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PCOL Toxicology

ConditionAnditodeMOASpecial ConsiderationsSymptoms
Acetaminophen Overdose N-acetylcystine (NAC) Replenishes Glutathione Should still continue to give antidote even after the 8 hours effective time. Nausea/Vomiting, clinical signs of liver failure, can be measured in the blood
Toxic Alcohol Overdose Ethanol or Fomepizole Inhibition of alcohol dehydrogenase Fomepizole is the stronger ADH inhibitor with fewer adverse reactions. Active metabolites can cause anion-gap metabolic acidosis and ocular toxicity. EG metabolites can cause crystallization in the microvasculature, causing renal toxicity.
Benzodiazepine Overdose Flumazenil Competitive antagonist of GABA receptor May cause withdrawal symptoms in a dependent (chronic) patient. CNS depression and normal vitals, can be measured in the blood.
Beta Blockers Atropine, calcium, glucagon, HIET, Vasopressors, IV FE Atropine: Increases HR Calcium: Increase of Ca2+ into cardiac cells. Glucagon: Increases CAMP HIET: Not Understood Vasopressors: Increase BP IV FE: Act as a sink for lipophilic drugs May have altered mental status Hypotension, bradycardia, altered mental status, respiratory depression.
CCB Overdose Atropine, calcium, glucagon, HIET, Vasopressors, IV FE Atropine: Increases HR Calcium: Increase of Ca2+ into cardiac cells. Glucagon: Increases CAMP HIET: Not Understood Vasopressors: Increase BP IV FE: Act as a sink for lipophilic drugs Most likely will be alert Hypotension, bradycardia, often alert
Digoxin Overdose Specific antibody fragments Binds drug, and is renally excreted Taking serum concentration is no longer useful because of a total increase in plasma concentration. Bradycardia, arrhythmias, elevated serum potassium, nausea/vomiting. Can be measured in the blood.
TCA Overdose IV Fluids, Dopamine, NE, Sodium Bicarbonate for elongated QRS Supportive care options. Sodium Bicarbonate counteracts inhibition of sodium/calcium channels. N/A Tachycardia, dilated pupils, dry mouth, agitation, seizures, sometimes vasodilation, elongated QRS interval, reduced cardiac contractility.
Opioid Overdose Naloxone Competitive antagonist of opioid receptors May cause withdrawal symptoms in a dependent Somnolence, coma, decreased HR and BR, pinpoint pupils.
Salicylates Overdose Supportive care, IV sodium bicarbonate Renal ion trapping to enhance elimination N/A Hyperventilation and respiratory alkalosis then metabolic acidosis, hyperthermia, confusion and seizures.
Sulfonylureas and miglitinide Overdose Octreotide Inhibits insulin release from the pancreas N/A Hypoglycemia
Iron Dexferoxamine Chelates the circulating ferric iron N/A Vomiting, abdominal pain, and diarrhea within 1 to 6 hours. Lethargy, coma, seizures, bloody stool/vomiting and shock. Hypotension and tachycardia Liver dysfunction and failure
Created by: Rhettstering
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