|Drug Toxicity - clinical assessment
|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Carbon Tetrachloride Toxicity
|Renal Tubular Acidosis
|Tricyclic Antidepressant Toxicity
|Carbon monoxide Toxicity
|Paracetamol (Acetaminophen) toxicity
|Beta Blocker toxicity
|Calcium channel blockers toxicity
|Organophosphate (OP) Toxicity
|Toxin elimination by dialysis
|Drug Toxicity with Specific Antidotes
Check local/national poisons advice. Consider using Flumazenil and getting anaesthetic support if significant respiratory depression
- Beware as sedative effects increased with other drugs - alcohol, opiates, TCAs
- Often used for procedures and in management of status epilepticus
- Therapeutic excess can occur and the ability to manage ABC's vital
- Diazepam, Clonazepam, Lorazepam,
- Temazepam. generally used as sedatives.
- Drowsiness and coma in severe cases. Pupils may be partially dilated
- Dizziness, Ataxia, dysarthria. However, overdose often with alcohol.
- Significant coma rare e.g. GCS < 10 and may suggest other drugs taken
- Higher risk were combined with alcohol or underlying chest disease and elderly.
- Reduced GCS. Look for signs of other drugs - alcohol, opiates, TCA
- FBC, U&E, LFTs, Paracetamol level
- ABG: respiratory acidosis and CXR
- Salicylate levels to ensure normal
- ECG: changes consider TCA toxicity and mixed overdose
- ABC: 15 L/min oxygen to give saturations of 94-98%. IV fluids. Airway management.
- Within 1 hour activated charcoal may be given. Most overdoses are slept off. Left lateral position and nasopharyngeal airway if needed. IV fluids
- If respiratory depression or airway concerns consider Flumazenil 200 mcg (0.2 mg) over 15 seconds and then 100-300 mcg (0.1-0.3 mg) to max dose of 3 mg.
- There is a risk of lowering seizure threshold especially in a mixed overdose with other drugs that also lower seizure threshold e.g. alcohol, TCAs.
- If Respiratory failure or airway protection is unsafe then expert airway management and oxygenation are vital. Intubation and ventilation may be needed.
- If taken as an attempt at self-harm then assess suicidal risk and psychiatric assessment