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Aims
Case reports and small case series suggest increased central nervous system (CNS) toxicity, especially convulsions, after overdose of mefenamic acid, compared with other nonsteroidal anti‐inflammatory drugs (NSAIDs), although comparative epidemiological studies have not been conducted. The current study compared rates of CNS toxicity after overdose between mefenamic acid, ibuprofen, diclofenac...
β-Adrenoceptor blocking drugs exert their toxic effects in overdose not only by blocking β1- and β2-adrenoreceptors, but also by their blockade of sodium channels. Patients severely poisoned with β-adrenoceptor blocking drugs develop hypotension, marked bradycardia, coma, convulsions and intraventricular conduction defects. Glucagon has been the treatment of choice for severe hypotension, although...
Salicylate poisoning is potentially serious, particularly if the diagnosis or presentation is delayed, the patient is elderly (>70 years of age), comatose or has a fever, or if they develop non-cardiogenic pulmonary oedema or acidaemia. Urine alkalinization and haemodialysis increase salicylate elimination and should be used in patients with moderate or severe poisoning, respectively.
Generally, phenytoin and carbamazepine have greater toxicity in overdose than sodium valproate and the newer anticonvulsants, although case reports confirm that severe toxicity can uncommonly occur.
Substantial ingestion of an anticoagulant can result in haemorrhage into any internal organ; severe blood loss can result in hypovolaemic shock, coma and death. If active major bleeding occurs, dried prothrombin complex 25–50 units/kg and phytomenadione 10–20 milligrams intravenously (250 micrograms/kg body weight for a child) should be given.
Cyanide reversibly inhibits cytochrome oxidase a3. Severe poisoning is characterized by coma, convulsions, cerebral oedema, pulmonary oedema, cardiovascular collapse, cardiac conduction defects, arrhythmias and metabolic acidosis. In addition to oxygen, either dicobalt edetate or hydroxocobalamin should be administered intravenously. If these antidotes are not available, sodium nitrite and sodium...
Isopropanol is oxidized to acetone by hepatic alcohol dehydrogenase. The effects on the central nervous system are similar to those of ethanol but probably more severe. Coma and respiratory depression are the major sequelae after substantial exposure. The mainstay of treatment is supportive care, although in severe cases haemodialysis will remove isopropanol and acetone effectively.
Ethanol is a central nervous system depressant and peripheral vasodilator, thereby causing coma, hypothermia and hypotension in severe poisoning. Hypoglycaemia, particularly in children, is observed together with acid–base disturbances, which are common (respiratory acidosis is observed more frequently than metabolic acidosis, and metabolic alkalosis may be observed in those vomiting and hypovolaemic)...
Household products are generally ingested accidentally by children. In developing countries more toxic agents are available in a domestic setting, but in the developed world serious toxicity is rare.
Tremor, sinus tachycardia, agitation, convulsions, supraventricular and ventricular arrhythmias, hypokalaemia, hyperglycaemia and ketoacidosis are the typical features of severe poisoning with β2-agonists. Psychosis and hallucinations are occasionally observed. As severe hypokalaemia can precipitate arrhythmias, it should be corrected as soon as possible by the administration of oral and intravenous...
Paracetamol poisoning is common. If untreated, liver and/or renal failure can develop. The administration of acetylcysteine within 8–10 hours of overdose will minimize or prevent hepatic damage and ensure survival irrespective of the magnitude of the ingestion. Important prognostic factors are the international normalized ratio, pH and plasma creatinine concentration.
Assessment of an acutely poisoned patient involves taking an appropriate history, assessing the level of consciousness, ventilation and circulation, undertaking a physical examination, and requesting appropriate toxicological and non-toxicological investigations. Diagnosis is based on the history, circumstantial evidence (if available), a cluster of common features (if present) and, occasionally,...
Antidotes exert their beneficial effects by a variety of mechanisms, including forming an inert complex with the poison, accelerating detoxification of the poison, reducing the rate of conversion of the poison to a more toxic compound, competing with the poison for essential receptor sites, blocking essential receptors through which the toxic effects are mediated, and bypassing the effect of the poison...
There is no evidence that the use of single-dose activated charcoal, gastric lavage, syrup of ipecacuanha, cathartics or whole-bowel irrigation improves the clinical outcome in poisoned patients. However, activated charcoal and gastric lavage can be considered in patients who have ingested life-threatening amounts of a toxic agent up to 1 hour previously. To increase elimination, treatment with multiple-dose...
Initial management involves the treatment of any potentially life-threatening conditions, such as airway compromise, breathing difficulties, haemodynamic instability and serious dysrhythmias. Thereafter, convulsions should be treated, fluid, acid–base and electrolyte abnormalities corrected, and measures taken to correct hypothermia or hyperthermia.
Non-traumatic rhabdomyolysis may be caused by a direct insult to the cell membrane, affecting its ability to maintain ion gradients, or be secondary to local muscle compression as a result of coma or seizures. Acute renal failure and peripheral nerve damage are the two most common and important complications observed, although hyperkalaemia leading to a dysrhythmia is the main cause of death.
Sarin and VX were released on civilians in Japan on 11 occasions in the period 1994–1995. Clinicians must be prepared, therefore, to treat casualties from nerve agent exposure. This requires an understanding of the mechanisms of nerve agent toxicity and the factors that influence their clinical impact. Clinicians need to be able to make a rapid and accurate diagnosis and use atropine, an oxime and...
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