Toxicology table C

hrhodes's version from 2015-10-06 05:17


Question Answer Column 3 Column 4 Column 5 Column 6
Calcium channel blockersVerapamil SR x 10 tabsBradycardia, Heart block (PR interval 1st), Cardiogenic shock, Seizure and coma uncommon search other cause, HYPERglycaemia, ileusBSL< ECG< Para, Ca, Lactate, ABG, CXRFluids, Calcium 60mls CaGluconate, 20mls Calcium chloride, atropine 0.3-0.6mg, isoprenaline, adrenaline, HDIT, ECMO, I+V early once SBP <90 and 20ml/kg fluidsAggressive decontamination. AC for cooperative <1hr and all I+V patents, WBI if > 10tablets dilt or verapamil
cannabisUnknownNo direct deaths, CNS: Ataxia, sedation, CVS tachycardia, Euphoria, paranoia, agitated, PNX (rare)BSL, Para, ECGself limiting, symptomatic rxobservation, social care and Drug and Alcohol team
Carbamezipine20-50mg/kg - anticholinergic, CNS symptoms; >50mg/kg = coma and cardiotoxic 1 tablet (400mg) significant in kidsCardiotoxic - TCA-like Na blocker, hypotension, CNS: coma, anticholinergic sxBSL, ECG, para, CZP level Normal = 50mcmol/L severe =>170micromol/LNaHCO3 10-20mmol/kg bolus and repeat as per TCAs, BZP seizuresMDAC, Haemodialysis (>170micromol/L, most common drug cause for HD. Actively seek and treat seizures
CO 210 x affinity for Hb than O2Most deaths occur prehospital, remember that HbCO is only a confirmatory test and that is retrospective (already clearing)CNS - headache, ataxia, confusion, CVS- tachycardia, AMI, hypo or HTN, Resp - APO, lactaemia, acidosis, rhabdo, hyperglycaemia, DIC, Cherry red skinBSL, ECG, Para, ABG, COHb, troponin, CK, HCG (Mx change), CTHigh flow O2, Hyperbaric controversial-preg, AMI, HbCO >30%, neuro symptoms. T1/2- RA 240m, 100%O2 90m, 100% 3atm 23minsNeuropsych FU, index case in accidental exposure
Chloroquine>5g fatal adults, one tab in kidsQuinolone-related - hypotension, CNS depression, Cardiac QT QRS, HypoKBSL, ECG, Para, U+EsIntubation and hyperventilate, pH 7.5, NaHCO3, Benzos, Monitor and replace KAC if early, and intubated, expect rapid deterioration
Chloral Hydrate (kid hypnotic sedative)>100mg/kg ComaRapid onset CNS depression, Coma, Myocardial irritation - dysrhythmia, hypothermia, gastric injuryBSL, ECG, para, TCE levelResusciate, early intubation, fluids, avoid adrenalineHD and Charcoal if I+V, probe no outcome change
Clonidine (A2 agonist)>20mcg/kg Resp depressionOnset rapid, transient HTN, Hypotension, bradycardia, CNS depression, miosis, repiratory depression, apneoa (like opiates)ECG, BSL, paracetamol, serial ECGFluids, atropine, consider naloxonesupportive, observation esp kids
Clozapine>2.5mg/kgExtrapyridmal, sedation, hypersalivation, seizures, QT prolongationBSL, Para, Seria ECGMonitor QT (rare), detect and correct urinary retentionSupportive, egage socil and psych, need observation of medication administration
Cocaine>1g potentially lethal1-3mg/kg LA safe dose, 20-30mg = line, Lethal >1gCNS: euphoria, anxiety, dysphoria, CVS: tacky, hyper, AMI-vasospastic or dissection, QT prolong, APO, Peripherla sympathetic: mydriiasis, tremor, hyperthermia, fasciculation, BAD: Dissection-aortic or carotid, chest pain, SAH/ICH, Iscahemic colitis, PNX, pneumomediastinum, Rhabdo, renal failure, cerebral oedema :Para, BSL, Serial ECG - QT, Brugada, AMI, CXR-dissection, CT headBenzos is mainstay, avoid Bblockers - unapposed Alpha, NaCO3 for VT, Usual AMI rx aside BBlocker, fluidsSupportive Temp, BSL, electrolytes, investigate CP if continues
Colchicine>0.8mh/kg lethal 100% mortality!!Severe GIT upset, MODs if >0.5mg/kg, 3 stages: 1. GIT, 2. Bone marrow suppression, 3. Recovery alopecia and high WCCsupportive id mainstay, fluids, Specific antibodies available but not mainstreamEarly charcoal, MDAC, electrolytes and fluids
Cyanide>100microlmol/L lethalrare, deadly, severe lactic acidosis-inhibit oxidative metabolism, usually survive if get to hospital, seizures, HTN/hypotension, drowsiness, coma delayed neurotoxBSL, ECG, para, ABG and LACTATE, Cyaide levelsremove from source, 100% O2, hydroxycobalbumin 5g over 30mins, thiosulfate 12.5mg iv Resuscitation takes priority over decontamination, remove clothes and bag, wash with soap