Poisoning

Question 1

alcohol withdrawal Tx?

Answer 1

chlordiazepoxide

Question 2

what to give a patient with nutritional deficits from alcohol?

Answer 2

thiamine/pabrinex/vit B complex

Question 3

Tx for Wernicke’s encephalopathy?

Answer 3

Pabrinex (Vit B)

Question 4

how to Tx withdrawal from alcohol/DTs?

Answer 4

chlordiazepoxide

Question 5

how to prevent alcohol relapse?

Answer 5

acamprosate

Question 6

Tx acute poisoning?

Answer 6

• cannula and catheter, strict fluid balance, IV fluids, analgesia
• correct electrolytes
• ↓ absorption if w/n 1 hr:
  1) gastric lavage (i.e. ‘stomach pumping’ unless caustic/acid content
  2) whole bowel irrigation (Li+/Fe)
  3) charcoal (dx-dependent)
• ↑ elimination: IV fluids +
  1) NAC (if paracetamol >4 hrs is above Tx line)
  2) naloxone (if ↓RR or GCS)
  3) flumazenil (benzos)
• psychiatric management

Question 7

when would you Tx paracetamol OD with NAC before waiting for blood results?

Answer 7

if taken >150 mg/kg (should be considered potentially toxic - give NAC!)

to avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).

Question 8

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)?

Answer 8

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:

• prothrombin time > 100 seconds
• creatinine > 300 µmol/l
• grade III or IV encephalopathy

Question 9

charcoal in paracetamol OD?

Answer 9

The minority of patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug

Question 10

when to give NAC?

Answer 10

• staggered overdose
• or doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration
• or the plasma paracetamol concentration is on or above a single treatment line between (100 mg/L at 4 hours) and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity

Question 11

over what time to infuse NAC?

Answer 11

• over 1 hour (rather than the previous 15 minutes)
• reduce the number of adverse effects
• commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release)
• generally treated by stopping the infusion, then restarting at a slower rate