MEDI7111 Lecture Notes - Lecture 9: Bowel Obstruction, Hyperglycemia, Thrombocytopenia
Drug Overdose/Poisoning
Drug overdose/poisoning is a common presentation to the emergency department (5-
10,000/year) with most of these being children under 5 years. ~25% of these are accidental
poisonings, usually small children getting into the cleaning cupboard however 75% are
deliberate, often involving more than one poison.
ED Management
The general principles for management are resuscitation, diagnosis of the agent of
overdose/poisoning and then treatment specific to the diagnosis.
1. Resuscitation
a. Airway, Breathing, Cardiovascular
2. Diagnosis
a. History
a.i. When, what, how much?
a.ii. Why?
a.iii. PMHx, other meds, PPsychHx
b. Consider the circumstances
c. Patient may lie about how much they took/what they took – especially
parents poisoning children
3. Treatment (one or more of below options – specifics outlined in table)
a. further absorption ↓
b. elimination of existing poison ↑
c. Administer antidote – if possible
d. Treat symptomatically
Therapy Agents/Procedur
es
Indications Contraindications Risks
Inducing
Emesis
Pharyngeal
stimulation
Apomorphine
Ipecac
Not used anymore Unprotected
airways
Strong
acid/alkali
Petroleum
derivatives
Aspiration
Impedes subsequent
use of activated
charcoal
Gastric
Lavage
0.9% saline using
NG tube
Used for slow release
agents on ingestion
Analgesics
Antidepressant
Unprotected
airways
Strong
acid/alkali
Aspiration
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Questionable
usefulness
s
Alcohols
Petroleum
derivatives
Absorbents Activated charcoal
Fuller’s earth
(only for paraquat
poisoning)
Significantly reduces
elimination half-life
Activated charcoal can
draw toxin from blood
back into gut and bind
it there
Unprotected
airways
Strong
acid/alkali
Petroleum
derivatives
Not used for:
Most heavy
metals
Alcohol
Pesticides
Cyanide
Catharsis Whole bowel
irrigation
Induced diarrhoea
Agents not
absorbed by
activated charcoal
Sustained release/
enteric coated
tablets
Paralytic ileus
Bowel obstruction
PKA
Forced
Acid/alkalin
e Diuresis
Acid – (NH4Cl),
Alkali – (NaCO3)
Acid – amphetamines
Alkali - salicylate,
barbiturates, MTX
Impaired renal
function
Can induce
hypokalaemia &
fluid overload
Haemodialys
is
Dialyser Extreme cases of
poisoning where
poison is already in the
blood
Anticoagulation
Thrombocytopenia
Haemolysis
Electrolyte
imbalance
Pyrogenic reactions
Hyperglycaemia
Forced Diuresis
By making a weak acid or weak base fluid in the glomerular filtrate, the drugs will be held in
the tubule by the ion balance resulting in increased net excretion of the drug. This technique
works well if the drug itself is a weak acid or base and the opposite substance is used to
bind the drug in the filtrate.
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Document Summary
Drug overdose/poisoning is a common presentation to the emergency department (5- 10,000/year) with most of these being children under 5 years. ~25% of these are accidental poisonings, usually small children getting into the cleaning cupboard however 75% are deliberate, often involving more than one poison. The general principles for management are resuscitation, diagnosis of the agent of overdose/poisoning and then treatment specific to the diagnosis: resuscitation, airway, breathing, cardiovascular, diagnosis, history a. i. Activated charcoal can draw toxin from blood back into gut and bind it there. Extreme cases of poisoning where poison is already in the blood. By making a weak acid or weak base fluid in the glomerular filtrate, the drugs will be held in the tubule by the ion balance resulting in increased net excretion of the drug. This technique works well if the drug itself is a weak acid or base and the opposite substance is used to bind the drug in the filtrate.
