Makindo Medical Notes

🧪 Toxicological emergencies are life-threatening situations caused by poisons, overdoses, or environmental exposures. Recognition of patterns + rapid supportive and antidote therapy saves lives 🚑.

⚡ Common Toxicological Emergencies (Quick Reference Table)

⚕️ Toxin / Poison	🧠 Key Clinical Features	🔬 Investigations	💉 Antidote / Key Management	💡 Notes / Pearls
💊 Paracetamol (Acetaminophen)	RUQ pain, nausea, vomiting, ↑LFTs, coagulopathy after 24–72 h	Plasma paracetamol level (use Rumack–Matthew nomogram), LFTs, INR	N-acetylcysteine (NAC) IV (start if >8 h post-ingestion or level above line)	Early NAC prevents hepatic necrosis; check for staggered overdose pattern.
📉 Tricyclic Antidepressants (TCA)	Anticholinergic toxidrome, QRS widening, seizures, arrhythmias	ECG (QRS > 100 ms → high risk), ABG for acidosis	IV sodium bicarbonate, benzodiazepines for seizures	Avoid class Ia/III antiarrhythmics; monitor in HDU/ICU.
☠️ Paraquat	Oral ulceration, vomiting, pulmonary fibrosis, multi-organ failure	Urine dithionite test, renal & LFTs	Supportive; early activated charcoal; ICU care	Highly fatal; O₂ can worsen oxidative injury—use minimal FiO₂.
🌾 Organophosphates	SLUDGE: salivation, lacrimation, urination, defecation, GI upset, emesis; fasciculations, bradycardia	Cholinesterase activity levels	Atropine + Pralidoxime (2-PAM), airway protection	Remove contaminated clothing; continue atropine until lungs dry.
💉 Opioids	Coma, pinpoint pupils, respiratory depression	ABG, glucose, toxicology screen	Naloxone (IV/IM/IN), airway and ventilation support	May require infusion if long-acting opioid (e.g. methadone).
🔥 Carbon Monoxide	Headache, dizziness, confusion, cherry-red skin, metabolic acidosis	Carboxyhaemoglobin (venous), ABG, ECG	100% O₂ via non-rebreather; Hyperbaric O₂ if severe	Pulse oximetry unreliable; look for co-exposed family members.
🍺 Alcohol Poisoning	CNS depression, hypoglycaemia, hypothermia, metabolic acidosis	Glucose, ethanol level, ABG, electrolytes	IV fluids, glucose, thiamine, rewarming	Always give thiamine before glucose in at-risk patients (Wernicke risk).
🧲 Iron Overdose	GI upset, haematemesis, shock, hepatic failure (after latent phase)	Serum iron level at 4–6 h, ABG, LFTs	Deferoxamine chelation, IV fluids, correct acidosis	Charcoal ineffective; serum iron > 90 µmol/L → chelate.
🐍 Snake Bite	Local pain/swelling, bleeding, coagulopathy, shock	Coagulation profile, FBC, renal function	Antivenom, fluids, wound care, tetanus prophylaxis	Immobilise limb, avoid tourniquets or incision.
💔 Beta-Blockers	Bradycardia, hypotension, hypoglycaemia, bronchospasm	Glucose, ECG, electrolytes	Glucagon, atropine, pacing if refractory	High-dose insulin euglycaemic therapy (HIET) if severe.
💊 Calcium Channel Blockers	Bradycardia, hypotension, hyperglycaemia	Glucose, ECG, calcium level	IV calcium, vasopressors, high-dose insulin therapy	Glucose infusion required during HIET; monitor K⁺ closely.
🌈 Digoxin Toxicity	Nausea, vomiting, confusion, visual halos, arrhythmias	ECG (scooped STs), serum digoxin level, K⁺	Digoxin-Fab antibodies, atropine, pacing if needed	Hyperkalaemia = poor prognostic sign; avoid calcium in arrest.

💬 Remember: Always secure the airway, support circulation, and seek early NPIS / TOXBASE advice for all poisonings. Activated charcoal is most effective within 1 hour for many ingestions, provided the airway is protected.

🩺 Core Principles in Management

• 🔄 ABCs first: Airway, Breathing, Circulation – always stabilise before specific therapy.
• 🧴 Decontamination: Activated charcoal if within 1–2 hours (selected poisons only).
• 💉 Antidotes: Use where available – time critical.
• 💊 Supportive care: Fluids, O₂, seizure control, correction of electrolytes.
• 📞 Poison Centre: Always involve early for specialist guidance.

🧪 Toxidrome Map – Clinical patterns of poisoning to rapidly identify likely agents and guide antidote use 🚑.

😴 Sedative–Hypnotic Toxidrome

• 🧠 CNS depression → drowsy, ataxic, coma
• 💨 Respiratory depression
• ❤️ Bradycardia, hypotension
• 👀 Normal pupils
• ⚠️ Causes: Benzodiazepines, Barbiturates, Alcohol
• 💉 Antidote: Flumazenil (benzos), supportive care

⚡ Sympathomimetic Toxidrome

• 🧠 Agitation, seizures, paranoia
• 👀 Mydriasis (dilated pupils)
• ❤️ Tachycardia, hypertension, arrhythmias
• 🌡️ Hyperthermia, sweating
• ⚠️ Causes: Cocaine, Amphetamines, MDMA
• 💉 Antidote: Benzodiazepines, cooling, supportive

🌿 Cholinergic Toxidrome (SLUDGE)

• 💦 Salivation, Lacrimation, Urination, Diarrhoea
• 🤢 GI cramps, Emesis
• 👀 Miosis (pinpoint pupils)
• 💨 Bronchospasm, bronchorrhoea → respiratory failure
• ⚠️ Causes: Organophosphates, Carbamates
• 💉 Antidote: Atropine + Pralidoxime

🚬 Anticholinergic Toxidrome

• 🧠 Agitation, hallucinations, delirium
• 👀 Mydriasis (dilated pupils)
• 🌡️ Hyperthermia, flushed skin, dry mouth
• 🧍 Urinary retention, ↓ bowel sounds
• ⚠️ Causes: Antihistamines, TCAs, Atropine, Antipsychotics
• 💉 Antidote: Physostigmine (with caution), supportive

💉 Opioid Toxidrome

• 🧠 CNS depression, coma
• 💨 Respiratory depression → apnoea
• 👀 Miosis (pinpoint pupils)
• ❤️ Bradycardia, hypotension
• ⚠️ Causes: Morphine, Heroin, Methadone, Fentanyl
• 💉 Antidote: Naloxone