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Overdose and Poisoning

A vial of Morphine

A vial of Morphine

Opiates

Naloxone will reverse the effect of opiate overdose, typically in the presence of CNS and respiratory depression.

Benzodiazepines

symptoms: agitation, euphoria, blurred vision, slurred speech, ataxia, slate-grey cyanosis
Flumazenil – can reverse the effect of benzodiazepines, however, is not always recommended. It is mainly used to reduce the sedative / drowsiness effects of benzodiazepines

Paracetamol

Paracetamol overdose is considered separately in its own article.

 

Aspirin (salicylic acid)

Note that Pepto-Bismol(R) is very high in salicylate!
<125mg/Kg is not toxic
250mg/Kg is mildly toxic. Signs and symptoms include:

500mg/Kg is severe. Signs and symptoms include (as well as the above)

Other features indicating a life-threatening attack include:

Investigations

Salicylate concentration should be measured, but unlike paracetomal is not an indication of the severity of poisoning

Renal function (U+E’s)
Glucose
Plasma Potassium – hypokalaemia likely, correct with IV KCl
Urine pH + ABG – Check hourly – severity of poisoning can be asses using blood pH and urine pH:

Management

Activated charcoal – if >125mg/Kg ingested <1hr ago
Gastric lavage – if >500mg/Kg ingested <1hr ago
Aggressive rehydration
Consider glucose – intracellular glucose is often depleted even if blood glucose remains normal
Increase alkalinity of urine – can increase excretion of salicylate

CAUTION – forced dieresis is not effective at increasing salicylate excretion and may cause pulmonary oedema.
HAEMODIALYSIS is the treatment of choice for severe cases (also continue alkalisation or urine providing no oliguria). Consider in:

β – blockers

Positively inotropic agents (e.g. dobutamine, or catecholamines, e.g. dopamine, noradrenaline, adrenaline) are often not effective in β-blockade. Glucagon is usually the treatment of choice.
Hypocalcaemia may also be present, and should be corrected with calcium.

Cannabis

Dry cough, increased appetite, social withdrawal and paranoia, altered perception of time

Sympathomimetics e.g. cocaine, amphetamines

Tachycardia, mydriasis, euphoria, formication- insects crawling, agitation, tremor, dilated pupils, tachycardia, arrhythmias, convulsions.

Carbon Monoxide

Inebriation, coma, reduced reflexes, tachycardia, pulmonary oedema, shock, met acidosis, flushed cherry pink skin. headache.

Antidotes

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