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81 Cards in this Set
- Front
- Back
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Paracetamol |
150mg/kg - 200mg/kg (higher threshold in children)
or Maximum 10g |
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Golden time to start NAC for paracetamol overdose
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within 8 hours
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How do you deal with staggered dose within 8 hours
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Worse case scenario technique
Serum paracetamol level is drawn and platted against nomogram, assuming entire dose was taken at the earliest time |
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What is the concerning dose for repeated supra - therapeutic ingestion |
200mg/kg or 10g over single 24 hours
or 150mg/kg or 6g per 24 hours spanning 48 hours or 100mg/kg or 4g per 24 hours spanning for those at risk or spanning 72 horus in children |
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What is the treatment of sup therapeutic investigation of paracetamol based upon |
ALT or AST level and Paracetamol level
ALT/AST normal and paracetamol level <20mg/L or 120micromol/L --> no treatment Any other result NAC for at least 8 hours and measure ALT/AST |
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Iron toxicity doses
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>60-120mg/kg systemic toxicity anticipated
Toxic dose in blood at 4 hours of 90micromol/L |
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Whole bowel irrigation
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PEG ELS (Polyethylene glycol electrolyte) solution via NG tube 2L per hour (or 25mL/hour) till effluent runs clear (may take up to 6 hours) |
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Metal chelators
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1. Dimercaprol |
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Cyanide poisoning treatment
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1.Hydroxocobalamine (B12) |
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Treatment for iron poisoning
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DesFerrioxamine |
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Treatment for methanol and ethylene glycol poisoning
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ADH inhibitor called 4MP (or fomepizole) |
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Folinic acid for
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1. Methotraxate overdose
2. Methanol poisoning --> increases metabolism of Formic acid |
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Flumazenil dose
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0.1-0.2mg IV every minute till reversal of sedation achieved up to 20mg |
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Pralidoxime
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Organophosphate poisoning life threatening dose |
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Pyridozine
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To control metabolic acidosis and seizures associated with isoniazide overdose |
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Digoxin toxicity - common ECG changes
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Bradyarrythmia (1st, 2nd and 3rd degree AV block) |
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When to do a level
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Every 4 hours post ingestion then every 2 hours until definite management |
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Dose of digibind
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1. in Cardiac arrest, 20 ampoules |
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Children's dose of glucose and insulin
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0.1units/kg PLUS 5mL/kg of 10% glucose |
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Antiarrythmic used for ventricular tachyarrythmia in Digoxin overdose
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Lignocaine 1mg/kg
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How do you work out the elemental iron level of iron tablet
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Usually available Ferrous sulphate |
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What are the Toxic doses of iron
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> 60mg/kg --> systemic toxicity suspected |
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Severe iron poisoning courses
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Initial gastrocorrosive symptoms (Vomiting/diarrhoea/abdominal pain/fluid loss enough to cause hypovolaemic shock)
Resolution of symptoms 6-12 hours 12-28 hours Hepatorenal failure, metabolic acidosis, 3rd space loss 2-5 days Acute hepatic failure 2-6 weeks cirrhotic liver disease |
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Digoxin toxic dose
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10mg adults |
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What electrolyte abnormality can neuropeltic malignant syndrome give? |
Hypocalcaemia Hypomangesaemia
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What does LP show in neurolpetic malignancy syndrome |
can show elevated CSF protein in up to 37% of the cases |
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What can show in neuroleptic malignant syndrome in EEG |
GEneralised slow wave activity that can be conssistent with metabolic encephalopathy |
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Is elevated CK a necessary accepted diagnostic criteria for neuroleptic malignant syndrome |
No |
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What is the difference between serotonin syndrome and neuroleptic malignant syndrome in terms of onset and recovery |
SS are usually rapid onset and resolves in 48 hours. NMS usually is slower onset over couple of days and takes days to months to recover. |
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What would you consider IV lipid emulsion |
In agents that are highly lipid soluble to draw the lipid away from the affected tissue e.g, cardiac and cerebral e.g. TCA, propranolol, Verapamil
20% 1mL/kg bolus over 1 min Can infuse 0.25 - 0.5mL/kg as infusion |
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What is the difference between Haemodialysis and haemofiltration |
Haemodialysis is where blood and dialysis fluid run next to each other divided by semipermeable membrane
Haemofiltration is where blood goes through this membrane and via convection (heated molecule to colder place), excretion of waste.
Thus haemofiltration needs water/electrolyte replaced
Because haemofiltration is CONTINUOUS, it is more HD stable but slower to remove toxic drug than dialysis
NB: Haemoperfusion is where blood goes through a filter |
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What are the indication for NaHCO3 |
Na channel blocker obviously
Cyanide Isoniazid Toxic alcohol
Depressed cyanide is isolcated and thsu try to kill herself by drinking toxic alcohol
This prevents restribution fo drug to CNS |
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What are the side effects of NAHCO3 therapy |
Alkalaemia Hypokalaemia (secondary to alkalaemia) Volume overdose Hypocalcaemia (rare) |
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Can Iron be dialysed |
NO. Only thing that can be dialysed is
Lithium and K Theophylline Salicylate Metformin with lactic acidosis Na valproate, Carbamaepine |
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What is the toxic dose for carbamazepine |
50mg/kg Serum carbamazepine level should be done |
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WHat symptoms does carbamazepine cause |
CNS - confusion, ataxia, nystagmus, seizures ANticholinergic Na channel blockade - rare |
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List the 2 pills that can kill 10kg toddler |
ABCDEFG PHO
Amphetamine Beta blocker - prapranolol CCB especially SR, Carphor (moth killer) Disability drugs - opiates, TCA Don't ever forget glucose - Hypoglycaemia
Paraquat Hydrocarbon Organophsophate |
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Paraquat symptoms (herbicide) |
Para Para Paraquat (Eat dirt) - fuller's earth, food, soil) Para Para Paraquat (Gut dead) Para Para Paraquat (lung dead)
Multi organ failure, Metabolic acidosis secondary to lactate |
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In local anaesthetic toxicity does CNS toxicity come first or does Cardiovascular toxicity come first |
CNS toxicity! |
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What LA gives you Methaemoglobinaemia |
Fe2+ to Fe3+ coz Met has 3 vertical sticks
Lignocaine Prilocaine
NOT DOSE RELATED CHILDREN MORE SUSCEPTIBLE THAN ADULTS |
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Indication for intralipid drugs |
For lipophillic drugs Cardiovascular collapse or cardiac arrest once adequate resuscitate measure had been initiated secondary to Betablocker ( Propranolol) CCB (verapamil) TCA
Dose: 20%, 1mg/kg |
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Common finding for TCA OD |
Broad QRS - more than four small squares, high risk of VT - more than 2.5 squares, increased risk of seizure RAD Large R wave aVR >3 Can have Brugada pattern including right BBB and dowslong ST segment in leads V1-2
THUS in Brugada, think TCA OD |
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What are the toxic antidepressant other than TCA? |
Venlafaxine - 14% of seizure but dose dependent - onset can be delayed up to 6- 12 hours thus observe for 16 hours regarldess of doses - QT prolongation may occur - consider charcoal if >4,5g of venlafaxine
Citalopram - can cause bradycarida and QTc prolongation but dose dependent - seizure uncommon but in citalopram 2% can have it |
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Lithium toxic level |
Acute: >25g causes significant GI symptoms but rarely leads to nerotoxicity given good supportive care is given Serum level >5mmol/L 4-8 horu post ingestion
Chronic Serum level >2.5 |
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What is the toxic dose of citalopram and how long do you watch for |
Citalopram >600mg watch for 8 hours >1g watch for 13 hours
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What dose of venlafaxine are toxic |
ALL dose as can cause seizures
But >4.5g high high risk fo seizures
>7g needs early intubation |
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Quetiapine toxic dose |
3g for adults 100mg for kids |
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Quetiapine symptoms |
CNS - sedationm agitation, coma CVS - tachycardia, mild hypotension but can be profound - don't use adrenaline, use NA |
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What drugs are dangerous if taken in large quantity by kids |
1. Paracetamol 2. Iron 3. Colchicine 4. Digoxin |
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Toxic dose of super crazy colchicine |
if you take more than 0.8mg/kg your outlook is atrocious |
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Symptoms of colchicine |
Early GI symptoms abdo pain/vomiting/diarrhoea Leucocytosis Mutiorgain failure - heart, lung, renal, liver metabolic acidosis, marrow rhabdo |
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What are the symptoms that mushrooms cause |
Most feared is Amanitaphalloids which can cause liver failure and death Other scary ones can cause severe neruologcal poisoning seizures,renal failure and rhabdo
But there are also - GI irritants (usually occur <6 hours - hallucinogenic (magic mushroom) - disulfiram like reaction - cholinergic (usually not toxic) |
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Antidotes for mushroom poisoining |
NAC Penicillin high dose 1 million unilts/kg/day! Silibinin |
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Hydrocarbon presentation |
Ingestion/aspiration - vomiting - coughing/dyspnoea secondary to pneumonitis and pulmonary oedema - CNS - alatered mental state, seizure, CNS deression (this is why petro sniffer sniff it) Permanent use can cause permanent atxia - cardiac arrthmia with inflaed hydercarbon
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What hydrocarbon leads to higher aspiration |
low viscosity hydrocarbon such as gasoline has high aspiration risk
So if you are going to sniff, mabe to motor oil which is low aspiration risk |
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HOw do you treat the ventricular dystruthmia caused by hydrocarbon |
Bizzarely enough beta blocker 5mg IV |
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Phenytoin toxicity |
Most benign out of anti-seizure drugs
In acute toxicity - in massive overdose i.e. 100mg/kg can have coma, hypernatramia, hyperglycaemia
In chronic toxicity - ataxia, dysarthria, nystagmus - extrapyramidal side effects |
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Why does phenytoin make you ugly |
becuase chronically it can cause frontal bossing and gingival hyperplasia |
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Why does phenytoin given quickly cause deterioration? |
becuase propolyne glycol dilutent can cause hypotension, bradycardia, asystole, ventricular arrthmia
Tissue necrosis can also occur |
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What is the toxic dose for valproate |
400mg/kg CNS depression 1g/kg prolonged coma, multiple organ toxicity
Comes in 100mg, 200mg and 400mg tablets |
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Mecanism of sodium valproate labatory result |
ANything starting with N is up Na, NH3 Anythign that reselbes a C or G is low Hypoglycaemia Hypocalcaemia |
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Symptoms of Na valporate |
Mutiorgan failure -Cerebral oedema -Bone marrow failure -CVS instability - renal failure - live r failure - pancreatitis - lactic acidosis |
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Treatment for Na valproate |
Whole bowel irrigation Carnitne Nalaoxine of don't breat |
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Thyroxine ingestion cause immediate symptoms. True or false |
False It usually causes symptoms 2-7 days post ingestion and it requires more than 10mg of thyroxine in adults and more than 3mg in children |
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For acute CO poisoning, risk of dveloping long term neuropsych sequalae is low |
True |
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Venom induced coagulopathy causes this laboratory abnormality |
INR Raised D-dimer low Fibrinogen
Can also have thrombocytnpaenia and MAHA |
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Does amlodipine causes reflex tachycardia in severe toxic poisoning? |
IN moderate poisnoing, there is selective vasodialation thus can cause this but in sever poisoining, it causes bradycardia and hypotension |
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Propranolol causes |
Na channel blockade
Treat like TCA poisoning
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Sotalol caues what changes in ECG |
Causes QT prolongation |
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Octreotide use and dose |
use 1. Sulfonylureas 2. GI bleed
Dose: 50microgram stat 25-50microgram/hour
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What % of patient with oesophagus burn have oral burn |
85-90% |
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What are the 3 things does H2O2 cause |
Corrosive burn Oxygen - systemic gas embolism causing neurological disruption and seizure - Distension of hollow viscus |
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Features of MetHb |
Chocolate bronw blood Grey/blue discoloration O2 sat deceptively high (85%) PaO2 saturation deceptively high as calculated from partial pressure of oxygen |
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How soon does button battery have to be removed |
6 hours |
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What is O2 saturation gap in MetHb |
Where arterial O2 sat is high becuase it is calculated by partial oxygen and pulse oximeter is low 85% |
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Why is monovalent antivenom preferred over polyvalent |
becuase less risk of anphylaxis |
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What does red back spider cause |
Localised autonomic dynsfunction Mild hypertension |
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What does funnel web spider cause |
Pain on site Fang on site All over the shop symptoms Autonomic: salivation, sweating Abdo: abdo pain, vomiting CVS/RESP: Increased or decreased HR, increased or decreased RR, pulmonary oedema Neuro: fasciculation, seizures, coma |
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What does tick bite cause |
Ascending paralysis Found in east coast |
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How much Funnel web antivenom do you give |
4 ampoules if seizure 2 ampoues if symptoms
IV |
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Is magnesium a proven treatment for jellyfish |
For Box jelly fish FOr irikandji, no proven treatment but can try Mg |
