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
Many of these agents may also cause coma or delirium and so clinical signs may assist when history is unavailable. Always check local/national poisons advice and senior help
General Measures when there is diagnostic uncertainty
Risk factors
Clinical Clues
Clinical assessment Possible cause 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 Specific antidotes
Drug Antidote 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 BenzAtropine 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
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Drug Toxicity Assessment and Management
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