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Paracetamol overdose, its anitdote(s), who qualifies for them and their dosing regimens.
Activated charcoal and N-acetyl-cysteine (precursor for glutathione the antioxidant which is used up). But only if their blood paracetamol levels fulfill the Drug Normogram outlined by Rumack-matthew. Given as an infusion of 300mg over 20 hrs, 150mg\1hr then 50mg\4hrs then 100mg\16hrs.
Poor prognostic factors in paracetamol overdose. (5)
- Acidosis, especially ph <7.3
- Elevated Prothrombin time
- Elecated Lactic Acid
- The above carry a mortality between 80 and 95%
Flumezanil - bdz receptor antag
Alkalinisation of urine or dialysis if severe acidosis
Glucose + glucagon + potassium if necessary
They are non-reversible inhibitors of acetylcholinesterase i.e. too much acetyl choline kickin about.
Pralidoxime, rips the organophosphate off the achase and lets it work normally again, probably need to consider a good dose of atropine too.
Ethanol!! both compete for alcoholdehydrogenase and so ethanol slows the breakdown of methanol to formaldehyde
Heavy metals, lead, mercury, gold, arsenic
Dimercaprol. Narrow therapeutic index, competes for the same thiol residues on the sides of amino acids as the heavy metals do.
Atropine then glucagon. Your blocking the sympatheic function so stop the parasymp too and you bring back a level of normality.
Found in weedkillers and you should look out for farmers and keen gardeners especially. Causes really sore mouth with ulcers and all your organs failing... Catch em quick, ask about weedkiller ingestion and start them on activated charcoal.
Liver failure, kayser-fleischer rings and flapping tremors, Penicillamine is your boy.
Iron overload\ Haemochromotosis\ bronze diabetes.
Pancreatic failure, Liver failure, Golden ring around the iris, Bronzing skin, arthritis, cardiomyopathy...all because of iron deposition...Therapeutic venepuncture or desferroxamine
For the brownie points...Cyanide poisoning...?
Cyanide inhibits cytochrome c oxidase, leading to inhibition of mitochondrial respiration. So patients present with seizures, coma, apnoea. Sources include, pesticide, weedkiller, almonds, apricot kernels, yucca, manioc, cassava and apple seeds.