV sodium bicarbonate enhances elimination |
Salicylates, Theophylline, Ethylene glycol, Methanol or Carbamazepine. | Haemodialysis |